Management of chronic pain through pain management programmes.

INTRODUCTION: Chronic pain carries significant impact and is difficult to treat with limited success. Pain management programmes (PMPs) use cognitive behavioural therapy (CBT)-based multidisciplinary rehabilitative approaches to drive functional improvement. SOURCES OF DATA: A search was conducted using Medline and the Cochrane Library to identify published literature about PMPs or CBT to treat chronic pain. AREAS OF AGREEMENT: PMPs have significant benefit on functioning for some patients but relatively little impact on the pain. Not all patients, nor pain types, benefit. Around a third of patients show improvement, with considerable variability. AREAS OF CONTROVERSY: There is much heterogeneity between approaches and outcomes measured, and the extent and duration of benefit is inconsistently reported. The investment required of patients, staff and commissioners is significant. Existing data provides limited information to judge whether PMPs represent good value for each of those stakeholders. GROWING POINTS: The British Pain Society provide guidelines for PMPs, due for revision in 2018 which may provide opportunities for greater clarity and demonstrating value. Other approaches are emerging and being evaluated. AREAS TIMELY FOR DEVELOPING RESEARCH: Participation may have more subjective impact than objective outcomes and merits qualitative research. With a (significant) minority of patients showing improvement, research into patient and treatment selection is essential alongside longterm outcomes and sustaining benefits.