An updated audit of the patient selection process for pain management programmes in a speciality care service before and during the COVID-19 pandemic

Abstract

Background The provision of pain management programmes (PMPs) changed substantially in response to the COVID-19 pandemic with virtual delivery implemented in many services. Little is known about patient selection processes for virtual PMPs and how this might differ from in-person programmes. The aim of this audit was to document the patient selection process for PMPs at a speciality pain service prior to and during the pandemic. Methods This retrospective audit used data from consecutive patients attending a multidisciplinary assessment to determine the suitability of a PMP. Anonymized data were extracted from assessment letters and hospital records in the months prior to the pandemic (n =168) and during the start of the pandemic once the service began delivering virtual PMPs (n =171). Results For the standard pain management pathway, most patients were offered a PMP option within the service before and during the pandemic, although a greater proportion of patients were offered treatment during the pandemic. For the neuromodulation pathway, most patients were offered a pre-neuromodulation PMP option, and this was similar before and during the pandemic. Psychosocial complexities and unwillingness to engage in a pain management approach that does not principally focus on pain reduction were the most common reasons that patients were not offered a programme. Discussion This audit points to a pattern of more inclusive assessment outcomes within our service over time and particularly during the pandemic. Offering a range of in-person and virtual PMPs can meet a wider range of patient need. Research is needed to understand how to best assess and match patients with the breadth of treatment delivery formats now available.

An Observational Study of Outcomes Associated with Virtual Pain Management Programmes Based on Acceptance and Commitment Therapy Implemented During the COVID-19 Pandemic

“…However, an audit (separate from the current study) conducted within the same service identified that the most common reasons for exclusion from the programs offered were the presence of serious and poorly controlled psychiatric conditions, not being ready for a self-management approach, and pain not significantly impacting on daily functioning. 13 …”

“…[10][11][12] To address varying levels of patient need and complexity, different formats and intensities of ACT-based PMPs have been implemented within the UK's National Health Service. 13 For example, an intensive residential ACT-based PMP has been running for more than 12 years for patients presenting with severe and complex pain-related disability or distress. 14,15 A less intensive outpatient format is also offered for people presenting with less pervasive impacts of pain on their lives.…”

“…ACT is increasingly used within interdisciplinary PMPs in routine clinical practice 10–12 . To address varying levels of patient need and complexity, different formats and intensities of ACT-based PMPs have been implemented within the UK’s National Health Service 13 . For example, an intensive residential ACT-based PMP has been running for more than 12 years for patients presenting with severe and complex pain-related disability or distress 14,15 .…”

Evaluating the feasibility of delivering a pain management programme for adults living with sickle cell disease

“…The aim of PMPs is to increase functioning through the development of cognitive and behavioural self-management skills, rather than to directly reduce pain. [22][23][24] The largest body of research relates to PMPs utilising a traditional Cognitive-Behavioural Therapy (CBT) framework. 25 'Third wave' cognitivebehavioural approaches including Acceptance and Commitment Therapy (ACT) and mindfulness based approaches are now also incorporated into many contemporary PMPs.…”