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British Journal of Anaesthesia and British Pain Society publish two new BPS Pain Patient Pathways

24 June 2013

In a new initiative the British Journal of Anaesthesia (BJA) has collaborated with the British Pain Society (BPS) to publish two of the new BPS Pain Patient Pathways.

These pathways, published in the new Postgraduate issue of the BJA, address common and challenging chronic pain conditions, which affect a large number of people: low back pain (and radicular/sciatica pain) and neuropathic pain. These publically available pathways aim to provide a framework for healthcare professionals to manage these problems using the best available evidence and expert consensus. They will also empower patients themselves to be actively involved in managing their chronic pain.

The BJA reviews give a comprehensive commentary that adds to the value of these two pathways.

Spending on spinal pain is around 20% of UK healthcare spending, greater than for most other medical conditions. The new pathway is the first comprehensive guide for this patient group. An important aim of the pathway is to improve effective management, which may not only reduce healthcare spending, but also improve quality of life for a large number of patients. One of the advantages of the BPS pathway on spinal pain is the broad multidisciplinary team involved in producing them, from a wide range of backgrounds including pain specialists, physiotherapists, psychologists, nurses, surgeons and, perhaps most importantly, patients.

Several key discussion points were addressed in the BJA commentary, including:

- Patients often feel they have limited information on how to self-manage their back pain. The pathway provides important resources for patients for this purpose.
- A new tool, STarTBack, is recommended to allow early identification of which patients are most likely to have problems. This innovative approach can help target intensive resources towards the people most likely to benefit.
- Returning to work is an important treatment goal, but evidence of how to do this most effectively is limited.

Neuropathic affects around 8% of the population and is challenging to treat effectively. It is a particularly unpleasant type of pain, with a major impact on quality of life for patients, equivalent to that of severe heart disease or serious mental illness. Despite a number of good quality evidence-based reviews, it is still under-recognised and under-treated. This new pathway aims to be easily accessible and readable, and will be useful for both non-specialists and patients.

There are several specific discussion points in the BJA review of the neuropathic pain pathway:

- Proper assessment is vital – there are good, effective treatments for neuropathic pain, but if neuropathic pain is not diagnosed, then these will not be tried and the pain will persist. Non-specialists can find diagnosis difficult - support for this is provided in the pathway as an essential first step.
- Key to improving treatment is individual assessment of the pain and early review of treatment responses.
- If treatment is NOT working or pain is particularly severe, then timely specialist referral is needed.

For further information, please contact:
Kirsty Doole, Publicity Manager, Oxford Journals | 01865 355439

Low back and radicular pain: a pathway for care developed by the British Pain Society by J. Lee, S. Gupta, C. Prise, and A. P. Baranowski
Neuropathic pain: a pathway for care developed by the British Pain Society by B. H. Smith, J. Lee, C. Price, and A. P. Baranowski