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    O'Riordan, Cliona Clifford, Amanda Van De Ven, Pepijn and Nelson, John 2014. Chronic Neck Pain and Exercise Interventions: Frequency, Intensity, Time, and Type Principle. Archives of Physical Medicine and Rehabilitation, Vol. 95, Issue. 4, p. 770.

    Choudhury, Yasmin Bremner, Stephen A. Ali, Anwara Eldridge, Sandra Griffiths, Chris J. Hussain, Iqbal Parsons, Suzanne Rahman, Anisur and Underwood, Martin 2013. Prevalence and impact of chronic widespread pain in the Bangladeshi and White populations of Tower Hamlets, East London. Clinical Rheumatology, Vol. 32, Issue. 9, p. 1375.

    Nielsen, Mandy Foster, Michele Henman, Paul and Strong, Jenny 2013. 'Talk to us like we're people, not an X-ray': the experience of receiving care for chronic pain. Australian Journal of Primary Health, Vol. 19, Issue. 2, p. 138.

    Carnes, Dawn Gallagher, Jayne Leak, Samantha and Underwood, Martin 2010. An evaluation of the implementation of a multidisciplinary persistent pain service in the inner London Borough of Tower Hamlets. Primary Health Care Research & Development, Vol. 11, Issue. 03, p. 233.

  • Primary Health Care Research & Development, Volume 9, Issue 4
  • October 2008, pp. 241-247

Mapping care pathways and estimating the number and cost of musculoskeletal chronic pain patients to inform the development and implementation of a new service

  • Dawn Carnes (a1), Jayne Gallagher (a2), Sally Herne (a3), Elaine Munday (a3), Sara Ritchie (a3) and Martin Underwood (a4)
  • DOI:
  • Published online: 01 October 2008

Patients living with chronic pain are typically resource intensive, their care requirements are long term and referral to secondary care is not always expeditious. To provide more appropriate, accessible and cost-effective care, Tower Hamlets Primary Care Trust reviewed the needs of the patients, their current care and the numbers requiring treatment for non-malignant chronic pain, initially starting with musculoskeletal pain.


We estimated the number of people with chronic pain being treated outside general practice by the NHS in Tower Hamlets. A working group established set criteria to define a chronic pain patient. We surveyed appropriate clinicians to determine the approximate number of patients who fitted our inclusion criteria, the approximate number of follow-up appointments they required and their care pathways. Secondly, we estimated the cost of care for chronic pain patients using NHS national tariff and reference cost data. We also took a convenience sample of chronic pain patients and recorded their history of care.


The routes and pathways of care are complex and multiple. We estimate between 4.0% and 5.5% of new patients in rheumatology, orthopaedics, occupational therapy and musculoskeletal physiotherapy and up to 90% in the pain clinic are people living with chronic pain. The cost of this care ranged from £296 for a course of physiotherapy to £1911 for a patient seen in physiotherapy, orthopaedic and the pain clinics.


There is no facility in current management information services that identifies people being treated for non-specific chronic pain; therefore, estimating both the numbers and costs for treating these people is difficult. National tariff and notional cost data provide estimates only, of an ‘average patient’; the real cost of these patients is unknown.

Corresponding author
Correspondence to: Dr Dawn Carnes, Barts and The London School of Medicine and Dentistry, Centre for Health Sciences, 2 Newark St, London E1 2AT, UK. Email:
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Primary Health Care Research & Development
  • ISSN: 1463-4236
  • EISSN: 1477-1128
  • URL: /core/journals/primary-health-care-research-and-development
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