Figure 2: Chronic Pain Policy Matrix Health Policies from 2012 to 2018 (11) Quality Prescribing for Chronic Pain. A Guide for Improvement. 2017-2020 (13) eHealth Strategy (14) Effective Prescribing (15) National Clinical Strategy (16) AHP Delivery Plan (17) Achieving Excellence in Pharmaceutical Care: A Strategy for Scotland (18) Improving together: A National Framework for Quality and GP Clusters in Scotland (19) Allied Health Professions Co-creating Wellbeing with the People of Scotland The Active and Independent Living Programme in Scotland (20) Health and Social Care Delivery Plan (21) Targets and Indicators in Health and Social Care in Scotland A Review (22) Consideration for Good Management of Chronic Pain Shared decision making ✔ ✔ ✔ ✔ ✔ ✔ Reducing harm, waste and variation in care ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Personalised approach to care ✔ ✔ ✔ ✔ ✔ ✔ ✔ Early assessment ✔ ✔ Ongoing review ✔ ✔ ✔ To enhance the availability of appropriate information for relevant parties to inform decisions on service delivery, performance and improvement ✔ Demographic changes in our population ✔ ✔ ✔ ✔ ✔ ✔ Financial considerations ✔ ✔ ✔ ✔ ✔ ✔ ✔ Cluster working and collaboration between services ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Source: Richardson C, Berlouis K, Smith B, Cameron P, Colvin L. Data and Measurement for Chronic Pain Services. A Pilot Study to Inform National Service Improvement. 2018 (10) 2017
Table 1: Level of pain related to estimated affected Scottish population Level of pain How they fit into the Scottish service Percentage of general population reported in literature Number of people in Scotland* Any chronic pain Majority manage themselves or with level 2 35.0-51.3 (ref Fayaz 2016) 1.9 million to 2.8m million Moderate to severely disabling chronic pain (CPG III & IV) with level 1, most manage with level 2 10.4-14.3 (ref 2016) 562,000 – 773,000 Severe chronic pain (CPG IV) with level 1, then 2, then referred to level 3, a minority go onto level 4 4.9-6.5 (ref Smith 2001) 265,000 - 351,000 *Based on 2016 mid-year Scottish population estimate 5,404,700 (38) CPG = chronic pain Co-morbidity with chronic pain Chronic pain may occur in isolation but more usually it occurs in association with other comorbidities (7). In Scotland in 2016, 16.2% of patients with diabetes, 14.8% with cancer, and 19.3% with anxiety or depression, were also being prescribed medication that is used for chronic pain (although the patient may be using this medication for another purpose, i.e. acute pain or epilepsy (Table 2). However, the proportion of patients who were comorbid for chronic pain with diabetes, cancer, or anxiety or depression varied by NHS Board, with the Borders, Lanarkshire, Tayside and Ayrshire and Arran having consistently higher proportions of co-prescribing. Barnett et al’s work would suggest that there is increased co-morbidity in patients from deprived areas (7).
Table 10: Disciplines included within secondary care pain service, by board NHS Ayrshire & Arran NHS Borders NHS Dumfries & Galloway NHS Fife NHS Forth Valley NHS Grampian NHS Greater Glasgow & NHS Highland (North) NHS Highlands (Argyll & Bute) NHS Lanarkshire NHS Lothian NHS Orkney NHS Shetland NHS Tayside NHS Western Isles Medical Consultant Anaesthetist/Doctor x X X X X X X X X X x X X X Physiotherapist x X X X X X X X * X X * * X X Psychologist x X X X X X X X X X * * X Nurse x x X X X X X X X * X Occupational Therapist X X * Pharmacist * * X X * X/* * * X Psychiatrist * X X X/* Addiction team * * x * above) * Other Associate specialist Nursing assistant Health care assistants Pain Fellow, health care assistant, others specialty doctors* GP with Special Interest, non-chronic pain Anaesthetist * X= member of team, *assists on ad hoc basis/informal links Source: Interviews