More about the Integrated Pain Management HIT


The Integrated Pain Management Health Integration Team (IPM HIT) is a team of clinicians, researchers, commissioners and patients, working together to provide a fully integrated, multidisciplinary, lifespan clinical service for chronic pain.

In 2009 the Chief Medical Officer for England reported that "each year over 5 million people in the United Kingdom develop chronic pain, but only two‐thirds will recover. Much more needs to be done to improve outcomes for patients."

An estimated 11 per cent of adults and 8 per cent of children report moderate to severe pain that has lasted more than 6 months, representing 7.8m people in the UK. Older age, being female, poor housing and type of employment are significant predictors of chronic pain in the community. With an ageing population, increasing levels of obesity and decreasing levels of physical activity, the need for a consistent and integrated regional pain management approach has never been greater.

Over 25% of people with chronic pain lose their jobs within five years of diagnosis

Chronic pain is often associated with depression, anxiety, other mental health conditions, sleep disturbance and interference with normal physical and social functioning. It is therefore hugely detrimental to individuals' health‐related quality of life, and places an enormous emotional and financial burden on patients, carers and society.

Over 25 per cent of people with chronic pain lose their jobs within five years of diagnosis. The financial costs of childhood pain are huge, estimated in 2005 to be in excess of £3.8billion per year, including loss of education, parent's ability to work and social care costs. Current drug treatments for chronic pain and especially neuropathic pain are largely inadequate and there is a huge unmet clinical need for more effective treatments.

Chronic pain is usually accompanied by substantial co‐morbidities, such as diabetes, arthritis and heart disease, mental health issues and atypical developmental histories which make the clinical management of the patients' needs more difficult, especially when complex social circumstances are also present.

The National Pain Audit 2012 demonstrates a paucity of local pain management centres (PMCs) that meet basic standards in certain parts of the country with a wide variability in the level and types of care provided. Of those replying to the question on healthcare utilisation, 4,825 (20 per cent) of respondents reported visiting A&E in the past six months in search of help, all of whom had seen their GP. Over 3,000 respondents (66 per cent) had made more than three visits to healthcare providers. Encouragingly however, 56.5 per cent of clinics showed their patients to have a mean improvement in quality of life after six months. For disease‐specific change, 70.6 per cent of the clinics reported an overall reduction in pain severity.

The current national and local commissioning processes aims to correct these inequalities of care through a network of regional PMCs supporting and working with secondary care pain management centres to support primary and community care pain services. Regional PMCs consist of key professionals (clinical and academic) who have a remit to lead and deliver the highest standard of patient care, research, audit output, teaching, and training in the area of complex pain and pain‐associated disability, within a dedicated environment.

The IPM HIT is working closely with the relevant CCGs and NHS England to deliver these service objectives across Bristol and Bath and will particularly focus on a lifespan approach to ensure that people of all ages receive optimum care for chronic pain. Close links to our collaborating clinical partners will help shared learning and dissemination of good practice.

Aims and objectives

The IPM HIT will provide a fully integrated, multidisciplinary, lifespan clinical service for chronic pain that brings together senior clinicians, researchers and local and national health commissioners with service users across Bristol and Bath. The tertiary nationally-commissioned specialist service will be delivered within a "hub and spoke" organisational structure, under the umbrella of the SW Clinical Pain Consortium.

We will focus on improvements in performance, productivity and efficiency by ensuring that our multidisciplinary research programmes and international expertise in the management of chronic pain are integrated into the clinical service.

Who's involved

The leading experts in chronic pain management in Bristol and Bath are involved in the team. The HIT directors are:

  • Secondary care lead: Peter Brook, Consultant, Clinical Lead, University Hospitals Bristol NHS Foundation Trust (UHBristol) and Royal National Hospital for Rheumatic Diseases (RNHRD)
  • Secondary care lead: Janine Mendham, Consultant, Clinical Lead, North Bristol NHS Trust (NBT)
  • Tertiary care lead: Jacqui Clinch, Consultant, UHBristol and RNHRD, National Clinical Reference Group for Pain, SW Senate for Highly Specialised Pain Services
  • Tertiary care lead: Hannah Connell, Consultant Clinical Psychologist, Clinical Lead, RNHRD
  • Christopher Eccleston, Professor of Pain Research, University of Bath
  • Candy McCabe, Florence Nightingale Foundation Clinical Professor in Nursing, Clinical Lead for the CRPS and Complex Cancer Late Effects Services
  • Tony Pickering, Wellcome Senior Clinical Research Fellow, University of Bristol, Consultant, UHBristol
  • David Wynick, Professor of Molecular Medicine, University of Bristol and UHBristol

For a full list of HIT members and collaborators, visit the who's involved page.

How patients and the public are involved

In Bath and North Bristol, research is already designed with patients through a patient panel (PARTICIPATE, Bath) and the Patient Experience Partnership in Research (PEP‐R, Bristol). Our strong links with the Elizabeth Blackwell Institute and People and Research West of England will ensure meaningful patient and public involvement (PPI) in the HIT. Patients and members of the public to be involved in the work of the HIT will include patients with experience of services for pain and the key person in their lives who may or may not be described as a 'carer'.

Members of our HIT team have considerable experience in facilitating successful PPI activities and conducting research on PPI. The HIT will work in partnership with patients through existing involvement groups, new workshops and consensus sessions, and will have two patient representatives on the HIT steering group. Patients and members of the public involved in the HIT will be supported by a dedicated PPI co‐ordinator.

Patient and public involvement will focus on the following aspects of the HIT, but further activities and areas for involvement will be identified in partnership with patients:

  • Development and refinement of new pathways
  • Identification of acceptable interventions from available research evidence
  • Co‐working to optimise adherence
  • Establishing appropriate ways to evaluate new services
  • Prioritisation of areas for further research
  • Co‐working to identify avenues for communication
  • Development of communication resources
  • Identification of innovative methods for conducting sound PPI
  • Evaluating the impact of research on clinical and academic practice

Projects and activities

We will focus our combined clinical, research and leadership skills on reducing pain‐associated disability across the lifespan: from children to older adults. The HIT will have three major themes:

  • Improvements in performance, productivity and efficiency. This will come from economy of scale, and simplified and agreed pathways for the majority of the causes of chronic pain. This will result in service users (people with pain, families and organisations) being given evidence based interventions, at the correct time, by practitioners with appropriate expertise.
  • Ensure that our multidisciplinary research programmes and international expertise in the management of chronic pain are rapidly and appropriately integrated into the clinical service, leading to a reduction in health and social costs. This will lead to the generation of novel evidence based interventions that will inform future changes in clinical practice.
  • An interdisciplinary rotational training and education programme will be setup across all of our centres to improve the uniformity of clinical services and to train the next generation of outstanding clinicians who will deliver our pain services.

Find out more detail on the projects and activities page.


To find out more, please contact:

Integrated Pain Management at the HIT conference

The IPM HIT presented this poster (PDF) at the 2018 Bristol Health Partners Health Integration Team conference.

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