Hello and welcome to Pain Press, the monthly e-newsletter from Pain Concern, the charity working to support and inform people living with pain and those who care for them, whether family, friends or healthcare professionals.
Feature - from the Archives
Managing medications: A holistic approach
Working with people who live with chronic pain requires a holistic approach which often includes both pharmacological and non-pharmacological interventions. Advanced Physiotherapist Practitioner (APP) Katrine Peterson provides a look into how seeing an advanced physiotherapist earlier in the process of managing chronic pain could make all the difference
There is no single medical intervention, pharmacological or non-pharmacological, that is deemed effective in reducing chronic pain for more than a small proportion of people. However, we can cause harm by offering treatments without sufficient monitoring or offering safe alternatives. Physiotherapists in England have been able to undertake training to legally prescribe medication since 2013.
As a physiotherapist, I felt that my consultations would be improved if I had the credibility and competency to discuss the role of medication in pain management, and to support patients in making informed choices about the different treatments available. It may be a surprise to learn that I took this comprehensive and demanding qualification to focus on not prescribing more medication.
TO PRESCRIBE OR NOT TO PRESCRIBE?
It appears that medication is almost always the first line of treatment. Not everyone will be offered all of the interventions listed in the box below, but most will have been offered medications, and most people with chronic pain will have tried a range of different drugs. Doses and types of medications are often increased rather than adopting or incorporating other approaches when the initial prescription is not effective. Often, by the time I see people in my clinic, they believe that pain management is about finding the right medication or combination, despite the potential for iatrogenic (unintentional) harm. They have not been offered alternative treatment approaches such as those that can be offered by pain specialist physiotherapists.
‘De-prescribing’ is an important part of medication management and is a skill in itself. You have to take time to consider your patient’s beliefs and preferences, as well as provide adequate information for them to make informed decisions about the risks and benefits of using different medication to manage long-term pain.
There is currently a range of treatments for people with chronic pain. These are just a few examples:
Injections and infusions
Manual therapy and exercise programmes
Psychological and behavioural interventions either individually or in pain management programmes using cognitive behavioural therapy and acceptance and commitment therapy
Alternative therapies such as acupuncture
FIRST POINT OF CONTACT
We, at the University College London Hospital (UCLH) pain management centre, have been doing the initial assessment of people presenting with chronic pain by running first-point-of-contact clinics managed by advanced physiotherapy practitioners for 15 months. The physiotherapists involved all have prescribing qualifications, offer support for making choices about the use of medication and discuss alternatives that include self-management support. Our evaluation has demonstrated high patient satisfaction, particularly around communication, where the patient feels listened to, better informed and more supported to make self-management decisions and consider medication in a holistic context. This is in line with other research which supports the safety, competency and patient satisfaction in clinics where physiotherapists have the skills to assess and manage medication.
Advanced practice is expanding for physiotherapists to become the first-point-of-contact in primary care, working within general practice so patients see the right person at the right time, in line with the NHS’s 10-year plan. There are many advantages to having healthcare professionals with interdisciplinary skills for patients both in primary care and specialist pain services.
APPs with prescribing skills can offer the following benefits to patients:
A holistic prescribing experience by introducing alternative management strategies and treatments early in the management plan
A reduction in the number of different appointments necessary by offering a holistic, patient centred, assessment appointment with advice and other information on treatments, such as self-management
The early introduction of skills which focus on improving quality of life and managing activity with the expertise of the physiotherapist
‘De-prescription’ by offering alternative ways of coping, education and supporting patients with a graded approach to reduce reliance on the medication.
Katrine Petersen is an Advanced Physiotherapy Practitioner at the University College London Hospital pain management centre
Commonly used treatments for chronic pain can do more harm than good and should not be used, says NICE in draft guidance
A number of commonly used drug treatments for chronic primary pain have little or no evidence that they work and shouldn’t be prescribed, NICE has said in its draft clinical guideline published on 3rd August 2020 on the assessment and management of chronic pain in over 16s.
For more information on the NICE draft guidance, click here
Pain Concern's statement on draft NICE guideline published on 3rd August 2020
Dr Martin Dunbar, Chairman of Pain Concern's Board of Trustees, published the following statement on 4th August 2020:
"We welcome the guidance on collaborative working between patients and health care professionals, however we are aware of the anxiety that the recommendations are likely to raise amongst people living with chronic pain who rely on these medicines to cope, and we will carefully consider this in our response to the draft guidelines. Our Barriers Project, which the NICE committee considered, helped to identify many of the difficulties that people with chronic pain experience in their interactions with health care professionals. Pain Concern have developed a tool (The Self-Management Navigator Tool) which we believe goes a long way to addressing these issues and would hope that the NICE guidance will lead to a greater use of the Tool."
