Implementing ESCAPE-pain to help manage chronic joint pain

ESCAPE-pain is an award-winning programme designed to help people manage chronic knee, hip or back pain. This is achieved through 12 supervised sessions where groups of 10 to 12 participants receive education and tailored exercise programmes, resulting in better health and mood.

Dr Peter Lanyon, President of the British Society for Rheumatology

ESCAPE-pain is a group rehabilitation programme which is used to help those with knee and hip osteoarthritis or chronic pain, or chronic back pain.

The programme entails 12 supervised sessions for small groups, delivering educational self-management and coping strategies alongside an exercise regimen individualised for each participant. The sessions are run for 6 weeks by either a psychotherapist or an exercise professional as the trained facilitator.

From 2013, physiotherapists and exercise professionals have been trained on the programme across more than 280 sites, facilitating the delivery of the programme across primary, secondary and community care, including through leisure centres and other community hubs. Training was initially delivered by Health Innovation Network, with the AHSN Network later adopting ESCAPE-pain as a national programme.

Adoption and spread or improvement methodology

Several factors were important in achieving scale and spread, including:

• Design and delivery of an accredited training programme for programme facilitators
• Development of an ESCAPE-pain community – people delivering and interested in the programme’s development
• Continued capture and sharing of outcome data
• Development of an implementation guide to show services and commissioners how to set up ESCAPE-pain, and the business case
• Involvement of all 15 AHSNs as honest brokers to encourage the uptake of the programme
• Developing a digital version of the programme
• Responding to requests to test the programme for people with chronic back pain (the original studies focused on knee/hip pain).

Since 2021, ESCAPE-pain has been operated by Orthopaedic Research UK, a medical charity, under license from Health innovation Network (Guy’s and St Thomas’ NHS Foundation Trust).

Almost 20,000 people have taken part in ESCAPE-pain, saving the health and social care system an estimated £30 million in costs compared to treatment as usual. The programme has helped ease pressures on primary care; musculoskeletal pain accounts for 20-30% of all GP consultations.

70% of ESCAPE-pain participants found that their ability to complete daily tasks improved significantly, 66% of reported pain reduction and 59% indicated their mental wellbeing had improved because of the programme. Evaluation has showed that participants maintain benefits from the programme for up to two and a half years following completion.