Review the April 2021 NICE guidelines emphasising holistic assessments and personalised chronic pain management through rehabilitation and self-management.
The words ‘chronic pain’ can instil fear of a lengthy and expensive case. Matters are often protracted and costly with treatment unsuccessful. This is enhanced with concerns on whether symptoms are genuine and expert evidence is often polarised.
The NICE guidelines published in April 2021 were welcomed in recommending holistic assessments both through rehabilitation and self-management. Acupuncture was recommended. The gold standard is providing personalised care and support for high impact chronic pain cases. Whilst this is a high bar we are now in a position that common sense therapies should cost insurers less.
Treatment recommendations now focus on mindfulness and physical therapy by exercise and diet. The NHS website also states that continuing work can help with management of pain conditions.
The opioid crisis has made certain drugs harder to access. Opioids were (and are) commonly prescribed in pain cases with limited success. There were constant changes in medication, lack of efficacy in long term cases and some sufferers became addicted. Where symptoms are severe what are the current recommended options?
- Pain reprocessing therapy – this is a psychological treatment adopting mindfulness to help ‘unlearn’ pain.
- Nerve ablation – the nerves around the site of pain are numbed with medication, heat or cold and then purposely damaged. The lesion prevents the nerves from sending pain signals. This is not permanent. Effectiveness varies depending on the individual and the site of pain.
- Neuromodulation – we commonly see this with spinal cord stimulation where a battery delivers electrical signals to the spinal cord nerves to scramble those pain signals. This is expensive and the results are often limited. Once recommended and/or in place it can be difficult to dissuade a Judge to ignore the continuing costs for the purpose of future losses particularly if the claimant suggests there has been some, even if very low-level improvement in the pain condition. Experts are divided on the efficacy of spinal cord stimulation.
Not all claimants, their solicitors or experts are onboard in considering a holistic approach to treatment. Some experts still favour a lengthy pain management programme which seldom leads to a resolution of symptoms and is costly for insurers. Many claimants suffering from a pain condition have been reinforced into their sick role from interventions which haven’t worked and are particularly difficult to treat. Even when litigation is highlighted as an aggravating factor cases continue with rising costs.
The early involvement of rehabilitation to consider a gym programme, mindfulness and self-management is key to actively progressing cases following the NICE guidelines. Pain conditions often ‘appear’ later in a case, but the guidelines should still be followed. Pain experts are increasingly referencing holistic approaches which is turn is mirrored by Psychiatrists. With an estimated 10% of the global population and one in four of the UK population (Versus Arthritis UK survey 2021) suffering from pain many (whether genuine or not) will be personal injury claimants. Whilst a standardised treatment plan isn’t possible in all pain cases as there is a societal move to holistic self-management, this proactive and less costly approach should lead to better recovery rates and earlier settlement in pain cases.
For more information or recommendations in catastrophic injury cases contact our defendant catastrophic personal injury solicitors team.
