Persistent pain is difficult to treat and the aim of any intervention is to support the patient in living well with their pain symptoms. We aim to encourage a culture of good understanding of the complexity of pain and the role of medical treatments including medicines across our healthcare community. In this way patients and their carers can be supported to set appropriate expectations of the outcomes from interventions and minimise avoidable harms from unnecessary or unhelpful therapeutic interventions.
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Please see the "Urgent Care: general" section on G-care for SWAST's guidance on Requesting Ambulance Transport (999 or Urgent).
Patient presents with pain as primary reason for seeking help. May be:
All pain is likely to be associated with some impairment of day to day function including reduced mobility, poor sleep, difficulty in working and low mood.
Pain is a common symptom of many medical conditions and may appear as a complication of medical or surgical treatment. A full medical assessment is always needed to exclude treatable pathological processes.
Common mental health diagnoses particularly depression and anxiety often co-occur with pain and can precede onset of pain or develop subsequently. These need to be identified and managed in accordance with local protocols. If untreated, these conditions can be a barrier to effective pain management.
It is well documented that previous traumatic experiences including physical or sexual abuse, neglect and post-traumatic stress disorder (PTSD) are prevalent in populations with persistent pain and can complicate pain management. Screening for previous trauma is particularly important for patients with severe pain and distress and pain associated with symptoms in other systems and in patients who have disabling pain despite high doses of pain medicines. This allows additional emotional needs to be identified and support offered as part of the pain management plan.
Exclude treatable causes of disease related pain.
A detailed pain assessment may be impractical within a GP consultation. The following can be useful in deciding next best steps. Much of this information will be known already: consider how this may impact on the experiences of pain.
Diagnostic tests should be ordered in accordance with clinical judgement and locally agreed protocols. Explain to the patient that diagnostic tests are often normal in complex pain presentations.
Explain to patient:
Discuss (where appropriate) importance of general measures e.g. weight loss (lower limb arthritis), activity, sleep hygiene, relaxation.
NB. Manage yourself! Complex pain is difficult to treat and GPs describe pain consultations as some of the most challenging in clinical practice. Recognise and manage your own emotions and discuss cases with colleagues. Failure to relieve pain symptoms is the norm in complex presentations and is not a sign of incompetence or lack of effort.
Consider referral to secondary care for patients with persistent disabling symptoms despite general wellbeing advice (including activity, sleep hygiene, relaxation) and optimisation of pain medicines as per the pain formulary.
Referral to secondary care pain services provides support for the ongoing pain management plan including:
Pain self-management programme:
There are no significant varaiations from the national standards in this pathway.
|Dr Cathy Stannard||Clinicial Lead||Gloucestershire Clinical Commissioning Groupemail@example.com|
|Ellen Rule||Programme Sponsor||Gloucestershire Clinical Commissioning Groupfirstname.lastname@example.org|
|Sadie Trout||Programme Manager||Gloucestershire Clinical Commissioning Group||Sadie.email@example.com|
|Dr Charles Buckley||GP Lead||Gloucestershire Cliniial Commissioning Group||Charles.firstname.lastname@example.org|
Persistent pain is difficult to treat and the aim of any intervention is to support the patient in living well with their pain symptoms. We aim to encourage a culture of good understanding of the complexity of pain and of the role of medical treatments including medicines across our healthcare community. In this way we can support patients and their carers to set appropriate expectations of the outcomes from treatments and minimise avoidable harms from unnecessary or unhelpful therapeutic interventions.