A systematic review of the effect of waiting for treatment for chronic pain

Abstract

In many countries timely access to care is a growing problem. As medical costs escalate health care resources must be prioritized. In this context there is an increasing need for benchmarks and best practices in wait-time management. The Canadian Pain Society struck a Task Force in December 2005 to identify benchmarks for acceptable wait-times for treatment of chronic pain. As part of the mandate a systematic review of the literature regarding the relationship between waiting times, health status and health outcomes for patients awaiting treatment for chronic pain was undertaken. Twenty-four studies met the inclusion criteria for the review. The current review supports that patients experience a significant deterioration in health related quality of life and psychological well being while waiting for treatment for chronic pain during the 6 months from the time of referral to treatment. It is unknown at what point this deterioration begins as results from the 14 trials involving wait-times of 10 weeks or less yielded mixed results with wait-times amounting to as little as 5 weeks, associated with deterioration. It was concluded that wait-times for chronic pain treatment of 6 months or longer are medically unacceptable. Further study is necessary to determine at what stage the deterioration begins from the onset of pain to treatment and the impact of waiting on treatment outcomes. Most important is the need to improve access to appropriate care for patients with chronic pain, an escalating public health care problem with significant human and economic costs.

The Canadian STOP-PAIN project – Part 1: Who are the patients on the waitlists of multidisciplinary pain treatment facilities?

“…In two studies of patients being treated at an urban multidisciplinary pain centre in Denmark, no differences were seen after four months of waiting, 32 but when patients waited six months, health-related QoL, anxiety, and depression scores deteriorated. 33 These results are consistent with a systematic review 34 that found patients experiencing a reduction in health-related QoL and psychological well-being while waiting six months from the time of referral to treatment for chronic pain. 35 Like any other study, the present one has a certain number of limitations.…”

Supporting Better Access to Chronic Pain Specialists: The Champlain BASE ™ eConsult Service

“…The emotional toll exacted by chronic pain is well reported, with multiple studies noting the association between chronic pain and depression, anxiety, and loss of one's social role. 1,5,6,22 PCPs frequently expressed frustration and concern in their questions to specialists, a finding that is likewise reflected in the literature. 23,24 One study found that nearly three quarters of PCPs considered providing chronic pain care to be a major source of frustration.…”

Provision of Recommended Chronic Pain Assessment and Management in Primary Care: Does Patient-Centered Medical Home (PCMH) Recognition Make a Difference?

“…Long waits to access pain management and lack of access to addiction medicine and integrative and mental health specialists are barriers in CP management. 6,13 Reimbursement policies may limit patient-centered care, as PCPs have limited time for planning, performing comprehensive assessments, and coordinating care. 3 Further, there may be little teamwork or few structured opportunities for communication between office staff and PCPs, resulting in important information divulged by patients to staff, which is then not relayed to PCPs.…”