by Sue Brown, CEO ARMA
I write this reflecting on my day yesterday, which was unexpectedly dominated by discussions on pain. Pain is, of course, something we all talk about a fair bit in the MSK health world, as it’s one of the shared factors that cuts across all MSK conditions. I’m increasingly realising it is something we don’t always deal with particularly well.
My day yesterday began with reading New Scientist on the train, including an article about UK doctors’ concerns that we will follow the US into an opioid crisis. The question raised in the article was: is there a risk we will take things the other way, so that when someone does need opioids, they won’t be able to get them? The day ended at a wide-ranging lecture by Simon Stevens, Chief Executive of the NHS, including a slide showing opioid prescription rates by region: a wide variation, with London the lowest, and the North East the highest.
My discussions throughout the day all touched on pain in some way, but with a much broader agenda. Pain is rarely a simple matter which can be solved by pills alone. Yet that’s the only option offered to so many people. ARMA promotes a person-centred, integrated, biopsychosocial approach for anyone who experiences chronic pain. The prevalence of chronic pain is highest in the North East of England, and lowest in London (43.1% vs 29.0%). There is something going on here which is not just physical. We know that there are strong links between physical and mental health, which is why ARMA recently organised a roundtable on mental health. It is clear from my discussions yesterday that this is crucial in the context of chronic pain.
My issue with the debates about opioids is that they are about opioids. It seems to me that this is starting in the wrong place. The question is not what can we do about the increase in opioid prescription but what can we do about the increase in chronic pain? We need a much more sophisticated discussion. If pain is complex and individual, then the solutions must be personalised and multidisciplinary. We need to be able to refer people for psychological support. That might be IAPT psychological services for people with MSK pain. It might be health psychology in the context of a specialist pain service. We need to have appropriate peer support and social prescribing offers. We need to look at the underlying causes of pain and treat those where possible. The best pain services in the world are not useful if what the patient really needs is joint replacement surgery or rapid access to physiotherapy. And we need appropriate prescribing, and clinicians confident to discuss the different options and engage in good shared decision making with their patients.
This is not an issue which can be addressed by one profession. Patients in chronic pain may need GPs, rheumatologists, surgeons, pharmacists, psychologists, physiotherapists and others, working together. As with so much else in MSK healthcare at the moment, this support doesn’t join up and in the case of psychological support, too often isn’t available at all. This is why ARMA has made mental health a priority for this year. Together with our members, we will be pushing for improved access to joined-up, multidisciplinary personalised biopsychosocial support for people in chronic pain. We’ve already had some webinars on the subject, including how to deliver an integrated pain service and how to integrate mental health into physical health services. We’ve held a roundtable and produced our report. Look out for more activity including webinars and our annual lecture in November that push this agenda forward.
Join with us in calling for action to provide comprehensive services which address chronic pain from all angles. Patients with chronic pain deserve nothing less.