This is a category taken from the full feed of Musculoskeletal and Arthritis news provided by ARMA's members.
  • The Arthritis and Musculoskeletal Alliance (ARMA) is the umbrella body for the arthritis and musculoskeletal community in the UK, and our mission is to transform the quality of life of people with musculoskeletal conditions. We have 33 member organisations ranging from specialised support groups for rare diseases to major research charities and national professional bodies.

Musculoskeletal pain

by Sarah Duncan, Head of Clinical Policy, NHS England

An interview on the news recently about stem cell research into cartilage replacement for osteoarthritis, made me reflect on the phenomenal pace of change and progress in the relatively short time of my career. As a new physiotherapist in the mid-1980s we used short wave diathermy; long flexible heated tubes wrapped around a patient’s knees, to help with the pain of arthritis. Although patients really enjoyed the heat, it made little difference to their ongoing pain and mobility.

At that time, every orthopaedic ward housed patients on traction for spinal pain. Attached to heavy weights via tape stuck to their legs, patients were on bedrest for 6 weeks. It would be the physio’s job to get them standing up for the first time. Many people would nearly faint as their cardiovascular system tried to cope with being vertical again. I often thought the subsequent manoeuvres to get them flat again must have reversed the alleged benefits of the bedrest. This was a time when there were treatment regimes for everything and the main individualising factor was the surgeon’s preference.

I was working in Somerset when I came across a different approach to chronic pain management, led by Dr Alf Collins, now Personalised Care Group Clinical Director at NHS England. His approach for people living with persistent pain was to help them understand and come to terms with their pain, and adopt strategies which enabled them to lead as fulfilling and independent lives as possible. Physiotherapists ran education and exercise groups, which also enabled people to share their experiences with others who understood and could empathise. This approach really worked for many people, supporting both their mental and physical health, and they were empowered to take control of their condition. I learned that managing pain was less about giving a treatment to a passive recipient and more about collaborating and working with them.

Fast forward 30 years and I’m in a national clinical policy role, which includes the Musculoskeletal (MSK) Conditions programme. Digital technology, genomics, stem cell research, and advances in surgery are all enabling progress to be made, beyond anything imaginable in the ‘80s. This progress also includes the evidence-based personalised care approach that the membership organisations of ARMA have long supported and developed. In partnership with ARMA, NHS England has developed the MSK Knowledge Hub enabling the MSK community to debate innovative ideas, share learning and celebrate success. The NHS Long Term Plan published yesterday, has a whole chapter on personalised care building on the  Five Year Forward View, which recognised the need for better integration of services, and connection with the voluntary sector, to enable a more personalised approach.  The NHS Long Term Plan aspires to a fundamental shift in approach to deliver more person-centred care, including for musculoskeletal conditions.

We must continue to develop the focus on people as individuals amongst the high-tech treatment options, and ensure people are properly listened to. People with MSK conditions should have choice and control over the way their care is planned and delivered, based on what matters to them and not only on what’s the matter with them. I’m encouraged to see that the Long Term Plan for the NHS will build on the evidence and examples to show how personalised care could, and should be, business as usual across the health and care system.

Musculoskeletal conditions are common – we all know that. But it hadn’t struck me until recently just how common compared to other long term conditions. 17 million people in the UK have an MSK condition. Compare that with the 850,000 with dementia and think about how much we talk about dementia. It’s a similar picture for other conditions: diabetes, 3.5 million people, cardiovascular, 7 million. Only mental health exceeds the prevalence of MSK conditions.

Of course, we are rightly worried about dementia. But perhaps we should all worry a little more about our MSK health. It’s not “just pain” or something that is to be expected as we get older. It affects people of all ages and impacts of every aspect of life: work, friends, family, hobbies, the basics of independent living. We should all be working to maintain our MSK health throughout our lives. We should all be able to expect the right physical and psychological support and treatment if we do have MSK conditions.

