Wednesday, July 21, 2010

International Association for the Study of Pain - Task Force on Wait-Times

It is established that patients suffering with chronic pain deteriorate while waiting for treatment. The deterioration includes escalating pain and depression and decreased health-related quality of life (Lynch, Campbell et al. 2008). In addition, an international survey of IASP Presidents and other key informants has identified that problems with wait-times for appropriate service or with lack of access to service occur in many nations (Lynch, Campbell et al. 2007).

On October 11, 2004, during the first Global Day Against Pain, IASP joined with the World Health Organization and the European Federation of IASP Chapters in calling for pain control to be recognized as a major public health issue and a human right (Bond and Breivik 2004; Brennan and Cousins 2004). In keeping with the IASP guiding principle that all peoples have a right to treatment of their pain, patients should receive timely access to appropriate care for chronic pain.

To address this problem, it will be necessary to advocate strongly with health care funders and governments who look to health care specialists and the literature for guidance. We believe there are two steps necessary to accomplish this goal:

Identify appropriate wait-times benchmarks for treatment of chronic pain and produce a document endorsed by IASP.

Support and pursue multi-national initiatives to address timely and appropriate treatment for the management of chronic pain.

In an effort to begin to address this problem, the IASP President established a Task Force in January 2009 to identify benchmarks to address the first of these two steps.

The Task Force completed an international environmental scan which identified several nations where rigorous initiatives have established guidance or benchmarking documents regarding the issue of wait times for management of chronic pain. These included Australia, Canada, Finland, Norway and the United Kingdom. A summary of the Benchmarks recommended by each of these countries appears in Table 1.

In summary, Finland, Norway and Western Australia (with the rest of Australia likely to follow) lead the world with regard to government mandated guidelines specific for wait-times for treatment of chronic pain. There is significant congruence in the guidelines across nations. The Task Force members have reviewed and synthesized the information and propose the following recommendations.

Recommendation for wait-times:

Most urgent (1 week): acute painful severe condition with risk of deterioration or chronicity (new CRPS) or pain related to cancer or terminal or end stage illness (acute herpes zoster also requires urgent treatment but ideally should be treated at the primary care level rather than requiring a pain specialist service).

Urgent or semi-urgent (1 month): severe undiagnosed or progressive pain and risk of increasing functional impairment generally 6 months duration or less (back pain not resolving, neuropathic pain, post surgical or post traumatic pain)

Routine or regular (4 months): persistent long-term pain without significant progression

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