The Centre for Active Lifestyle
Management (CALM)
Dr Stephanie Jarrett
Consultant Clinical Psychologist
Pain Management Unit
University Hospital Lewisham
Setting the scene
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Chronic pain - British Pain Society definition:
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“continuous, long-term pain of more than 12 weeks or after the
time that healing would have been thought to have occurred after
trauma or surgery”
Diagnoses:
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Osteoarthritis
Degenerative changes/disease
Spondylosis
‘Wear and Tear’
Complex Regional Pain Syndrome
Fibromyalgia
Chronic widespread pain
Setting the scene
People living with chronic pain: 7.8 million
Prescriptions for pain: £584 million
The cost to the NHS of chronic (long-term) back pain alone is
estimated to be £12.3bn per year
The management of chronic pain in primary care accounts for 4.6
million GP appointments, costing around £69 million per year
Patients with chronic pain experiencing depression: 49%
Setting the scene
Comprehensive, multi-disciplinary group programme is the most
efficacious and cost-effective treatment for patients with chronic
pain (Gatchel & Okufuji, 2006; Guzmán et al 2001)
Multidisciplinary group pain management programmes (PMPs) are
recommended for patients with chronic non-malignant pain by
The British Pain Society
European Guidelines
The International Association for the Study of Pain
Report by Dr Foster (2003) identified the patchy provision of PMPs
in the UK.
Lack of PMPs in South-East London
Northwick Park
National
Hillingdon
Ealing
INPUT
Chelsea
Wolfson
Kingston
COPE
Epsom
Lack of PMPs in South-East London
National
Northwick Park
Hillingdon
National
Ealing
Hillingdon
INPUT
Chelsea
INPUT
Ealing
Chelsea
KingstonWolfson
Kingston
Wolfson
20k diameter
COPE
COPE
Epsom
CALM
15k Diameter
Past:
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2001 – Recruitment of Clinical Psychologist to Chronic Pain Service,
University Hospital Lewisham
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2002 – Pilot Programme
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2004 – 1st Business plan put forward
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2009 – Obtained 12 month funding
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2010 – 6 month extension
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2011 – 12 month extension until March 2012
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2012 – Mainstream funding
Present:

The CALM team –
 Consultant Clinical Psychologist
 Clinical Physiotherapist Specialist
 Pain Nurse Specialist
 Psychology Assistant
 Administrator
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All 0.4 wte
The CALM Programme
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The CALM programme aims to help
patients:
 Develop
strategies to reduce the distress &
disability caused by pain
 Decrease
reliance on medical
professionals
 Improve
quality of life
Referral
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Referrers - secondary care pain related services
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Chronic Pain service
Rheumatology
Orthopaedics
Musculoskeletal assessment and triage (MSK) service
Physiotherapy
Referral process
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Check patient is registered with Lewisham GP
Check patient eligible for CALM programme:
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No ongoing litigation
No ongoing medical intervention (other than medication)
No ongoing investigations
No active psychosis
Discuss referral with patient
If patient in agreement – send referral letter to CALM team
Discharge patient to care of CALM team
Referral letter
received
Patient phones to
arrange individual
assessment
Patient phones to
arrange date for group
information meeting
Patient sent letter inviting
them to phone and arrange a
date to attend a group
information meeting about the
CALM programme
Programme
suitable offered place
Attends group information
meeting. Invited to contact
CALM team to arrange date
for individual assessment
DNA group
information
meeting
No contact from patient
within28 days
Seen individually by
psychologist,
physiotherapist &
nurse for assessment
DNA
assessment
No contact to arrange
assessment
appointment within 28
days
Discharged – inform
referrer and GP
Programme not
suitable –
referred to more
appropriate
service
Weekly group
sessions
for 10 weeks
6 months later –
Second follow-up
group session
Assessment –
offered place on
programme
6 weeks later –
First follow-up
group session
Open invitation to
yearly ‘booster’
session
Outcome Data – Quality of Life
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Distress
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Depression (Beck Depression Inventory II)
Catastrophising (Pain Catastrophising Scale)
Fear of movement (Tampa Scale of Kinesiophobia)
Disability
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Sit-to-stand (number per minute)
Pain interference (British Pain Inventory)
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96 patients reached 6 months follow-up
Complete data available for 90 patients
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Bonferroni’s correction for multiple analyses p<0.008
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Outcome Data – Quality of Life
N = 90 Patients who had
completed programme and
returned questionnaires
Statistically significant
improvement by end of 10
week programme
Statistically significant
improvement at 6 month follow-up
p ≤ .008
p ≤ .008
Depression (BDI II)
Yes
Yes
Catastrophising (PCS)
Yes
Yes
Fear of movement (TSK)
Yes
Yes
Sit-to-stand (No. per minute)
Yes
Yes
Pain interference (BPI)
Yes
Yes
Distress:
Disability:
Outcome Data – Health Care Use
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Computerised appointment system
 Secondary care pain-related appointments
 Physiotherapy appointment s
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Contacted GPs to get data on primary care painrelated appointments
Outcome Data – Health Care Use
Total number of appts
(N=55 patients who
finished programme >1
year ago)
12 months preprogramme
12 months postprogramme
% Reduction
Secondary Care Pain
Appointments
142
13
91%
Physiotherapy
Appointments
206
20
90%
NHS Lewisham Target
Primary Care PainRelated Appointments
(N=25)
80%
156
66
58%
Outcome Data – Health Care Costs
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Clinical coding department to get accurate costs
for:
 Secondary care pain-related outpatient
appointments
 Physiotherapy appointments
 Interventions (e.g. Epidural, trigger point
injection etc.)
Outcome Data – Health Care Costs
Cost of appointments
(N=55 patients who
completed the
programme >1 year
ago)
12 months preprogramme
12 months postprogramme
% Reduction
Secondary Care Pain
appointments
£21,115.46
£2,328.20
89%
Physiotherapy
appointments
£14,584.80
£1,122.60
92%
Secondary Care Pain
Related Interventions
£12,178.39
£2,989.27
75%
Happily Ever After?
Pilot phase ended and taken into mainstream
funding in April 2012
But...
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Trust Special Administrator’s draft report
“Securing Sustainable NHS Services” Consultation on the future of South London
Healthcare NHS Trust and the NHS in South
East London (November 2012)
Thank you

The CALM Team
 Sarah MacNeil – Clinical Physiotherapy Specialist
 Tamzin Bunton – Pain Nurse Specialist
 Ajay Clare – Psychology Assistant
 Reuben Richards – Administrator
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Lewisham support:
 Dr Tom Smith – Consultant in Pain Management
 Ashley O’Shaughnessy – Head of PBC and Services Redesign, NHS
Lewisham
 Lewisham Practice Based Commissioners
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Hilary Rankin, Consultant Clinical Psychologist and her team at COPE,
Sutton Hospital
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