How much osteoarthritis pain is enough?

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Pain tests used to ration joint replacement surgery

Anybody who has osteoarthritis will know that it is very painful. Mobility, muscle strength and balance can be quickly lost, as sufferers seek to minimise movement in order to try and keep the pain in check.

But how much suffering is enough for you to qualify for hip or knee surgery?

NICE says treatment should be given to prevent pain interfering with everyday life

NICE (National Institute For Health and Clinical Excellence) has given guidance that people shouldn’t have to live with a degree of pain that interferes with everyday life.

Nevertheless, CCGs (Clinical Commissioning Groups made up of local groups of GP practices) in many areas are using “pain tests” which grade people’s suffering, in order to decide whether they should be offered surgery.

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One in ten groups will only offer hip or knee replacement when the pain has reached “severe”.

The Oxford Hip Score and Oxford Knee Score, or the alternative New Zealand system are being used to ration surgery.

Research published recently in the Health Service Journal found that 24 out of 209 CCGs are using pain score criteria as a restrictive gateway to surgery.

Sixteen of the nineteen CCGs which have adopted the Oxford Hip and Knee Scores, will only refer patients the treatment once they reach a pain score of “severe”. In the East of England, five groups are using the “New Zealand” pain scoring system. NICE does not support the use of either system.

Pain used as a means of rationing treatment more widely

It isn’t just those CCGs which are using the Oxford or New Zealand scoring systems that base decisions about surgery on pain levels. A total of 84 CCGs insist that people demonstrate that they are experiencing “severe” or “moderate to severe” pain before they are allowed access to joint replacement surgery.

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Shortsighted cost-saving measure

While CCGs look at the money to be saved in the short term, by restricting the number of patients who can have surgery, they aren’t really making savings.

Osteoarthritis doesn’t go away, it gets worse. This means that, further down the line, the CCG has to fund an operation that may well be more complicated and expensive, because the joint is even more damaged.

Equally, the patient is becoming more immobile, and may well need social care support to carry on with daily living.

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Tracey Loftis, Head of Policy and Public Affairs at Arthritis Research UK comments:

“Nobody should need to wait until they are in severe discomfort with their hip or knee pain before being referred for treatment. Clinical commissioning groups must not use pain scoring tools as a basis of identifying people eligible for joint replacement.

There are 8.75 million people in the UK who live with the daily pain caused by osteoarthritis, which can affect their ability to carry out everyday activities such as climbing the stairs, walking and sleeping.

Joint replacement surgeries are highly successful and can be life changing, reducing pain and giving people back their independence. We believe that the ability to live pain free is someone’s right, and receiving the appropriate treatment should be based on clinical need, individually assessed by a surgeon.”

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Further resources

What do you think? With limited NHS resources, how should doctors decide about treating conditions such as osteoarthritis? You can add comments below the article.

You can read top tips on avoiding or managing osteoarthritis here

Some suggestions for remaining active in older years, here

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