Chronic pain management
Some patients with chronic pain face waiting years to see a specialist
Exclusive: Waiting times for specialist services for chronic pain vary hugely across Great Britain, with some patients waiting more than two years to access the treatment they need.
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The majority of patients living with chronic pain in Great Britain are having to wait much longer than recommended for specialist help to manage their symptoms, with some waiting two years after being referred by their GP.
According to information obtained by The Pharmaceutical Journal under the Freedom of Information Act, pain management clinics are offering a wide range of treatment options for chronic pain — such as interventional procedures, physiotherapy, psychological therapy and occupational therapy — but average waiting times from referral to treatment range from 6 to 112 weeks across the country.
Of the 39 specialist pain services that responded to the request, 87% said they had a longer average waiting time for a non-urgent outpatient appointment than the maximum wait of eight weeks recommended by the International Association for the Study of Pain.
Some 26% of pain management services in England and Scotland had an average wait longer than the 18-week referral-to-treatment target.
In Wales, four out of five providers that responded reported average waiting times of more than 20 weeks; however, this meets the NHS Wales target for referral-to-treatment times, which is for all patients to be seen within 36 weeks.
NHS Highland said that the average wait for its pain management service ranged from 40 to 112 weeks. A spokesperson said this was a result of “increased referrals to the pain management service”.
At Swansea Bay University Health Board, patients faced an average wait of 24 weeks for chronic pain treatment. A spokesperson said: “We are always aiming to continually improve access to services were possible”. However, they pointed out that the board meets the NHS Wales targets for referral-to-treatment times.
Meanwhile, the Countess of Chester Hospital NHS Foundation Trust reported an average wait of 35 weeks. “We recognise this is particularly upsetting for those with chronic pain symptoms. The waiting times for our chronic pain services are much longer than we would like. We are actively recruiting for a chronic pain specialist to help with this and we are also seeking solutions internally to increase our capacity moving forwards. We apologise to all patients that have been let down by long waiting times,” a spokesperson said.
The Royal Free London NHS Foundation Trust reported an average waiting time of 37 weeks for its pain management service. A spokesperson for the trust said: “Local commissioners are developing services in the community to manage chronic pain. This will mean that only patients requiring treatment in a hospital setting are referred to the Royal Free London in future and waiting times will decrease.”
Commenting on the investigation, pain specialists warned that longer waiting times often mean that patients’ health has deteriorated by the time they reach pain management clinics, meaning that it is harder for pain management therapies to tackle their symptoms.
Lorraine de Gray, a pain consultant at Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust in Norfolk and vice dean of the Faculty of Pain Medicine at the Royal College of Anaesthetists, said: “My experience of seeing patients in the pain clinic is that it has been a long, long time before they actually get there. And a lot of them have lost faith in the medical profession by the time they do.”
Emma Davies, advanced pharmacy practitioner in pain management at Abertawe Bro Morgannwg University Health Board in Wales, said: “Patients can deteriorate over that time quite dramatically. It is harder for pain services to support more debilitated or severely affected people and their options may be more limited.”
Antony Chuter, chair of the charity Pain UK, said that there should be more specialised services available in the community so that they are easier for patients to access. “The system is failing patients; it’s failing GPs. And pain consultants in the hospitals probably feel that everything is being thrown at them,” he said.
A spokesperson for the Welsh government said: “[In 2019], we issued revised guidance about the management of persistent pain, with actions to improve the range and quality of services available. We want people to be supported to manage pain themselves in their daily life with improved physical, psychological and economic wellbeing. Hospital services are important for some patients, but the long-term solution must come from improvements in the patient pathway.”
A spokesperson for the Scottish government said: “Living with chronic pain can be incredibly difficult and we are determined to improve services for all those affected.
“We know that in some areas of Scotland, people wait too long to be seen for the first time after they are referred to a pain clinic. We continue to work with relevant NHS boards on actions they are taking to improve performance, supported by record investment and our reform programme.”
As an alternative to waiting for a referral to a hospital-based pain management clinic, NHS England has launched trials in 41 areas which offer patients the option to choose to be assessed and treated for common musculoskeletal conditions, such as back pain and arthritis, by general practice-based physiotherapists with enhanced skills.
NHS England was asked for comment, but did not respond in time for publication.
Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2020.20207637
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