This lecture was given by Dr David Craig, Consultant Clinical Psychologist with NHS Greater Glasgow & Clyde, to the North British Pain Association Spring Scientific Meeting in Edinburgh on Friday 18th May, 2007. Dr Craig is introduced by Dr Colin Rae. The lecture forms part of a conference "Blurring the Boundaries - Managing Pain in Primary Care and Secondary Care".

1. Addressing Psychosocial issues in Primary Care Dr. David Craig Dept of Anaesthetics Southern General Hospital 1345 Govan Rd. Glasgow G51 4TF [email_address]

2. “ In planning the future of the NHS in Scotland we need to… view the NHS as a service delivered predominantly in local communities rather than in hospitals” Kerr Report, 2005

3. “… graduates of the MSc in Psychological Therapies in Primary Care are equipped with the relevant competencies to assess and manage less complex chronic pain in primary care.” “ I accept your point that the MSc on it’s own may be insufficient to manage chronic pain and knowledge of the condition is important” Andy Kerr, personal communication 2006

4. What are some of the concerns? What is happening right now? What are the benefits? How might existing psychology help? Can we do this without sounding paranoid?!

5. Concerns CP presentations are diverse Self-management needs careful balance Most long term CP is in primary care Mental Health a big issue MSc currently only working with mild/moderate MSc not always working as part of teams Uni-professional working in CP? CP inherently complex Awareness of new developments in pain? Access to medical knowledge?

6. Concerns (2) 1/3 experience severe pain 1/5 diagnosed with depression Depression different in chronic pain

7. What is happening right now? Recent survey of 33 clinical psychologists 70% see chronic pain patients (5-10% caseload) Few offer specialist service Most 50% confident in treating or less 70% felt training was inadequate Many saw distraction/visualisation as important This with 3 years of training! Quality issue needs addressing in PC?

8. What are the Benefits? Early intervention is effective (Linton et.al. 2001, Craig et.al. 2007) Self-management as the norm Better follow up of patients Pain management closer to home Training opportunities for other staff

9. Enhanced Back Class outcome

10. How might existing psychology help? Expertise exists in the pain clinics Present GGBPS psychology service Outreach clinics Input to CMHT on consultancy basis Input to MSc courses We must evaluate the outcomes of PC psychosocial interventions to monitor quality

11. Addressing Psychosocial issues in Primary Care Dr. David Craig Dept of Anaesthetics Southern General Hospital 1345 Govan Rd. Glasgow G51 4TF [email_address]