NHS services for management of chronic pain are inadequate to the needs of many patients, according to a report following the first UK ‘pain summit’.

The report, produced by a coalition of medical experts, identifies lack of clear guidelines, delayed referrals, long waiting times and suboptimal medication as problems affecting pain management services.

It recommends that the planned NICE quality standard on pain management include nationally agreed commissioning guidelines and a data strategy.

According to Beverly Collett, chair of the coalition, “chronic pain is not being taken seriously” though it impacts powerfully on general health.

Collett also argued that the conventional “analgesia staircase” was developed primarily for cancer patients and is less effective in patients with other types of chronic pain, who would benefit from a wider range of drug and non-drug therapies.

The report was produced by the Royal College of General Practitioners and the Faculty of Pain Medicine of the Royal College of Anaesthetists, together with the British Pain Society (a professional organisation) and the Chronic Pain Policy Coalition (an industry-sponsored group).

Chronic pain (persisting for more than three months) affects one in eight people in the UK, and has many causes.

According to the report, patients who would benefit from early intervention are often not referred to a specialist or face long waits for treatment, with reliance on suboptimal medication being the norm.

The report calls for:

• Clear national standards for the identification, assessment and initial management of chronic pain, forming the basis of the NICE quality standard.

• Nationally agreed commissioning guidelines to reduce service variation.

• A data strategy to collect and share information about the extent, severity and medical impact of chronic pain.

• Better education of medical students, clinicians and the public in pain management.

Industry association Eucomed has proposed a new unified regulatory framework for medical devices across Europe.

The association’s position paper outlines six steps that will ensure patients have rapid access to innovative medical technologies that are value-based and safe.

Consistency, transparency and an integrated approach are the key themes identified by Eucomed as being in the shared interest of industry, healthcare providers and patients.

Eucomed’s position paper ‘A new EU regulatory framework for medical devices’ calls for enhanced member state engagement together with unified and science-based co-ordination of the regulatory system.

While prioritising delivery of high-quality healthcare, patient safety and rapid access to value-based medical technologies, the proposals also aim to encourage R&D and reduce the administrative burden on SMEs.

The association calls for a legal framework to provide a unified regulatory approach to the evaluation and certification of medical devices, with consistent and comprehensive implementation across all EU member states.

Existing bodies such as the European Commission, Competent Authorities and Notified Bodies can be used efficiently to provide a ‘smarter’ legal framework for medical devices, Eucomed says.

The six steps outlined are:

1. Only the best Notified Bodies – better control and monitoring of NBs are needed, including mandatory requirements for designation.

2. A single approach to vigilance and market surveillance – with a centralised reporting and surveillance system based on an EU portal.

3. Stronger harmonised standards – with greater engagement of international experts and earlier involvement of member states.

4. Consistent implementation of guidelines – to make medical device guidance more efficient and consistent across the EU, the current procedure must be revised (e.g. by commitment of member states to uniform implementation) and the European Commission’s current Medical Devices Expert Group (MDEG), which develops guidance, must be upgraded to a formal Advisory Committee.

5. Improved transparency – for better access to information for patients, consumers, healthcare professionals and manufacturers as well as regulatory and legislative bodies, it is critically important to establish a single EU database with information relating to such areas as market surveillance, vigilance and what products are available.

6. An integrated approach – better co-ordination and management, which could be supported by the Commission’s DG SANCO and Joint Research Centre (JRC). The JRC could play a crucial role in such areas as auditing Notified Bodies, co-ordinating vigilance, providing foresight intelligence on health issues, and giving scientific and policy advice to legislators.

John Brennan, Eucomed’s Director of Regulatory and Technical Affairs, commented: “By improving the regulatory framework for medical devices through the six solutions outlined in our position paper, we believe Europe will become stronger in many areas. We suggest many improvements that aid better management of the system by authorities and the Commission.

“In achieving this we think that the JRC is the natural partner for DG SANCO, member states and industry to shape and drive a smart EU medical technology legislative framework, as it is independent and experienced in the broad range of technologies that reflect the medical device industry.”

For the first time in a century, new guidelines outlining how to diagnose and treat blood pressure has been issued by NICE.

The document, developed in corporation with the British Hypertension Society (BHS), features the major recommendation that blood pressure should be monitored over the course of 24 hours using ambulatory methods, which confirms draft guidelines published in February.

Professor Bryan Williams, from the University of Leicester, chaired the guidelines and estimates that up to 25% of people diagnosed with high blood pressure using the current method of attending routine check-ups with a GP, may not be hypertensive and may not require treatment.

Professor Williams commented: “This new guideline is going to change the way blood pressure is diagnosed and treated for millions of people in the UK and around the world.

“It means that we will be more accurate in treating those who need treatment and in avoiding treating those who don't”.

The new devices cost a heft £1,000-£2,000, but the guidelines note that “by improving the speed and accuracy of diagnosis, we will actually save money by only targeting treatment at those who need and will benefit from treatment”, stated Professor Williams.

“I am under no illusions about the challenges to implement this but I believe this guideline will be well received by both doctors and patients not just in England and Wales, but worldwide”.

As well as claiming that the new approach is highly cost-effective, the guidelines also simplify the treatment strategy for high blood pressure, giving focus to the most effective treatments. The document also contains specific advice on the treatment of blood pressure in young adults and the very elderly.

The official guidelines can be read here.