Economics of pain and pain management: impact on policy, practice and patients
Research within the Swansea Centre for Health Economics at Swansea University has been leading the way in increasing the awareness of the significance of pain to healthcare systems, economies and societies.
It is well known that around 20% of the population in the UK suffer with some form of chronic pain - pain that is experienced every day for at least 3 months within a 6-month period. As well as the debilitating effect on the quality of life for anyone suffering from chronic pain, it also brings with it wider social, clinical and economic effects, for example, through increasing levels of dependency, prolonged absence from work and the costs of treatment to the NHS.
Since 1997, staff from the Swansea Centre for Health Economics (SCHE) have been researching the economics of pain and pain management, and their research into this topic has been supported through funding from agencies such as: the National Institute for Health Research, Department of Work, Wales Centre for Health, Medical Research Council and Pensions, Welsh Government and pharmaceutical companies.
This programme arose initially from research which investigated the impact of major side effects caused when treating pain with non-steroidal inflammatory drugs. The findings showed that for every patient prescribed this type of drug, the subsequent additional cost to the UK NHS in managing the side effects amounted to £48, and with prescribing of these medicines costing around £220 million at the time, the additional cost of managing these side effects was an additional £180-£380 million. The scope of their work widened in later years to include the workplace, with one study assessing the costs and benefits of physiotherapy on work retention and return to work rates. The scheme demonstrated significant reductions in sickness absence and improvements in work-related performance; significant reduction in the use of healthcare resources; significant improvements in the conditions of employees with musculoskeletal problems and significant improvements in quality of life.
The methods developed in assessing the full range of costs and benefits (including the adverse events) of pain management have been subsequently applied, with funding from a number of sources, to other conditions and healthcare interventions – including cancer, dentistry, multiple sclerosis, public health and wound management. These have led to direct impacts on policy, practice and therapeutic developments in each area.
Increasing the awareness within the political community of the societal burden of pain
The findings have also raised the political awareness of pain and its management. Presentations at the Parliamentary Health Group in 2003 and 2004 (House of Commons) were instrumental in the formation of the Chronic Pain Coalition - a forum established in 2006 to unite patients, professionals and parliamentarians in a mission to develop an improved strategy for the prevention, treatment and management of chronic pain and its associated conditions.
Staff from SCHE have also presented at international meetings in Brussels and Copenhagen where European politicians and policy makers were informed of the impact of pain on society and the need for concerted action to alleviate its effects on individuals and societies.
Stimulating pharmaceutical companies to develop new pain therapeutic agents and refocus patient management
The work has also been highly instrumental in demonstrating the economic benefits of new therapies that can contribute to more effective patient management, leading to their development and use in clinical practice. Findings from the research programmes have contributed to the development of NICE guidance for employers, NHS and other professionals and managers involved in the management of long-term sickness absence and incapacity, while clinical update sessions for medical professionals have been provided, including the Royal College of Anaesthetists and Royal College of General Practitioners.
The work was also a key component in assessing the need for a national occupational health service for Wales, and the basis for Fit for Work pilots – a major component of the UK government’s policy of welfare reform.
Enhancing the status of pain and its management in the development of health policy and practice
Research findings have also been widely used to influence policy developments in UK and overseas, such as Canada. For example, the evidence was extensively utilised in the development of the Service Directive and Commissioning Framework of Chronic Pain in 2008 – a key strategic document in establishing and developing pain services in Welsh hospitals. Subsequently, Health Boards have achieved 87% compliance with the actions within this Directive and established greater levels of integration to support more effective pain management.