Faculty expresses concerns about the misuse of pain scoring systems for hip and knee surgery commissioning

Published: 12/04/2017

The Faculty of Pain Medicine read with interest the recent HSJ article on the use of pain scores to restrict access to hip and knee surgery.  We are concerned by any misuse of clinical scoring systems for the apparent purposes of rationing services, especially where the impression is being given to the public that it is for purely clinical reasons.  It is important for our health service to not ignore the larger economic impact of prolonged disability, which falls on the employer, the individual and society.  The Faculty has commented before about the risk of making decisions based purely on financial savings.

Important medical decisions of this kind need to focus on the overall impact on quality of life for patients rather than an arbitrary pain score, with consideration given to the risks and benefits of surgery for that patient going forward.  Pain is multidimensional and should be measured appropriately with reference to the individual patient.  Care must be taken to use a validated tool only for their proven function, helping to guide discussions and not attempt to use them out of context as a replacement in decision making pathways.