Primary care chronic pain toolkit
Pain is a leading cause of disability
Chronic pain is pain that persists for more than 3 months, or beyond normal injury healing time. It is a major clinical and public health challenge. Prevalence figures vary, with estimates in 2016 ranging from 35.0 to 51.3% in the UK, increasing with age (18–25 years: 14.3%; 25–64 years: 30–50%; over 75 years: 62% - age groups did not overlap precisely across the studies). The prevalence of moderate to severely disabling chronic pain is up to 14.3%.
A more recent systematic review of chronic pain in Europe found a point prevalence ranging from 12% to 48%. Factors associated with higher risk included female sex, older age, lower education and unemployment.
In Scotland, in 2022, overall prevalence was 38%, with more than 15% of people reporting significant limitations in work or life due to chronic pain. A higher proportion of women compared with men (43% vs 33%) are affected. Prevalence increases with age (25–34 years: 23%; 65–74 years: 51%) and with deprivation (least deprived: 29%, most deprived: 50%). Chronic pain is projected to increase in the coming years, with a greater rate of increase in more deprived areas.
Traditional approaches to managing pain
The traditional biomedical approach to pain, which largely focuses on symptoms, has resulted in incomplete care and, in some cases, harmful prescribing practices. Many patients are simultaneously over-medicated and under-informed about their condition, with a lack of appropriate support. This can lead to harmful drug related side effects, multiple pain flares, distress, and increasing disability.
GPs are working in time-pressured environments and are often under enormous pressure from patients to prescribe medication to fix their symptoms. As has often been said, “it takes 20 seconds to prescribe, but 20 minutes to explain.”
Modern science shows that a paradigm shift is needed in how pain is understood and managed. Both NICE and SIGN chronic pain guidelines along with the Scottish Government Quality prescribing guide for chronic pain guide emphasise rehabilitation and the importance of limiting ineffective or potentially harmful prescribing. However, while guidelines are widely supported, they can be difficult to deliver in frontline healthcare. Effective delivery requires time, training and a multidisciplinary approach to provide holistic, person-centred care.
A toolkit for chronic pain in primary care
There is currently no nationally agreed model for chronic pain management in primary care, with high variation in approaches between clinicians. This variation can lead to patient harm through unsafe prescribing and lack of appropriate support. The Centre for Sustainable Delivery (CfSD) has evidence from multiple test-of-change projects across Scotland, which highlight the value of multidisciplinary team (MDT) working in primary care and the importance of delivering a consistent message that chronic pain is a long‑term condition.
Since 2019, the new General Medical Services contract has seen variable delivery of Pharmacists, Mental Health Liaison Nurses, Physiotherapists, Occupational Therapists and Link Workers across Scottish GP practices.
Developing an established toolkit to support the role of the multidisciplinary team in chronic pain management can help deliver patient centred, safe and effective care. Evidence from occupational therapy use across 8 GP practices in Lanarkshire demonstrated improved patient outcomes for 58% of patients, alongside a 22% median reduction in GP appointment at 6 months. Evidence from pharmacy-led prescribing reviews in Church Street Practice, Coatbridge, demonstrated a 60% reduction in opioid prescribing.