Pain Concern will continue to provide information on this draft guideline which is open for public consultation until 14th September 2020. Please email email@example.com if you wish your comments to be taken into account.
Online paediatric chronic pain management: assessing the needs of UK adolescents and parents, using a cross-sectional survey by Anna Hurley-Wallace, Daniel E Schoth, Suzanne Lilley, Glyn Williams and Christina Liossi, the British Journal of Pain – 21 July 2020
Adolescent chronic pain is prevalent, and interdisciplinary treatment is recommended. Although it is well known that technology is a key part of adolescents’ daily lives, there have not been any online, interdisciplinary interventions developed for adolescents with chronic pain in a UK healthcare context. Little is known about how adolescents currently use online resources to manage chronic pain, or what guidance they seek.
Ninety-five participants from the community were asked to answer an online survey which assessed the needs of UK-based adolescents for a new online chronic pain management resource.
The findings show that adolescents and parents have a positive outlook towards the development of a UK-specific online resource to help manage chronic pain.
Post-pandemic pain services: a new world by Paul Cameron, British Journal of Pain – 16 July 2020
The first half of 2020 has seen a significant change in the way we work, live and play and, for many, has forced us to evaluate the most important things in life. Our priorities and goals for the future may have changed, and the way we perceive our work/life balance may well have altered substantially. Likewise, the National Health Service (NHS) has seen a fundamental shift in its capacity and capability and an increase in the demand on its resources in a manner unprecedented and at a scale never seen before, altering the way both clinicians and patients view the NHS. Regardless of location, it is notable that pain services, covering both acute and chronic pain populations, have all suffered the same fate.
The significant reduction in resources to pain service provision did not see the disappearance of the need for such services, and it is a concern for many clinicians as to the impact the pandemic response will have on patients now and in the future. Digital technology featured highly as a new approach, with the speedy creation and compilation of online resources to be offered to patients. However, little is known of the efficacy or sustainability of such approaches or of the impact it will have on patients unable, or unwilling, to access such technology.
Rhythms produced by the brain can reliably be used to predict how sensitive we are to pain, new research shows ScienceDaily – 6 August 2020
The living brain is constantly producing regular rhythmic patterns of activity, which can be compared to musical notes. Scientists at the University of Birmingham in the UK, and the University of Maryland School of Dentistry in the US, have successfully demonstrated that one particularly prevalent pattern of brain activity, called alpha waves, strongly relates to the body's susceptibility or resilience to pain.
According to one of the research’s co-author, "severe pain following surgery is often also a good indicator of whether or not a patient is likely to go on to develop chronic pain. Understanding whether or not a person is at high risk of developing these symptoms will help patients and clinicians make better informed choices about the best course of treatment."
The results of the study showed that measuring alpha waves did give a reliable indication of a person's susceptibility or resilience to pain. These results were reliable both in the initial assessment and in the eight-week follow up.
According to the most recent Scottish Diabetes Survey in 2018, an estimated 1 in 20 people in Scotland is currently living with diabetes. A long-term effect of diabetes can be the development of diabetic neuropathy. This edition of Airing Pain focuses on neuropathic pain in people with diabetes, and how the X-PERT diabetes courses help people to deal with the complications that arise when living with diabetes. Featuring Professor David Bennett and Steve Sims.
Subscribe to Airing Pain via Apple Podcasts, Spotify or wherever you get your podcasts
What do we mean when we talk about pain? In this edition of Pain Matters, we have invited the members of the Flippin’ Pain™ campaign to guest-edit a pain neuroscience education special. A public health campaign delivered by Connect Health, Flippin’ Pain’ aims to improve health literacy around persistent pain, building on the work done by world-renowned pain scientist and science educator Professor Lorimer Moseley.
As Professor Cormac Ryan says, ‘for over half a century, much of what scientists have learned about pain has remained hidden away in academic journals gathering dust’, unobtainable to the people who need it most: the people who live with pain every day. This edition of Pain Matters, along with the Flippin’ Pain’ campaign, aims to change this, one step at a time.
WhyamIseeingthis? This email address was listed in our archive of contact details for people interested in Pain Concern.
We promise not to overload, but if you wish to be removed from this list you can email us or click the link below.
Our email address for all things relating to Pain Press is: