The story of specialist pain services in Scotland is one of chronic failure. It mirrors all too closely the experience of patients who are fobbed off with ever higher doses of painkillers and the promise of future help, but whose desperate need is never properly tackled.
The story of specialist pain services in Scotland is one of chronic failure. It mirrors all too closely the experience of patients who are fobbed off with ever higher doses of painkillers and the promise of future help, but whose desperate need is never properly tackled.
We have known for 14 years that provision is inadequate and varies from one area to another, even within health boards, because four separate reports (in 1994, 2000, 2002 and 2004) have told us so. Each, in turn, has made suggestions for improving the service, yet now, in 2008, NHS Quality Improvement Scotland (QIS) reports: "If anything, the need for these services is greater." This state of affairs is not only unacceptable (on an individual patient level it could be described as a dereliction of duty), it is a damning indictment of health boards and their service managers. Patients in chronic pain do not fit neatly into any one category. Because their condition results from a variety of causes, from cancer to slipped discs or recurrent migraine, they often don't show up as a separate group when outcomes and efficiency are measured. Instead, their access to services depends on having a sympathetic consultant who refers them to a specialist pain clinic.
The latest QIS report has made a point of gathering the experiences of patients as well as the views of medical staff, and as a result provides a disturbing picture of the reality of many people's lives. Long-term sufferers of pain report that they are "made to feel a nuisance" and that GPs "don't believe in chronic pain, don't know what to do about it and don't know what specialist treatment is available".
No doubt that reflects GPs' own helplessness and frustration, but people who keep returning to their doctors do so because they want to regain their normal life. Many long-term sufferers have had to give up work and rely on incapacity benefit (IB). Apart from the sheer relief, their main reason for overcoming the pain is so that they can return to work.
One such is Helen Cadden, who was injured while working as a nurse and whose story we tell today. Like her, others cannot find an employer who will allow them to work for only a few hours a week. The government's intention to assess all IB claimants for work capability from 2010 could penalise chronic-pain sufferers, whose condition often fluctuates. That prospect should be grasped as an opportunity to spur the provision of more specialist pain clinics. They offer a variety of effective treatments, but are so few and far between that patients can wait years before being referred to one. Even those who have had to stop painkillers owing to side-effects then join another long waiting list.
In this instance, Quality Improvement Scotland reports in uncharacteristically blunt terms. " We need to stop talking about what is not working and start improving these services as a matter of priority." The message could not be clearer: patients must not suffer any longer.
