May 28, 2015
What makes an optimal national pain strategy? IASP developed recommendations for desirable characteristics of national pain strategies, which are very similar to a plan developed in Scotland. Driven by the recognition that chronic pain is a critical public health problem with massive economic implications, Scotland's government commissioned several pain-related reports between 2002 and 2008. The last, "Getting to GRIPS with Chronic Pain in Scotland," concluded with a call for action to improve pain-management services and laid the foundation for a national pain strategy.
Work undertaken by Healthcare Improvement Scotland between 2008 and 2014 led to the appointment of a national lead clinician and national steering group, as well as development of a Scottish Service Model for Chronic Pain. This initiative, together with government funding for 14 regional health boards, provided a framework for sustainable change in their areas.
In April 2014, the Scottish government established the National Chronic Pain Improvement Group, charged with improving chronic pain resources across Scotland. Since this work started in 2008, Scotland has seen a number of successful changes:
- The establishment of a Government Ministerial Steering Group and six national working groups covering research, education, self-management, pediatrics, primary care, and website
- A new national guideline for the management of chronic pain in adults and approval for the development of an additional guideline for children's pain
- Establishment of a National Pain Management Centre based in Glasgow, consisting of a multidisciplinary team offering intensive, residential pain-management support to individuals with highly complex ongoing pain
- Improvements in access to other health-care providers directly from primary care doctors through the development of computerized referral systems
- Development of codes for chronic pain for use by primary care physicians to assist with identification of chronic pain conditions and proper treatment
- Improved access to psychological pain treatment across Scotland
- Increased number of pain-management programs, now available in nearly all areas
- Improved resources for self-management of pain, including leisure center classes, book distribution, and nonprofit pain support groups
As part of the national strategy, the Scottish government recognized the importance of research in clinical practice, a key goal of the IASP recommendations, with the national steering group establishing a research subgroup in 2008. This group aims to promote the notion that current research informs clinical practice in managing chronic pain.
The national strategy has stimulated several strands of work. First, the Scottish Intercollegiate Guideline Network produced a new guideline on the management of chronic pain. A multidisciplinary guideline development group carried out a comprehensive systematic review and made recommendations clearly linked to the supporting evidence. The second step, to ensure that patients are treated according to the best available evidence, is to implement the guideline.
Third, the Scottish Pain Research Community (SPaRC) has brought together researchers, clinicians, and patients to address research gaps and foster collaboration. In March, SPaRC held its 5th Annual Scientific Meeting, which presented a wide range of research on topics from "laboratory to bus stop." An excellent, informative, and thought-provoking invited talk titled "Gain Control Mechanisms of Pain Sensitivity," was given via Skype by Prof. Rolf-Detlef Treede, the IASP president.
Chronic pain is a complex area, and much work remains to be done. However, Scotland's clinicians and patients have shown a commitment to make improvements, and the results are evident. The future continues to be promising, and we look forward to providing further examples of good practice.
--Paul A. Cameron, PT, MCSP, is National Chronic Pain Coordinator, Fife Integrated Pain Management Service, Queen Margaret Hospital, in Fife, Scotland.
--Lesley A. Colvin, FRCA, PhD, FFPMRCA, FRCP is acting chair, National Research Subgroup for Chronic Pain, Department of Anesthesia & Pain Medicine, University of Edinburgh.
--Blair H. Smith, MEd, MD, FRCGP, FRCP, is National Lead Clinician for Chronic Pain, Division of Population Health Sciences, Ninewells Hospital and Medical School, Dundee, Scotland.