Background & Aims

There are known links between psychological factors and pain experience but this is rarely recognised in inpatient populations.1
Pain specialist nurses receive patient pain referrals. During systematic triaging of referrals, they thoroughly review the patient’s records and perform assessment using a biopsychosocial approach. Knowledge of acute and chronic pain conditions is essential for a valuable patient interaction and in-depth understanding of the links between psychological factors in pain presentations contributes to skilled pain management plans. Often there is unidentified mental health disorder which is disclosed during assessment of the patient.
Our aims were to identify the challenges inpatient pain services face when receiving inpatient referrals, identify the prevalence of psychological factors in-patients with challenging co-morbidities referred to the inpatient pain services and examine the link between psychological factors contributing to pain referrals.

Methods

The pain specialist nurses examined the inpatient referrals from two London hospitals; The Royal London Hospital, a major trauma centre (MTC) and St Bartholemew’s Hospital, an elective specialist hospital.
The data collection took place over three months between 2022 and 2023.

Results

In the three-month period of data collection, the MTC had 174 new referrals to the pain team; the elective hospital collected 84 patients. In addition to acute/post-op pain management referrals which are generally expected of inpatient pain services, both sites received referrals for acute-on-chronic pain management and chronic pain management, requiring the specialist advice from the inpatient pain team.
Mental health disorders and substance abuse were found to be present in approximately 40% of the referrals received. We suggest that these factors prompt many referrals to our inpatient pain services, reflecting the complexity of patients seen.

Conclusions

Identification of co-morbidities is essential in highlighting and appropriately addressing patient care, however this is only possible with relevant clinical knowledge and experience gained from education and clinical experience. More education on mental health disorders and identification of these is essential as part of specialist pain management.
Our results support the FPM Core Standards statement that all pain specialist nurses must have exposure and experience in chronic pain management. Furthermore, pain specialist nurses must have exposure in the management of complex medical histories including concurrent mental health, substance misuse, and other long-term conditions. Failure to equip inpatient pain services with this knowledge could contribute to poor pain management approaches, prolonged hospital admissions, poor healthcare outcomes and poor patient engagement.

References

1.King’s Fund (2016) Bringing together physical and mental health A new frontier for integrated care. Available at: https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/Bringing-together-Kings-Fund-March-2016_1.pdf (Accessed 14th December 2023)
2.King’s Fund (2012) Long -term conditions and mental health: The cost of co-morbidities. Available at: https://www.kingsfund.org.uk/publications/long-term-conditions-and-mental-health (Accessed 14th December 2023)
3.Faculty of Pain Medicine (2021) Core Standards for Pain Management Services in the UK. Available at: https://fpm.ac.uk/sites/fpm/files/documents/2022-01/FPM-Core-Standards-Dec-2021_0.pdf (Accessed 14th December 2023)

Presenting Author

Harriet Scott

Poster Authors

Harriet Scott

MBBS BSc MRCP FRCA FFPMRCA

Barts Health

Lead Author

E-mail

Topics

  • Epidemiology