Dr Simon Thomson MBBS FFPMRCA
Consultant and lead clinician in pain medicine and neuromodulation, Mid & South Essex University Hospital NHSFT
Dr Jan Willem Kallewaard
Anaesthesiologist, Amsterdam University Medical Centre and Rijnstate Hospital, Arnhem
Pain specialists call for ‘right patient, right treatment, right time’ approach to the treatment of long-term pain.
Specialists in pain management say that one of the most common problems with health systems is that patients are not referred to the correct treatment for their specific pain at the right time.
This can be due to financial restrictions within health systems, but it can also be due to clinicians’ lack of awareness of the benefits of available therapies and the health outcomes that may be achieved.
According to Dr Simon Thomson, consultant in pain medicine and neuromodulation, there are many different types of pain, and a wide range of physical components to consider for each. In addition, each patient will have psychosocial factors that may impact the outcome of treatment, including the patient’s attitude to their pain and to the available treatments – of which there are now many different types.
However, it’s rare that all these factors are taken into account when a clinician considers making a referral, Dr Thomson believes. He says: “There can be a degree of ‘old school thinking’ among pain clinicians. The challenge is to work out what are the most cost-effective ways to achieve better outcomes.”
Before treatment patients might not even have been able to walk 50 metres, and afterwards they can walk up to two hours. This can make a huge difference to people who otherwise have to live in pain.
Less risky options could help with pain management
Too often, people suffering long-term pain remain stuck, taking potentially addictive medicines such as opioids, or are fast-tracked into invasive surgeries, when less-invasive, less risky and more effective treatments are available.
As an example, in the Netherlands, an outpatient therapy called radio frequency (p) RF ablation is commonly used ahead of surgery for patients with chronic pain in the cervical and lumbar regions, and in the knee and hip.
Performed under local anaesthetic, RF ablation involves the use of electricity to create lesions on a target nerve to reduce pain. According to Dr Jan Willem Kallewaard, anaesthesiologist at the Amsterdam University Medical Centre and Rijnstate hospital in Arnhem, the great advantage of this treatment is that it can target very specific nerves reducing the impact on surrounding tissue and can offer significant improvements in a patient’s quality of life.
Dr Kallewaard explains: “Before treatment patients might not even have been able to walk 50 metres, and afterwards they can walk up to two hours. This can make a huge difference to people who otherwise have to live in pain.”
Pain referral e-tool can help clinicians with diagnoses
To support clinicians through the maze of pain indications, patient attitudes and treatments, an international panel of experts have devised a pain referral e-tool. This aims to improve the way patients are selected for referral to specialist pain therapies, for example, spinal cord stimulation (SCS).
Dr Thomson believes that giving patients the right treatments quicker and more easily can have cost savings for health systems, which otherwise will fund the long-term costs of drug therapy. For patients, the results of a successful treatment can be life changing.
He says: “People talk about getting their lives back, or finally seeing their partner free of pain. Often, by the time they receive SCS, people have spent six years in chronic pain. After all they’ve been through, it’s amazing if, right at the end, we can make a difference.
“Part of what we are trying to do is to gently push for earlier recognition of suitable cases, and to create a referral pathway that is quicker and easier for everyone to access.”
