Ian A McMillan reports for Physio Update
A professional network recognised by the Chartered Society of Physiotherapy (CSP) has voiced concerns over a document released by the Faculty of Pain Medicine (FPM) in June.
In a letter sent to the faculty at the end of last month, Diarmuid Denneny, who chairs the Physiotherapy Pain Association (PPA), raises questions about ‘misleading’ claims in a faculty document titled ‘The role of the specialist in pain medicine’.
The nub of the issue appears in a prominent statement at the beginning of the document. This set outs what differentiates medical pain specialists from others in the field.
It claims that pain specialists are ‘the only healthcare workers with specialist knowledge, skills and training as defined by the FPM across all pain management issues from acute in hospital pain through to chronic pain in primary or secondary care settings’.
Claims of 'uniqueness' challenged
A later section states that FPM-endorsed training ‘uniquely equips’ doctors with the ‘knowledge and skills to evaluate, diagnose and manage all types of pain’. Based in London, the FPM is part of the Royal College of Anaesthetists.
Mr Denneny’s letter notes: ‘Unfortunately, the implicit message suggests there are roles that only pain medicine consultants can perform that other HCPs [healthcare professionals] who work with people with pain are not capable of.’
Mr Denneny refers to a CSP and PPA framework that highlights what pain specialist physiotherapists offer, such as:
- the application of behavioural science to physiotherapy practice including psychological, social and cultural factors and their influence on health, health status and response to health interventions
- knowledge of the neurophysiology of pain, including peripheral and central nervous system mechanisms
- biopsychosocial assessment methods
- diagnostic skills including differential diagnosis and awareness of ‘red flags’
- knowledge of and referral for appropriate diagnostic tests including imaging.
‘We therefore suggest that other professional groups also have [training] pathways and this [FPM] statement is misleading,’ the letter notes. Following the introduction of independent non-medical prescribing for groups such as nurse specialists and physiotherapists, other professionals can now do to similar work, within their professional scope and competencies, Mr Denneny notes. As a result, the FPM statement is ‘not accurate’.
Elsewhere, the letter says that as diagnosticians and movement specialists, physiotherapists are uniquely placed to assist patients with pain. It also criticises the FPM document for suggesting that only doctors can lead pain services in the UK. ‘Letting this stand as a recommendation will leave existing services open to leadership challenges and effectively removes the possibility of other HCPs ever leading tier 2 pain services.’
The PPA’s letter acknowledges that some physiotherapists currently lack skills in biopsychosocial management, but says it is actively attempting to remedy this through training and supervision.
‘Additionally, we are working with HEI [higher education institutions] partners to develop an accredited training programme for advanced practice physiotherapists working with people with pain.’
Mr Denneny ends his letter by asking the FPM to ensure future publications refer to other health professionals and that it consults with their professional bodies.
‘We would be happy to discuss our concerns further if helpful and to consider ways to address them. Please let me know if this is something you would be willing to engage in.’
The FPM response (added at 7pm on 7 August)
John Hughes, the dean of FPM, responded to the PPA on 7 July, stating: 'We appreciate the considered response and comments you have provided. We are aware that the publication of this document has caused concern among our multidisciplinary colleagues, and we would like to reassure you that this was not our intention. We as a Faculty are firmly engaged and supportive of the multidisciplinary nature of pain management and the important role all members play. Indeed, pain management requires input from all multidisciplinary members if patients are to gain the best outcomes.
'We sincerely value your input and can assure you that we will be reviewing the document in light of the feedback we have received.
Dr Hughes added: 'As part of the review process, we would like to take up your offer to engage further with the PPA on addressing concerns. The FPM secretariat will be in touch at an appropriate stage to facilitate this engagement.'
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