Delivery of the Comprehensive Multi-Disciplinary Combined Physical and Psychological Programme of the National Low Back and Radicular Pain Pathway in England and Wales: where do we stand?
DOI:
https://doi.org/10.59210/wmrkmd45Keywords:
Low Back Pain, Chronic Pain, Pain ManagementAbstract
Objectives This survey study aimed to map the current provision of the Comprehensive Multi-Disciplinary Combined Physical and Psychological Programme of the National Low Back and Radicular Pain Pathway in England and Wales.
Design Online Survey.
Setting England and Wales.
Participants In total there were 66 respondents; 18 Trusts provided a full data set for their programmes - one delivered in Wales and 17 in England.
Results All programmes met the core criteria for CPPP laid out in the Pathway but there was great variation in many key areas of content, outcome data collected, structure and delivery mode and staffing.
Discussion The variation seen reflects a non-standard quality and nature of care across England and Wales. This likely reflects the absence of detail to inform NHS Commissioning in the corresponding NICE Guidelines, which in turn arises from the paucity of robust, pragmatic, evidence of efficacy and effectiveness of different models of CPPP.
Conclusions Robust, pragmatic, evaluation of CPPP service provision is required to inform NHS Commissioning and bring best care to all. A standard ‘data dictionary’ of outcomes would facilitate cross-site comparison and enable ongoing monitoring of provision across sites.
References
1. Murray CJL, Aravkin AY, Zheng P, et al. UK health performance: findings of the global burden of disease study 2010. Lancet. 2013;381(9874):997-1020.
2. Office for National Statistics (ONS). Rising ill-health and economic inactivity because of long-term sickness, UK: 2019 to 2023. ONS website. Released 26 July 2023. Accessed 21 May 2025. Available from: https://www.ons.gov.uk
3. Hong JY, Kim L, Lee S, et al. Costs associated with treatment of chronic low back pain: An analysis of the UK General Practice Research Database. Spine. 2013 Jan 1;38(1):75-82. doi: 10.1097/BRS.0b013e318276450f.
4. Zemedikun DT, Green S, O'Neill J, et al. Healthcare resource utilisation and economic burden attributable to back pain in primary care: A matched case-control study in the United Kingdom. Br J Pain. 2024;18(2):137-47. doi:10.1177/20494637231208364.
5. Waddell G. The back pain revolution. 2nd ed. Edinburgh: Churchill Livingstone; 2004.
6. Macfarlane GJ et al. Predictors of early improvement in low back pain amongst consulters to general practice: the influence of pre-morbid and episode-related factors. Pain. 1999;80:113–9. doi: 10.1016/s0304-3959(98)00209-7.
7. NHS England Trauma Programme of Care. National low back and radicular pain pathway 2017. Available from: https://www.versusarthritis.org/media/3077/national-low-back-and-radicular-pain-pathway-2017.pdf Accessed 25 May 2023.
8. National Institute for Health and Care Excellence (NICE). Low back pain and sciatica in over 16s: assessment and management [NICE guideline NG59]. Available from: www.nice.org.uk/guidance/ng59
9. Kamper SJ, Apeldoorn AT, Chiarotto A, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ. 2015 Feb 18;350:h444. doi: 10.1136/bmj.h444.
10. Rabiei R, Sheikhi B, Letafatkar A. Comparing pain neuroscience education followed by motor control exercises with group-based exercises for chronic low back pain: A randomized controlled trial. Pain Pract. 2021;21(3):333-342.
11. Pardo G.B., Girbés E.L., Roussel N.A., et al. Pain neurophysiology education and therapeutic exercise for patients with chronic low back pain: a single-blind randomized controlled trial. Arch Phys Med Rehabil. 2018;99(2):338-347.
12. Ibrahim AA, Akindele MO, Ganiyu SO. Effectiveness of patient education plus motor control exercise versus patient education alone versus motor control exercise alone for rural community-dwelling adults with chronic low back pain: a randomised clinical trial. BMC Musculoskelet Disord. 2023 Feb 23;24(1):142. doi: 10.1186/s12891-022-06108-9.
