This is a category taken from the full feed of Musculoskeletal and Arthritis news provided by ARMA's members.

Tag: chronic pain

Chronic (persistent or long-lasting or recurrent) pain significantly impacts individuals, their families and carers. For people with pain, the day-to-day concerns of living with and managing pain are of the highest importance, more so than the underlying condition. Here are some resources on pain available to people at home.

Pain toolkit There are some free video resources; there are also workshops now being delivered online. There may be a fee. http://www.paintoolkit.org/

Pain Physio Association See https://ppa.csp.org.uk/news/2020-03-24-pain-management-resources-during-covid-19-response

ARMA roundtable on Pain

In October 2019 ARMA held a roundtable bringing together people working on chronic pain from a range of perspectives to discuss what might be done to improve the experience of people living with chronic pain. Around 10–14% of people (6 – 8 million) experience moderate to severely disabling pain. Currently services and support for these people are difficult to access. Whilst not all chronic pain is musculoskeletal, osteoarthritis and back pain are associated with over half of all chronic pain, so that the lack of support is a key issue for us. 

The report of the roundtable sets out the key points made during the discussion of the issues and possible solutions, case studies of good practice and recommendations for action.

Recommendations for local health economies

  • Changing commissioning, taking a strategic population health approach to ensure money is focused on the right things.
  • Developing community, place based, networked, biopsychosocial approaches to pain – a pain MDT without walls.
  • Social prescribing to provide support for self-management and peer support at scale.
  • A local group with representation similar to that at the round table to drive change in each area.
  • There are opportunities presented by the current direction in the NHS, such as the way commissioning is changing through Integrated Care Systems and Primary Care Networks. People working in or advocating for pain services locally should engage with this work.

Recommendations for national bodies

  • HCP education to include understanding and management of pain.
  • Education and reinforcement messages to emphasise the biopsychosocial approach.
  • Public education – including employers and public attitudes

See also: ARMA’s policy page on Pain and other posts tagged ‘chronic pain‘ on our website.

I’ve read a few things about how hard it is to get going after the festive break, or “blue Monday” part way through January, rumoured to be the most depressing day of the year. I’ve had a very different experience this year with a positive start to 2020. January has involved conversations and planning for our 2020 activities. Lots of positivity from members and stakeholders means I’m optimistic and looking forward to a successful year.

One of the things our members want to focus on is multidisciplinary working – how different MSK professionals can work better together, with each other and with patients. People with MSK conditions need us all, from skilled surgeons to support from others with the same condition. MSK health is all about teamwork. With the introduction of Primary Care Networks there’s a lot more focus on teamwork and networked services, so the wider NHS agenda is moving in the right direction. We just need to make sure that PCNs make MSK a priority.

One aspect of our work where multi-disciplinary working is vital is pain. One thing I’m proud of this month is the publication of the report from our roundtable on pain. Feedback so far has been very positive. ARMA has two angles on the subject of pain. We want to see people with chronic pain have access to biopsychosocial support. We also want to reduce the delays in treatment for conditions which cause pain, whether that’s timely access to joint replacement surgery or reducing delays in diagnosis of MSK conditions. Both sides of this will form part or our work plan this year.

We get very positive feedback about the resources we produce, especially this newsletter and our webinars. We are aware that there are many people working in MSK who don’t yet know about them. So if you know of colleagues who might benefit, please forward this newsletter, or share on social media. The more we come together, the stronger we become.

CEO update by Sue Brown

One of the things I love about my job is the variety of things I get involved in. The wide scope of what is covered by musculoskeletal health and the variety of ARMA members, partners and stakeholders means no two days are ever the same.  August has been a month to prepare for the exciting variety of activity we have planned including our annual lecture, a roundtable on pain, an event on physical activity and more webinars.

Physical activity has been quite a theme this month, with the launch of the We Are Undefeatable campaign. I love the positive but realistic messaging which is so relevant to MSK conditions. This will help reinforce the messages from clinicians using Moving Medicine or the RCGP Active Practice Charter. My concern is that when people turn up at their chosen activity, be it a local leisure centre, gym or walking group, staff/volunteers won’t understand MSK and will be concerned about them taking part. This is the reason ARMA supports the parkrun Facebook group for people with MSK conditions, as it gives peer support and encouragement for people to be active in a way that works for them.

ARMA is planning an event for providers of mainstream activities to help them understand how to support people with MSK conditions to be active, and to include them in their activities. The emphasis of We Are Undefeatable is on self-management and being more active without medical supervision or special programmes, just like the parkrun initiative. I hope that we can help those motivated by the campaign to get a positive response wherever they choose to go.

The other big theme of my August has been pain. ARMA collaborated on some qualitative research around chronic pain which I presented at a Chronic Pain Policy Coalition event. It is clear that chronic pain is extremely common. It’s not all MSK related, but at lot of it is. The lack of services for chronic pain leaves patients and healthcare professionals alike struggling to know what to do for the best. That’s why we are promoting IAPT-MSK pain in a webinar later this month. It’s why we are holding a roundtable in October to look at how the situation can be improved. Look out for more from us in the coming months on this.

One thing that pain and physical activity have in common is complexity. There are a whole variety of barriers to people with MSK conditions being active and effective multidisciplinary pain services need to be available at every level from community peer support to specialist services. No one can solve either of these issues alone. Work together – then we might stand a chance.

Designing care for people living with both mental health problems and persistent back and neck pain

by Jenna Collins, Marketing and Communications Manager, Q Labs, The Health Foundation

In September 2018, the Q Improvement Lab (part of the Health Foundation) and Mind embarked on a year-long collaboration to understand how care can be improved across mental health and persistent back and neck pain.

The Q Lab and Mind have recently shared the first insights from this work, drawing on the experiences of over 100 collaborators to give an overview of why this challenge warrants attention and promising opportunities to improve care. A small number of organisations are now developing and testing ideas and the findings will be shared later this year.

Read essays, learning and insights from the Mental health and persistent back and neck pain project.

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.

The Q Improvement Lab brings together organisations and individuals from across the UK to pool what is known about a topic, uncover new insights and develop and test ideas. The Q Lab and Mind have just started a 12-month project focusing on improving care for people with a long-term physical and mental health problem, specifically looking at the experiences of people living with both mental health problems and persistent back and neck pain.

Further details about the project can be found here.


The project is currently in the research and discovery phase where Q Lab is trying to get a better understanding of the topic and unearth the challenges and opportunities within this space.

The Insight Manager for this project, Hannah Patel, is seeking any research or materials linked to the topic of mental health problems and persistent back and neck pain which could support Q Lab in this phase of work. They are trying to gain as broad an understanding of this topic as possible, seeking multiple perspectives on the issue. Please contact hannah.patel@health.org.uk if you can help.

September 2018 has been declared International Pain Awareness Month by the International Association of Patient organizations (IAPO).

Pain Alliance Europe is trying to organize an event in Brussels, end-September, which would involve all bodies who have organized a pain awareness activity during September. This event will depend on the possibility of getting sponsors and the availability of MEPs and rooms.

More information and toolkits can be downloaded from the September is Pain Awareness Month webpage by the American Chronic Pain Association.