Impact case study database

Changed clinician practice in pain treatment nationally and internationally leading to improved children’s quality of life

Between August 2013 and December 2020 BCPR research on psychological mechanisms [3.1-3.3] has been applied to change how clinicians manage children’s pain [5.1-5.5], by shifting the focus to cognitive-emotion processes and incorporating measurement into care pathways. As noted by the Lead of the Paediatric Pain Research Group and the Consultant Lead of Paediatric Pain Service at Great Ormond Street Hospital [5.1] the Centre’s research has “ ensured that psychological constructs and mechanisms such as pain catastrophising, approach-avoidance and attention bias, are [understood by] a range of practitioners involved in paediatric pain management” and “ led to major improvements in clinical care” [5.1]. Rather than reduce painful sensations, clinicians now target fear-cognitions in treatment. This was acknowledged by the Managing Director of Paediatric Pain at Stanford University [5.2] who said that “ the recognition and codification of Fear of Pain by Bath [has led] to policy changes in formally incorporating measurement into the standard clinical pathways of care of several paediatric pain clinics” including Los Angeles Children’s Hospital [5.2]. In turn, this has “ improved the lives and health of children in many clinical practices…and continues to inform clinicians regarding the use of…[opioids] in infants and children” [5.2].

Provided new models of healthcare management of childhood pain

Since August 2013 BCPR’s treatment approach for childhood pain [3.4] has led to the development of new services and changes in care models [5.2-5.3]. The Head of Service for Paediatric and Adolescent Chronic Pain at Evelina Hospital, London [5.3] said the BCPR have “ influenced the standards of care of many services, including mine. The assessment or outcome tools have also helped commissioners and colleagues across our networks understand the demands of assessment and management”. The “networks” refer to clinical services that the Head of Service set up including the service in London established in 2014 (population of 8,000,000), which received 200-300 referrals per annum. He used the Centre’s research “ as a reference for business cases and persuading management teams and commissioners of the rationale for our model of care” [5.3].

Changed how pain treatments are appraised leading to increased effectiveness of treatments

Since August 2013, BCPR assessment tools [3.2, 3.3] have continued to be used to help improve the lives of children in pain and their families in the UK, USA, Australia and New Zealand [5.2-5.4]. Clinical healthcare practitioners used them to assess the effectiveness of their treatment programmes for children’s pain management, leading to better treatment regimes and, as a result, improvements in children’s quality of life [5.2-5.3]. One of the best examples can be found in the adoption of BCPR measures within the electronic Persistent Pain Outcomes Collaboration (ePPOC) system. ePPOC aims to improve the quality of care and outcomes for people with chronic pain in Australia and New Zealand. Over 90 adult and paediatric pain management services currently participate in ePPOC. Since 2014 BCPR scales are one of the standard measurement tools used in all hospital-based paediatric pain centres. The Director of ePPOC [5.4] describes the Centre’s work as “ critical” to ePPOC, using the BAPQ and BAP-PIQ to “ produce information on the effectiveness of pain management interventions; develop an Australasian benchmarking system to improve pain management outcomes; [and] provide comparative data to pain management services using the benchmarks developed”. In 2020 the BCPR assessment tools [3.2, 3.3] have been independently verified as having “ utility to audit pain clinic activity and potentially a use in demonstrating beneficial outcomes to commissioners” [5.6, p. 7].

Influenced policy guidance on treating children’s pain

The BCPR research on treatment efficacy [3.5-3.6] has informed clinical guidance and policy. Nationally, this includes informing recommendations in the Royal College of Anaesthetists Faculty of Pain Medicine’s Core Standards for Pain Management Services in the UK (2015) [5.7, p. 117-118] and in the Scottish Government’s National Clinical Guidelines on the Management of Chronic Pain in Children and Young People (2018) [5.8, p. 16-17, 32, 67]. Internationally, the Director of Pain Medicine at the University of Washington’s School of Medicine [5.5] used the Centre’s research to inform guidance given to US agencies (Food and Drugs Administration), expert testimony to regulators, and contributed to practice guidelines. He said “ A central issue is to provide evidence for when opioids may be useful (or not) in treating recurrent or chronic pain in younger patients. Here again, the aforementioned Cochrane reviews have proven invaluable in these deliberations and the policies and guidelines that resulted”. In 2020 the WHO published global guidance recommendations on paediatric pain treatment [5.9, p. 32], which drew on BCPR research [3.6]. BCPR also acted as the evidence support team for this document.