Map of Medicine: 5 new pathways for pain


The British Pain Society has launched five new pathways on the Map of Medicine to support commissioning and educate clinicians. The pathways may go on to inform the new NICE Quality Standard in pain.

The pathways are:

  • Initial assessment and early management of pain
  • Spinal pain
  • Chronic widespread pain, including fibromyalgia
  • Neuropathic pain
  • Pelvic pain
“Referral rates and quality of care for patients with pain problems show a concerning variation. For the first time, commissioners, providers and patients now have access to evidence-based and high-quality pain pathways through the Map of Medicine.  This is the first step in driving down variation in care, whilst enabling providers and commissioners to be able to negotiate and influence pain services in the best possible way to support patient care”

The pathways are available to healthcare professionals and can be adapted for local clinical use using Map of Medicine’s unique localising software tools available to clinical commissioning groups (CCGs). To take advantage of the high-quality, peer-reviewed pathways visit the Map of Medicine.

Map of Medicine – how can it help your practice?

Respiratory viruses during winter can strain the NHS with an influx of patients, as well as more staff illness. In most cases, rest, increased fluid intake, and paracetamol are sufficient. However, winter can be much more serious for people with pre-existing conditions, such as COPD.  Total excess winter mortality is between 20,000 and 50,000 annually in England and Wales, principally from respiratory, cardiovascular or cerebrovascular diseases.  Older age, female gender and a history of respiratory disease confer greater vulnerability.
Optimising management of chronic conditions is a process, not an event, and clinicians can be supported in this by using the Map of Medicine.   The following care maps are accredited by the Royal College of Physicians (RCP) and offer evidence-based, practice-informed guidance for the on-going management of chronic conditions:

  • ‘Chronic obstructive pulmonary disease (COPD)’ – covers management in both primary and secondary care, and includes treatment of acute exacerbations of breathlessness, which can occur in response to viral infection
  • ‘Cardiovascular disease (CVD) risk management’ – gives information on primary and secondary prevention of cardiac disease
  • ‘Stroke and transient ischaemic attack (TIA)’ – includes information on the secondary prevention of cerebrovascular events

The Map and the RCP bring together evidence and practice to support clinical decisions at the point of care. The Map can be customised to reflect local needs by clinicians looking to support clinical decision-making. Over 150 organisations have ‘localised’ more than 1,300 care pathways. Local additions to the care maps for these chronic conditions range from signposting services, for example local telehealth initiatives and social care packages, to providing information on topics such as factors to consider when deciding where exacerbations of COPD should be managed, and which teams are responsible for delivering care.

Click here to see how the Map could help your organisation.

Map of Medicine News

Improving care in diabetes

Since 2005, there has been a 50% increase in the number of people diagnosed with diabetes. Prevalence in England is expected to rise….

Read more about this story ….
UK | 23 Jul 12

Leeds Clinical Commissioning groups launch MSK care maps

The three newly-formed clinical commissioning groups (CCGs) in Leeds have launched an ambitious project to improve the quality of referrals by adding local pathways….

Read more on Leeds….
UK | 23 Jul 12

Map of Medicine | Leeds Clinical Commissioning groups launch MSK care maps

Map of Medicine | Leeds Clinical Commissioning groups launch MSK care mapsThe three newly-formed clinical commissioning groups (CCGs) in Leeds have launched an ambitious project to improve the quality of referrals by adding local pathways to the Map of Medicine. Leeds West CCG, Leeds North CCG, and Leeds South and East CCG, with a combined patient population of over 810,000 spread over 113 GP practices, aim to ensure all GPs use the care maps when making musculoskeletal referrals.

Having agreed the pathways for six musculoskeletal topics locally, the Leeds project team used Map Transform, a package of care maps and services, to establish their pathways on the Leeds ‘view’. This package supports clinically-led service improvement, and enables cross-service communication via easy online access to the agreed local pathways for all stakeholders. The topics Leeds chose were:

  • Hip pain
  • Hand/wrist pain
  • Spinal pain
  • Knee pain
  • Foot and ankle pain
  • Shoulder pain

The care maps display referral criteria at specific points within the pathways, with information that guides the user to the appropriate local referral form. The overarching aim of these care maps is to standardise and improve the quality of referrals from primary care to community MSK and secondary services. While a triage service for all MSK referrals was in place, and effective at ensuring good conversion rates for surgery following onward referral to secondary care, it was felt that GPs could perform some of the functions of triage, with the patient pathway being streamlined. The care maps are intended to expand GPs’ knowledge of MSK conditions, and also promote patient self- management.

read more via Map of Medicine | Leeds Clinical Commissioning groups launch MSK care maps.

Map of Medicine – local update

Local news spotlight: 
Mission possible – care pathways in Trafford’s pathfinder CCG

Trafford has set up a process to design care pathways, and implemented governance procedures so that the Map is a “business as usual” resource for local clinicians. The development of information specific to the area, along with the ease of access to this information, has been described as a smarter way of working which can only mean benefits for the public in the long term.

The ability to localise pathways has been extremely valuable to Trafford … Read full article>>

Also publishing local care maps on the Map of Medicine this month were:
Blackburn with Darwen, Derbyshire, Devon, Exeter, NHS East Lancashire, Leeds, Liverpool, North Devon, North Mersey, North Yorkshire & York, Peninsula, Plymouth, Southampton, South Devon, Sussex, Tees, Worcs, West Lancs CCG


Map of Medicine News

Local news spotlight:  North Mersey

North Mersey have localised over 80 care maps, carefully designed to tackle clinical or commissioning issues in their area as part of their QIPP scheme.

