1. Why pain should be on everyone’s agenda Dr Beverly Collett Consultant in Pain Medicine University Hospitals of Leicester Board Member Faculty of Pain Medicine Chair of the Chronic Pain Policy Coalition

2. Personal Cost 7.8 million people live with chronic pain in UK 13% UK population have chronic pain Average annual incidence is 8.3% (5 million people) Annual recovery rate 5.4% 25% lose their jobs 22% - 49% of patients with pain develop depression 23% thought that their doctor did not know how to treat their pain

3. Economic cost £3.8 billion spent per year on IB for those with chronic pain Pain is second most common reason given by claimants of IB £584 million per year on prescriptions for analgesics 4.6 million GPs appointments per year 70% people living with chronic pain are of working age Cost of back pain was £12.3 billion (22% of UK health expenditure) - mainly due to work days lost. 49% of those diagnosed with chronic pain take time off work.

4. Pain in children 8% -12% of children experience severe pain 25% of those report distress and disability £3.8 billion cost of adolescent pain Musculoskeletal Headache Abdominal pain Menstrual pain –5% to 14% girls regularly miss school

5. Pain is real when you get other people to believe in it. If no one believes in it but you, your pain is madness or hysteria. Naomi Wolf

7. Chronic pain training for all HCP Assessment of pain and disability in QOF Pain score part of vital signs in hospital Rapid access pain clinics Pathway of care with clear standards should be developed by experts Pain services to supply data to national pain database Local pain networks Health Survey for England should collect data on impact of pain on QOL

8. Reduce the time to satisfactory diagnosis and treatment of chronic pain from 2.8 years to a few months (BK) Ensure that chronic pain becomes a ‘high street’ disease (LD) Create integrated systems to eliminate the perpetual pinball (EH) Create right conditions to support people to remain in and return to fulfilling work (CB)

9. National Pain Audit Phase 1 To identify and collect data from service providers 214 clinics. Phase 2 Information re: patient journey to pain service 9,588 patients Phase 3 Outcomes at 6/12 4,414 patients (3,192 complete)

10. National Pain Audit Variation in availability of services Quality of life Healthcare utilisation

11. November 2011 The NHS Atlas of Variation in Healthcare Reducing unwarranted variation to increase value and improve quality http://data.parliament.uk/DepositedPapers/Files/DEP2012-0065/DEP2012-0065.pdf 40% of English Pain Clinics 60% Welsh Pain Clinics are multidisciplinary 28% PCTs /LHBs had no pain service

12. Staffing Minimum staffing for MDT: psychologist, physiotherapist, specialist doctor –40% in England –60% Wales 52% clinics had access to physiotherapy 29% clinics no consultant support 18 week target: 80% England; 50% Wales Psychologically based rehab: 48% (England) and 60% (Wales) had psychology input

14. Quality of Life Mean Quality of Life (EQ5D-3L) = 0.4 Post Rx: 56% improvement in EQ5D-3L 76% improvement in pain-related QoL (BPI)

15. Healthcare Utilisation Emergency Dept visits 16% visited ED in 6/12 before Pain Clinic 9% visited ED after Pain Clinic visit

16. Ten areas for improvement 1.Identification of services: code 191 2.Clinic information and timely access 3.Staff skills mix: multidisciplinary 4.Staffing competencies 5.Service commissioning +health needs assessment 6.Quality of care: quality standards needed 7.Information for patients 8.Coding 9.Impact on healthcare resource use 10.Treatment information