Decision Report 201902748

Summary

C suffers from severe joint and musculoskeletal (relating to the muscles and skeleton) pain throughout their body. C complained that the board did not reasonably test C to establish the appropriate level of pain treatment they required. C wanted medication for pain to be administered by an intrathecal pump (a medical device used to deliver very small quantities of medications to the spinal fluid) and by trigger-point injections (a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax). The board did not consider this to be appropriate.

We considered that the board was aware of the level of pain experienced by C and that the pain management had been reasonable. We found that an intrathecal pump is usually used to target pain in a specific area for cancer patients or in palliative care, rather than where pain is benign (not directly linked to another medical condition) and widespread. We found that an implant can cause infection and that this increases over time and therefore the risk of use is lower for those in receipt of palliative care. We also found that if pain is not responsive to opioids (a type of pain relief) then delivery of opioids by this method is not likely to be effective. We also found that trigger point injections offer short-term relief and their effectiveness reduces when repeated. We therefore agreed with the board that these treatments were not appropriate for C. We did not uphold this complaint.