Managing chronic pain in the non-specialist setting: a new SIGN guideline

Chronic pain, defined as pain lasting beyond normal tissue healing time (taken to be 3 months),1 is a syndrome that affects a large proportion of the primary care population. It is ‘significant’ in around 14% of UK adults, imposing a heavy burden on the physical and psychosocial health of sufferers, their families and society, at high cost to the healthcare services.2 It was estimated in 2002 that people with chronic pain account for 4.6 million GP appointments in the UK, at an annual cost to the NHS of £69 million, equivalent to the employment of 793 GPs.3 Although many clinical conditions can lead to chronic pain, there are common underlying neurobiological and psychosocial mechanisms, and the impact is generally independent of the clinical aetiology. Effective assessment and treatment of chronic pain therefore means that GPs should have: Unfortunately, none of these requirements is generally in place. Undergraduate training in management of pain is demonstrably minimal, accounting for