A million NHS users are suffering preventable or inadequately treated pain

UCL School of Pharmacy

At any one time a million people in England are living with long term pain which could have been prevented or be being significantly better treated, according to joint UCL School of Pharmacy and UK Clinical Pharmacy Association report published today.

Across the UK 5 to 10 million more members of the public have conditions which cause them varying degrees of intermittent or persistent pain, and who require good quality health and social support.

Co-author of the report Relieving Persistent Pain, Improving Health Outcomes Professor David Taylor (UCL School of Pharmacy) said: "Financially, pain related disorders cost this country in excess of £10 billion a year, over and above the unrecorded personal costs involved. Increased investment in specialist services is needed. But the problem this often neglected field presents is far too big for specialist care alone to resolve.

"New pain management related QoF payments for GPs might promote better outcomes. However, four out of five people already think they should go to pharmacies with pain related problems. Enhanced community pharmacy based services could help more of us respond to pain in timely and effective ways, and reduce the prevalence of persistent pain."

Professor David Taylor

Pharmacists have responsibilities for the safe and effective use of both prescribed and self purchased medicines, which in areas like pain management also requires understanding of the value of non-drug treatments and care. Examples of the ways in which improved community pharmacy services (which will in future be complemented by innovations such as giving NHS users power over who can see and amend their computerised health records) include:

• increasing the use of structured pain assessments in the community;
• providing self care support, including better protection against the harmful or ineffective use of ’minor’ analgesics and informing public awareness of what pains are best accepted and ’worked through’, and those which need prompt relief; and
• facilitating access to psychological and other non-pharmaceutical pain care providers, and the use of computer based services.

The incidence of persistent pain rises as populations age. It is commonly associated with conditions such as back disorders, rheumatoid and osteo-arthritis, diabetes (which can damage nerves), cancers and traumatic injuries, including the after effects of surgery. Yet persistent pain is also a condition in its own right.

Jennifer Gill (UCL School of Pharmacy) said: "Normal adaptive pain is useful - it protects us from injury and aids the recovery of damaged tissue by making it unusually sensitive. But maladaptive ’neuropathic’ and ’functional’ pains have become dis-linked from these beneficial ends. They result from nerve damage or from changes in the working of the nervous system in the spine and elsewhere which amplify pain signals in the brain for no good purpose.

"Modern neuro-imaging and other techniques are now revealing the biological mechanisms involved. We are also beginning to understand more fully how social factors and psychological states like relative deprivation and depression can link with physiological and genetic variables to make people more (or less) vulnerable to developing persistent pain disorders such as fibromyalgia and chronic post-operative pain."

Public health approaches to developing better community wide insight (in part through media ) into the nature of persistent pain and the need for combined biological, psychological and social strategies for its prevention and treatment have an important role to play in further improving prevention and care. So too should new medicines that complement or improve upon existing drugs.

Relieving Persistent Pain, Improving Health Outcomes describes how research in areas such as the role of nerve growth factor (NGF) in persistent pain, the function of neuronal sodium channels in transmitting pain, and the possibility that gene therapies will in future contribute to better outcomes.

Future innovations may also reduce current reliance on opioid drugs such a morphine. Morphine based and similar medicines have valuable properties. Failing to make them appropriately available to people in pain can at worst be seen as a form of torture. But they also have significant unwanted side effects. In poorly supported and vulnerable communities in particular, opioids are subject to hazardous and counter-productive usage.

The report argues that when innovative treatments and applications are developed they should be made available to patients promptly. Delaying and restricting the uptake of patented interventions reduces pharmaceutical spending in the short term. But it can also harm health service user and wider public interests, and undermine the funding needed for achieving pharmaceutical technology driven efficiency gains and long term economic success.

Media : Clare Ryan

Links:

UCL School of Pharmacy
Professor David Taylor