The North Mersey view covers all primary and secondary care Trusts within Liverpool, Sefton and Knowsley, and each area has its own view on the Map.
Dave Lawless, Project Manager for Map of Medicine in North Mersey, says: ‘In North Mersey we market Map of Medicine as the Yellow Pages for clinicians. All localised pathways contain specific information to add weight to the pathways, such as patient information leaflets and local clinic contact details. Pathways are accessed on all GPs’ PCs across the region and benefits are monitored by accessing Map of Medicine usage and referral rates.’

Athens users: can visit the Map here and select ‘International’ / ‘England’ or your local view.

Coming soon: Next month’s publication will include new care maps on Knee injuries and Perinatal mental health. In the meantime, 23-29 April is Orchid Male Cancer Awareness Week, so take a look at Prostate cancer and Testicular cancer care maps, both updated in February with the latest evidence.

Map of Medicine latest highlights

The latest evidence
Map of Medicine monitors over 150 guidance producers, and constantly searches over 3,000 sources for the latest meta-analyses and systematic reviews, enabling healthcare professionals to stay abreast of changes through a single resource. Over 40 care maps have been updated with the very latest evidence in our current issue, including:

Acute coronary syndrome: two new pieces of guidance from NICE incorporated. Ticagrelor added as a treatment option for selected patients. Management of hyperglycaemia, including testing, provision of information and lifestyle advice added for people with poor glycaemic control. 

Atrial fibrillation: new restrictions and monitoring requirements for the use of dronedarone in patients with atrial fibrillation, following MHRA Drug Safety Update.

Caesarean section: newly updated NICE recommendations including information on indications for caesarean section, including maternal request; and provision of evidence-based information and support for women.

Contraception: newly updated recommendations from the Faculty of Sexual and Reproductive Health (FSRH) on emergency contraception and combined hormonal contraception.

  • Athens users: visit the Map here and select ‘International’ / ‘England’ or your local view

Map of Medicine – Dementia care map updated

The Map of Medicine ‘Dementia’ care map has recently been updated to include the latest guidance from NICE, WHO, and the European Federation of Neurological Societies (EFNS). It provides succinct, accessible information on the diagnosis, assessment, and management of people with dementia, as well as advice on dealing with co-morbid emotional disorders and supportive information for carers.

Continue reading

Did you know of the latest evidence …

It’s never easy to stay up-to-date with the all the changes and latest healthcare guidance but did you know that subscribing to the Map of Medicine website can help by reducing some of the load?  The information contained in the post below can easily be sent direct to your mailbox.  Click here to subscribe for free to Map of Medicine.

The latest evidence
Map of Medicine monitors over 150 guidance producers, and constantly searches over 3,000 sources for the latest meta-analyses and systematic reviews, enabling healthcare professionals to stay abreast of changes through a single resource. The care maps below have been updated with the latest evidence-based recommendations:

  • Bladder cancer: use of pioglitazone (an oral treatment for type 2 diabetes) is associated with a small increased risk of bladder cancer. Healthcare professionals should be aware of new warnings and precautions for use in at-risk patients
  • Epilepsy in adults: now including the latest evidence from NICE recommending retigabine for the adjunctive treatment of partial onset seizures with or without secondary generalisation where other options have failed
  • Fluid and electrolyte imbalance: the Pathology Harmony Group have produced guidelines on reference intervals for normal sodium and potassium levels. This is of particular interest to users and commissioners of hospital diagnostic services
  • Gastro-oesophageal reflux disease (GORD) in children and adolescents: NICE have now updated their guidance on endoluminal gastroplication. Check out the secondary care page of the care map for the latest recommendation
  • Hip fracture: newly updated recommendations from NICE including the timing of surgery, patient and carer views and information are now incorporated throughout the care map
  • Miscarriage: updated to include new guidance from Royal College of Obstetricians and Gynaecologists on the investigation and treatment of couples with recurrent first-trimester and second-trimester miscarriage; also now with the latest evidence on indications for transvaginal and transbdominal cerclage in the treatment of cervical incompetence for women suffering recurrent miscarriage
  • Myeloma: see the ‘Initial chemotherapy’ care points for the latest evidence on bortezomib and thalidomide for the first-line treatment of multiple myeloma
  • Retinal detachment: includes recent new guidelines from the College of Optometrists on examining patients who complain of flashes and floaters, and when to refer urgently or as emergency
  • Rheumatoid arthritis: abatacept is now recommended for the treatment of rheumatoid arthritis after the failure of conventional disease-modifying anti-rheumatic drugs. See the medical treatment page of the care map
  • Warts: new evidence indicates that cryotherapy using liquid nitrogen is associated with higher costs per additional healed patient than 50% salicylic acid for the treatment of verrucae

Map of Medicine – local care maps


Following user’s feedback there have been a number of improvements made to Map of Medicine.
If you login you can now see your local care maps, bookmark those that are of most interest and change your default view of the Map.
In addition you can search for specific terms within each page; simplifying the look of search results; and making it possible for you to print the text of a single care point, together with the care map flow so you can see its context.

Go to