13. Polaski AM, Phelps AL, Smith TJ, et al. Integrated meditation and exercise therapy: a randomized controlled pilot of a combined nonpharmacological intervention focused on reducing disability and pain in patients with chronic low back pain. Pain Med. 2021;22(2):444-458.
14. Wellburn S, Ryan C.G., Coxon A, et al. Long-term improvements following a residential combined physical and psychological programme for chronic low back pain. BMJ Open Qual. 2021;10(2):e001068. doi: 10.1136/bmjoq-2020-001068.
15. National Institute for Health and Care Excellence (NICE). Low back pain: The early management of persistent non-specific low back pain [NICE clinical guideline 88]. Available from: guidance.nice.org.uk/cg88. Accessed 15 Jan 2025.
16. van Hooff ML, van der Merwe JD, O’Dowd J, et al. Daily functioning and self-management in patients with chronic low back pain after an intensive cognitive behavioral programme for pain management. Eur Spine J. 2010;19(9):1517-1526.
17. van Hooff ML, Ter Avest W, Horsting PP, et al. A short, intensive cognitive behavioral pain management program reduces health-care use in patients with chronic low back pain: two-year follow-up results of a prospective cohort. Eur Spine J. 2012;21(7):1257-1264.
18. British Pain Society. Guidelines for Pain Management Programmes for Adults. London: British Pain Society; 2023.
19. Gorji SM, Mohammadi Nia Samakosh H, Watt P, et al. Pain neuroscience education and motor control exercises versus core stability exercises on pain, disability, and balance in women with chronic low back pain. Int J Environ Res Public Health. 2022;19(5):2694.
20. Jess MA, Ryan C, Hamilton S, et al. Does duration of pain at baseline influence clinical outcomes of low back pain patients managed on an evidence-based pathway? Spine. 2018;43:E998–E1004.
21. NHS England. An improvement framework to reduce community musculoskeletal waits while delivering best outcomes and experience PR2022. Available from: https://www.england.nhs.uk/long-read/an-improvement-framework-to-reduce-community-musculoskeletal-waits-while-delivering-best-outcomes-and-experience/. Accessed 25 May 2023.
22. Hill JC, Kang S, Benedetto E, et al. Development and initial cohort validation of the Arthritis Research UK Musculoskeletal Health Questionnaire (MSK-HQ) for use across musculoskeletal care pathways. BMJ Open. 2016;6(8):e012331.
23. Sullivan MJL, Bishop SR, Pivik J. The Pain Catastrophizing Scale: Development and validation. Psychol Assess. 1995;7(4):524-532. doi: 10.1037/1040-3590.7.4.524.
24. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001 Sep;16(9):606-613. doi: 10.1046/j.1525-1497.2001.016009606.
25. Nicholas MK. The pain self-efficacy questionnaire: Taking pain into account. Eur J Pain. 2007 Feb;11(2):153-163. doi: 10.1016/j.ejpain.2005.12.008.
26. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May 22;166(10):1092-1097. doi: 10.1001/archinte.166.10.1092.
27. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361-370. doi: 10.1111/j.1600-0447.1983.tb09716.
28. Miller R, Kori S, Todd D. The Tampa Scale: a measure of kinesiophobia. Clin J Pain. 1991;7(1):51-52.
29. National Spinal Taskforce. Commissioning spinal services—Getting the service back on track: A guide for commissioners of spinal services. 2013. Available from: https://www.ukssb.com/_files/ugd/dd7c8a_c5075daa95274f1eb8b311bb74d2c1f7.pdf accessed 25/05/23
Downloads
Published
Data Availability Statement
Data is not yet available as full data set contains data not included in this submission.
Issue
Section
License
Copyright (c) 2026 Alasdair MacSween, Ruth Newsome, Louise White, Alastair Dickson, James Greenwood, Diarmaid Ferguson, Rita Santos, Cormac Ryan, Denis Martin (Author)

This work is licensed under a Creative Commons Attribution 4.0 International License.