Shifting pain management in the community

Across Britain, millions of patients, as well as their families and carers, are affected by chronic pain. Unfortunately, chronic pain can have a devastating impact upon a person's day-to-day life, work, hobbies and mental health and wellbeing.

Current thinking, developed over many years of turning routinely to pharmacological measures, presumes that pain should never be experienced in the modern world, and that there is a pill that can essentially resolve any type of pain.

This can, in a large part, be traced back to the development of the analgesic step ladder (or pain ladder) by the World Health Organization in 1986, and its inappropriate application to the management of non-cancer-related chronic pain, for which it was never validated (National Institute for Health and Care Excellence (NICE), 2017).

Importantly, NICE (2017) pointed out that:

‘using the WHO ladder in people with chronic pain, without taking into account the complexity of the person's individual needs, preferences for treatment, health priorities and lifestyle, may contribute to inappropriate prescribing.’