CHRONIC PAIN AND THE NEED FOR A GUIDELINE
Chronic pain, defined as pain lasting beyond normal tissue healing time (taken to be 3 months),1 is a syndrome that affects a large proportion of the primary care population. It is ‘significant’ in around 14% of UK adults, imposing a heavy burden on the physical and psychosocial health of sufferers, their families and society, at high cost to the healthcare services.2 It was estimated in 2002 that people with chronic pain account for 4.6 million GP appointments in the UK, at an annual cost to the NHS of £69 million, equivalent to the employment of 793 GPs.3 Although many clinical conditions can lead to chronic pain, there are common underlying neurobiological and psychosocial mechanisms, and the impact is generally independent of the clinical aetiology. Effective assessment and treatment of chronic pain therefore means that GPs should have:
adequate education and knowledge;
access to evidence-based effective management strategies; and
agreed criteria for referral to specialist clinics.
Unfortunately, none of these requirements is generally in place.
Undergraduate training in management of pain is demonstrably minimal, accounting for <1% of programme hours,4 despite its high prevalence and impact. Much of the available evidence for potential interventions is derived from specialist settings or in specific clinical conditions, making it difficult to apply to a general primary care population. Even standard treatments, such as drugs, often lack evidence for effectiveness …