Anything which has such major impacts on daily life takes its toll psychologically. ARMA members have been pooling their understanding of the links between MSK conditions and mental health. One recommendation we will be making to NHS England about their ten year plan is that everyone diagnosed with a long term MSK condition should have rapid access to psychological support. A pilot with other long term conditions has shown significant savings to the NHS. Providing access to people with respiratory illness, diabetes or a cardiovascular condition led to a saving of £200,000 for just 500 patients through reduced GP appointments, A&E attendance and hospital admissions. Including people with MSK conditions could double those figures.

As well as engaging with the ten year plan we’ve been making plans for the autumn. ARMA members have been supporting the parkrun ambassadors and we’re looking at what more we can do together. Our annual lecture will be on the 21 November and will have the CEO of parkrun as one of the speakers – look out for details in the next newsletter. Our webinar series begins again – see below for details of how to sign up for the first ones. And look out for more on mental health and MSK.

As you can see, there has been lots happening for ARMA over the summer. It feels very positive – MSK is rightly rising up the agenda. 17 million people need it to rise still further. ARMA will be working with you to make sure it does.

Arthritis Action will be holding a new two-day Self-Management Event on 2-3 May 2018 between 2pm–4.30pm at Blackpool Central Library, Queen Street, FY1 1PX

The aim is to help attendees take control of the symptoms of their arthritis, covering topics such as:

  • The impact of physical therapies
  • How you can best manage your pain
  • The benefits of exercise and a healthy diet
  • Ways to work in partnership with healthcare professionals

This event will be free of charge and refreshments will be provided, and is open to all.

For more information, please contact info@arthritisaction.org.uk or 020 3781 7120 and Arthritis Action will be able to provide you with further details.

Alternatively, please register via this Eventbrite link.

The British Orthopaedic Association (BOA) is pleased to announce the recent publication of four revised commissioning guides with the Royal College of Surgeons of England. These NICE-accredited guides set out best practice care pathways to assist CCGs in designing optimal care for their populations. We are extremely grateful to all those involved in the rigorous development and accreditation processes. The guides, which can be found here, are:

  • Pain Arising from the Hip in Adults
  • Painful Deformed Great Toe in Adults
  • Painful Osteoarthritis of the Knee
  • Treatment of Carpal Tunnel Syndrome

Following the recent BOA and ARMA position statements on the rationing of elective orthopaedic services, we are urging stakeholders to consider these guides and to promote their adoption wherever appropriate with local CCGs. The use of these guides will assist CCGs to deliver high quality care in each of these pathways.

If you have any further questions, please contact policy@boa.ac.uk.

Guest Blog by Neil Betteridge, co-chair, Chronic Pain Policy Coalition (CPPC)

As a former Chair of ARMA, it’s a great pleasure to be invited to write a piece for this month’s newsletter. Indeed, looking back to my seven years on the board, it is quite something to recall that the organisation entered the 21st century still called BLAR: the British League Against Rheumatism.

Apart from the name, much has changed in the world of rheumatic and musculoskeletal diseases since then, most of it for the better in my view. But one of the things about all 200 or so of these conditions that remains a huge challenge is the widespread prevalence of chronic pain. It is for this reason that, whilst CEO of Arthritis Care, I joined the Executive of the Chronic Pain Policy Coalition (CPPC), with whom I still serve, now as Co-Chair (together with Dr Martin Johnson, RCGP lead on chronic pain). ARMA and several of its members are affiliate members of the Coalition, and I strongly believe we should be working in tandem like this, given that around 70% of chronic pain is rooted in this family of disorders.

For those unfamiliar with our work, the name is pretty much self-explanatory. The focus is on the needs of people with long term, persistent pain; we operate exclusively in the policy domain; and our structure is that we are an umbrella body bringing together organisations that are stakeholders in chronic pain, be they voluntary sector or ‘patient’ groups, clinicians or other health professional bodies such as physios and occupational therapists.

Work is currently one of the Coalition’s top priorities. With the current interest in this area in England from the Dept. for Work and Pensions and the Dept. of Health, we see this as an opportunity to press for positive changes for people with any form of chronic pain who could be better supported in their efforts to get – or keep – a job suitable to their needs and wishes.

