Background A small number of cancer patients’ pain syndromes remain inadequately controlled despite applying the principles of the World Health Organization Analgesic Ladder. These patients often have neuropathic pain and experience severe symptoms. They may also experience medication side effects which limit dose escalation. NICE guidelines recommend that specialist palliative care teams should have access to pain management specialists with nerve blocking and neuromodulation expertise. A recent paper concluded that patient care and outcomes will be enhanced by establishing more formal relationships between pain services and palliative medicine. There is evidence of under-referral for advanced pain management procedures and a lack of integrated services nationally. Interventional pain management has been a longstanding gap in the commissioning of cancer services in our locality.
Aims To improve the care of patients with complex cancer pain by establishing a collaborative hospice-based service with a chronic pain management anaesthetist.
Methods A service-level agreement was established between the hospice and the local hospital trust to commission input from a chronic pain anaesthetist in January 2017. Fortnightly sessions were established to review hospice inpatients and to attend hospice multidisciplinary community team meetings. Patients with complex cancer pain syndromes are discussed and proactive joint reviews and procedures arranged where appropriate. Joint consultation with the chronic pain consultant and palliative care team is emphasised to ensure that all options are explored pre-procedure and follow-up is safe post-procedure. It is anticipated that case reviews presented back to the clinical teams will encourage referrals and contribute to ongoing education. In addition, over the first year of the service, the systems to support hospice-based spinal infusion services for intractable cancer pain will be established.
Evaluation A service evaluation will assess numbers of patients identified for discussion, assessment and intervention; clinical team confidence and knowledge; and case note review of perceived patient benefits.
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