Scandinavian Journal of Pain
Volume 1, Issue 1 , Pages 60-63, January 2010

National guidelines for evaluating pain—Patients’ legal right to prioritised health care at multidisciplinary pain clinics in Norway implemented 2009

  • Karen Walseth Hara

      Affiliations

    • Corresponding Author InformationCorresponding author at: Department of Pain and Complex Disorders, St Olav's Hospital, Olav Kyrres Gate 17, 7006 Trondheim, Norway. Tel.: +47 73868766; fax: +47 73866990.
    • ,
  • Petter Borchgrevink

Department of Pain and Complex Disorders, St Olav's Hospital and the University of Trondheim, Norway

Abstract 

Background

All nations are posed with the challenge of deciding how to allocate limited health care resources. A Patients’ Rights Law from 1999 gives patients in Norway with a serious health condition, for which there is efficacious and cost-effective treatment, a legal right to receive health care from the National Health Care system.

Methods

Recently national guidelines have been produced for implementing these legal rights within 32 fields of specialist health care. One of these fields deals with serious chronic pain conditions. A task force established by the Directorate of Health, comprising pain specialists, primary care and patient representatives, have produced guidelines for pain conditions. The newly published guidelines seek to answer the difficult questions of which patients should be prioritised at pain clinics and what is a medically acceptable waiting time.

Results

The guidelines deal with non-acute pain conditions that are too complex for primary care and organ- or disease-specific fields of specialist care. The guidelines state that if health-related quality of life is severely affected by the pain condition and efficacious and cost-effective treatment is available, then patients have a legal right to receive prioritised specialist health care in multidisciplinary pain clinics. The guidelines describe 5 categories of complex pain disorders that as a main rule should be given the right to prioritised health care in pain clinics. The 5 categories are

Category 1: Sub-acute (≤6 months) pain conditions with reason to fear chronification. Maximum waiting time 2 weeks, e.g., progressing complex regional pain syndrome (CRPS) 5 months after an ankle-fracture.

Category 2: Chronic complex pain condition, with or without known initiating cause, combined with substance abuse and/or psychiatric illness. These patients need concomitant follow-up by psychiatric and/or addiction medicine department(s) and a multidisciplinary pain clinic approach. Maximum waiting time 16 weeks, e.g., CRPS of an arm combined with depression and addiction to heroin.

Category 3: Chronic complex pain condition WITH known initiating cause (that can no longer be treated with a curative approach). Maximum waiting time 16 weeks, e.g., Post-herpetic neuralgia.

Category 4: Chronic complex pain condition WITHOUT known initiating cause. Maximum waiting time 16 weeks, e.g., chronic muscle pain syndrome.

Category 5: Severe and difficult to treat pain condition in patients suffering from a known serious and advanced illness. Maximum waiting time 2 weeks, e.g., advanced cancer, COLD, heart failure, end stage multiple sclerosis.

The maximum medically accepted waiting time is set at either 2 or 16 weeks depending on the condition. The full version of the guidelines describes pain categories in detail and gives information on cases that do not qualify to be prioritised for care in a pain clinic.

Conclusions

Norwegian national guidelines for prioritising among pain conditions are in the process of being implemented. Epidemiologic data and expert opinion suggest that in order to meet the chronic pain patient's legal claim to prioritised specialist health care, the national health care system in Norway will have to establish new pain clinics and increase capacity at existing pain clinics.

Keywords: Priority setting, Health care, Pain conditions, Pain clinic

 

PII: S1877-8860(09)00015-9

doi:10.1016/j.sjpain.2009.10.002

Refers to article:

  • Norwegian patients with chronic pain conditions that can be managed with reasonable cost/benefit now have a legally binding right to treatment in Norway

    Harald Breivik
    Scandinavian Journal of Pain January 2010 (Vol. 1, Issue 1, Page 11)

Scandinavian Journal of Pain
Volume 1, Issue 1 , Pages 60-63, January 2010

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