To facilitate views on this, during the recent consultation process on the Green Paper ‘Improving Lives: Work, Health and Disability’, the CPPC organised a roundtable chaired by Lord Luce. Officials from relevant government departments had the opportunity to hear the views of health care professionals and patient representatives from the chronic pain community, and the issues raised informed our formal written response.

The key issues to emerge were: highlighting the importance of work for the everyday lives of those with chronic pain; stressing the importance of empowerment, and of integrated support for people with chronic pain; and encouraging the provision of localised information and other support such as self-management for those living with chronic pain, in order that GPs can direct their patients to these resources in a timely way.

More information on this, and the work of the CPPC overall, is available at   www.policyconnect.org.uk/cppc/.

Going forward, we will shortly be conducting policy work into the ways in which opioids are currently prescribed. If any ARMA members are interested in this topic and would like to engage with our work in this area, please contact our Manager Katherine Perry via katherine.perry@policyconnect.org.uk.

It is free to become an affiliate member of the CPPC so if you wish your organisation to lend its name to the fight against the invisible epidemic that is chronic pain, please join us.

At a recent meeting of the World Federation of Chiropractic in Washington, founder of World Spine Care, Scott Haldeman MD, DC, reported on the latest developments.

The WSC is a collaboration of people working in MSK care, a charity dedicated to improving the lives of those suffering from spine related conditions in communities underserved by health care. Desmond Tutu and Elon Musk have put their names to WSC.

Work goes on in India, Ghana, Botswana and the Dominican Republic. Besides facilitating and funding clinicians’ work in these countries, the WSC also funds college education for future chiropractors from these countries.

The Global Spine Care Initiative has created a model for implementing care in countries without adequate provision. This includes evidence of the burden of MSK conditions, evidence-based guidelines, care pathways, resources and research. It recommends non-surgical, primary spine care. Scott Haldeman implored us all to donate and volunteer to support the WSC initiative.

See Nadine Harrison’s pictures of the World Spine Care Shoshong clinic in Botswana.

 

The Back Pain Show – 19 & 20 May 2017

After a decade, The Back Pain Show has moved from Olympia London to St Andrews Birmingham, to give access to sufferers from the Midlands and the North of England. This iconic, two-day show is a hub for sufferers to meet doctors and therapists who provide treatment and manufacturers who supply both preventative and therapeutic equipment.

There are many causes of back pain including crush fractures of the spine which are usually caused by osteoporosis. These fractures are amazingly painful and take many months to ease. For a small donation to the charity BackCare – www.backcare.org.uk – at-risk visitors to show can have a two minute DEXA scan to determine their bone density. With lifestyle changes they can significantly decrease the risk of this disabling condition. The scanner uses the same amount of radiation found in a banana!

Lectures for both the public and professionals will be given by leading researchers in the field of back pain. Don’t miss this opportunity to book the professional lectures and fulfil CPD requirements. Both public and professionals can register for the event and book any of the talks and lectures, free of charge, at www.thebackpainshow.co.uk.

For manufacturers, this is the once-a-year opportunity to show products to both the general public and professionals. With easy access (compared to the nightmare of London venues) and free parking, you should book your stand now before they are all snapped up as the number of stands is limited.

The show will host the AGM of the BackCare charity on Saturday afternoon. All members are welcome to come and meet the trustees and members of the research, publications and executive committees. Membership will be available at the charity’s stand at the entrance of the show. Come and support our unique charity supporting those with back and neck pain and preventing thousands of people from developing these disabling conditions.

 

ARMA is working with Public Health England and Business In The Community to develop a new toolkit for employers in the workplace, which launches in Spring/Summer 2017. Musculoskeletal conditions are an important consideration for businesses as they are a leading cause of pain and disability in the UK, affecting many employees.

The toolkit draws together information for employers to support staff in the prevention, early identification, management and adaptation for people affected by musculoskeletal conditions. The musculoskeletal toolkit is a simple step-by-step guide dealing with back, neck, muscle and joint pain at work. It will help employers access the best free resources that are available for their organisation and employees.

At the Health and Wellbeing at Work conference in the NEC on 7-8 March 2017, presentations and flyers will raise awareness and anticipation of the MSK toolkit pre-launch to employers and hundreds of delegates.