Remote pain management programme for persistent musculoskeletal pain

The Royal National Orthopaedic Hospital (RNOH) has provided pain management programmes (PMP) for people with musculoskeletal conditions for over 20 years.

The programmes are for inpatients with:

• persistent spinal pain
• peripheral joint pain
• hypermobility disorders
• complex regional pain syndrome
• chronic pain associated with inflammatory arthropathy

The aim of the programmes are to improve physical and mental wellbeing, enhance social engagement (including return to work), and enable self-management skills.

The programmes are interdisciplinary and have input from:

• physiotherapists
• occupational therapists
• therapy technicians
• clinical psychologists
• medical consultants in pain medicine and rheumatology

Situation

The COVID-19 pandemic meant it was unsafe to bring patients into hospital to attend a face-to-face pain management session.

Aspiration

• Patients can continue to access treatment through pain management and rehabilitation services despite the restrictions imposed due to the pandemic. The PMP is a core element of these services.
• RNOH can continue to deliver a live interactive programme, ensuring all the core parts of a PMP are kept in line with national guidance.

Solution and impact

Video conferencing technology delivers remote PMPs in:

• group education and discussions
• physical group sessions
• one-to-one therapy sessions

Patients are able to access rehabilitation support from their own homes and clinicians are able to deliver support remotely. This reduces:

• face-to-face contact when it may not be safe
• travel time and costs
• time in hospital

RNOH also offers support and information to the friends and family of their patients. This increased access to support, while face-to-face support was unsafe.

Functionality

The PMP was adapted so that it can be delivered remotely in real-time using video conferencing technology.

Functionalities include:

• being able to screen-share presentations and other resources during sessions
• a chat function for asking questions, having discussions and sharing links and resources
• breakout rooms where patients can share ideas and discussion in smaller groups
  

Capabilities

The RNOH PMP is a 3 week programme that can:

• facilitate societal engagement, including returning to work for many patients
• enable people to self-manage their pain and associated disability
• facilitate peer learning and support which is an important element of the programme

The video conferencing technology gives patients real-time support with physiotherapy, occupational therapy or psychology in any location.

Scope

The service can be:

• used by patients when they are at home
• used by clinicians either on site or when working remotely
• used in a tertiary PMP where patients are referred to consultants from secondary care
• accessed by any patient with persistent musculoskeletal pain like those with hypermobility, persistent spinal and peripheral joint pain, widespread pain and other rheumatological conditions

Key learning points

• Only patients who have access to technology, time and space can engage with the programme.
• The design, development and refinement of the service had input from stakeholders like patients, clinicians and administrative staff. Contributions from all stakeholders were essential to the success of the programme.
• A remote PMP requires clinical expertise and competence in dealing with people with complex pain.
• The Hospital identified in a recent study that there's a place for virtual PMPs beyond the pandemic.
• Patients are now offered a choice of virtual or face-to-face. They can discuss the programmes during their assessments with the care team to help them make the best choice.

Key figures

• As of 1 March 2021, 36 patients have attended the remote PMP and feedback has been positive. Each patient has a skilled and caring clinical and rehabilitation team to offer help and support for their individual circumstance.

Find out more

British Pain Society guidelines for pain management programmes for adults (PDF, 832KB. This document may not be accessible to assistive technology.)

Virtual PMP implementation paper

Key contacts

Greg Booth, Specialised Physiotherapist, Senior Research Therapist, Royal National Orthopaedic Hospital NHS Trust

gregory.booth@nhs.net