Chronic pain service delivery - draft framework: consultation

Why take action?

What is chronic pain?

2. We all experience pain as part of a normal response to injury or illness and treatment of the underlying medical issue or condition may resolve the pain. However, pain may persist beyond normal tissue healing time, or in some cases has no identifiable underlying cause. Chronic pain is pain that persists or recurs for longer than three months. It is a separate condition in its own right, and not merely an accompanying symptom of other diseases.

3. Chronic pain is a common condition and estimates suggest it affects between one third and a half of adults in the UK.^[2] In Scotland it is estimated that 5% report severe chronic pain, which impacts their daily activities and quality of life.^[3]

4. Chronic pain can affect many aspects of day to day life and wider health. Chronic pain can be associated with poorer mental health including depression, anxiety, fatigue and sleep issues.^[4] People with chronic pain are also more likely to report lower life satisfaction and poorer quality of life compared to those without chronic pain.^[5,6]

5. Chronic pain also has an impact on people's ability to be (or remain) in work, with conditions such as back pain accounting for a significant proportion of sickness absence and economic cost in the UK.^[7,8]

6. People with chronic pain report that their condition also impacts their social and family life.^[9] Loneliness can also be experienced by people with chronic pain, with some evidence that social isolation and may increase the impact and interference of pain.^[10]

7. Prevalence estimates for chronic pain in young people vary widely, and pain can often be a component of other conditions affecting children.^[11] However there is some evidence to suggest that there is a lack of information and training resources on pain and its management for professionals working in paediatric services.^[12] Work is currently underway to assess the current status of paediatric pain management services across Scotland with the aim of identifying opportunities to further improve support for children with chronic pain and their families. Outcomes for this group will be delivered in partnership as part of cross-cutting government policy work on paediatric care and the transition to adult services, and not in this Framework.

Inequalities and chronic pain

8. The impact of chronic pain is felt unequally in our society. Through the development of the Framework we understand that the experience of chronic pain, its impact and access to support varies across Scotland which needs to be addressed.

9. There are a range of factors which appear to be associated with an increased risk of developing chronic pain, including demographic, psychological and clinical factors.

10. Chronic pain is frequently found alongside one, more other long-term health conditions in people of all ages, and across all deprivation levels.^[13] As with other long-term conditions, chronic pain is more frequently reported amongst people in lower income groups.^[14]

11. Research suggests social disadvantage, trauma and psychological stress also increase people's risk of developing chronic pain. Other life stresses, for example adverse childhood experiences (ACEs), are also associated with a higher risk of developing chronic pain.^[15]

12. There is also evidence that women experience more chronic pain than men.^[16] More research is required to understand the chronic pain experiences of lesbian, gay, bisexual and transgender (LGBT) people, who may have poor health experiences more generally.^[17]

13. As we consider the implementation of the Commitments of this Framework, we will seek to address the inequalities faced by people with chronic pain, both historic and those arising and exacerbated by the COVID-19 pandemic.

What action has already been taken?

14. Scotland was the first country in the world to develop comprehensive guidelines on the assessment and management of chronic pain. In addition to the full guideline, a quick reference guide for healthcare professionals and a booklet for people with chronic pain, their families and carers are also available.

15. Scotland has also developed a National Service Model for Chronic Pain. The Model was intended to communicate a multi-level approach to care for people with chronic pain where access to healthcare or other support appropriately reflects the impact of the condition. However, people with chronic pain and those involved in their care have told us that further action is needed to deliver the Model and its intended outcomes.

16. Prior to the COVID-19 pandemic, work was also carried out to identify challenges in service provision and generate ideas for sustainable improvement of care and support for people with chronic pain. The NHS Centre for Sustainable Delivery (CfSD) Modernising Patient Pathways Programme (MPPP) has taken forward many of these recommendations and has provided support for a range of improvement projects across Scotland.

17. Case study examples of system and service improvement activities are available at the end of the Framework.