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.
Changing Understanding, Changing Lives
Ever lack the understanding needed to manage your pain? Or feel that those around you, and the wider public, misunderstand a life lived with persistent pain? Professor Cormac Ryan and Kathryn Gloor, who lives with persistent pain, explain to Pain Matters the benefits of pain neuroscience education in improving health literacy
CATCHING UP WITH THE SCIENCE
Since at least 1965, when researchers Patrick Wall and Ronald Melzack published their landmark ‘gate control’ theory in Science, scientists have understood that pain is influenced by physical, psychological and social factors. In the following fifty-five years, the scientific community has continued to learn a remarkable amount about the complex nature of pain. So why is so much of the public’s understanding of pain still trapped in the past, and how can we catch up? And why would this be important to someone living with persistent pain?
HEALTH LITERACY IS KEY AT ALL LEVELS
Health literacy – the degree to which someone can get and understand information about health – is not simply a matter of whether someone can read and understand a patient information leaflet. It also concerns whether that person knows enough about a condition to make informed choices about their own care. Since public understanding is so out of step with current scientific thinking, the issue of health literacy is especially important with regards to persistent pain. To address this issue, there needs to be a targeted approach to help people understand modern pain science. We believe this could, and should, be done at the patient, clinician, and public health levels.
USING EDUCATION TO MANAGE PAIN
The goal of pain neuroscience education is to help people understand that persistent pain is not always a sign of tissue damage or other bodily harm, but instead can result from our subconscious trying to protect our body from perceived or predicted danger. This is a shift from the outdated biomedical framework toward a more modern ‘biopsychosocial’ understanding: we now know that many factors outside of biology affect the pain experience. The book Explain Pain, first published in 2003 by David Butler and Lorimer Moseley, showed that while pain is indeed complicated, using metaphor and storytelling to explain these complexities can give people a more scientifically-informed understanding of their pain.
REDUCING PAIN-RELATED FEAR
The impact of pain neuroscience education on people living with pain has received attention from academics in the seventeen years that it has been in the public domain. A recent review found that while there seems to be little effect on pain and function in the short term, it can reduce pain-related fear and worrying. There was not enough evidence to judge the long-term effects based on randomized controlled trials, although there is preliminary audit data of more than 1,000 patients in Australia that suggests that treatment including pain neuroscience education helps people better understand pain, and that these individuals had recovered more at the one-year follow-up point than those who didn’t improve their understanding.
UNLOCKING THE BENEFITS OF PAIN NEUROSCIENCE EDUCATION
Many healthcare professionals possess a strongly biomedical understanding of pain, and those who hold these views are more likely to recommend against active management strategies for pain, contrary to current national guidelines. These biomedical views are present at the undergraduate level, and it has been noted that pain training at this level for healthcare professionals is woefully inadequate. Three recent randomised controlled trials have demonstrated that delivering a brief pain neuroscience education lecture to students can significantly improve their knowledge of pain and their attitudes toward people with pain, as well as increase the likelihood that they will recommend treatment more in keeping with national guidelines. These studies highlight the potential benefits of delivering pain neuroscience education teaching to healthcare professionals. This is crucial given the important role they play in people’s pain management journeys.
PUBLIC HEALTH CAMPAIGNS CAN UNLOCK BENEFITS FOR PATIENTS
Whilst changing understanding at the individual level is important both for clinicians and people living with persistent pain, perhaps the greatest potential benefit can be found in educating the public. A comprehensive public health campaign for back pain produced a positive shift in public attitudes to back pain, improved clinicians’ understanding of back pain and significantly reduced health care usage and costs related to back pain. It thus seems reasonable to assume that pain neuroscience education delivered at the public health level could be highly effective in shifting public understanding of persistent pain. The Pain Revolution (painrevolution.org), spearheaded by the aforementioned authors of Explain Pain, is a public health initiative seeking to do just that. This initiative has drawn attention internationally, and a number of other countries are considering how they might replicate this initiative.
In the UK, the Flippin’ Pain campaign (flippinpain.co.uk) has taken up the mantle. This public health campaign was recently launched in Lincolnshire by Connect Health in collaboration with NHS Lincolnshire Clinical Commissioning Group. It takes the key pain neuroscience education messages and shares them at public events throughout the region, reinforcing key messages through engagement with local media and online platforms. The aim is to shift how people think and talk about their pain, and to enhance their health literacy so that individuals can make informed choices about future pain management. If successful, this campaign could provide a template for community pain education across the UK.
BLOWING THE DUST OFF THE SCIENCE
For over half a century, much of what scientists have learned about pain has remained hidden away in academic journals gathering dust and making little real-world impact on the day-to-day lives of people with persistent pain. However, campaigns such as Pain Revolution and Flippin’ Pain present a wonderful opportunity to change all that. These campaigns pave the way for a contemporary scientific understanding of pain to be brought to the public and to radically transform the lives of millions of people with persistent pain.
Professor Cormac Ryan is professor of clinical rehabilitation at Teesside University & community pain champion for Flippin’ Pain. This latter role is funded by Connect Health, who are funding and delivering the Flippin’ Pain campaign in collaboration with NHS Lincolnshire Clinical Commissioning Group
Kathryn Gloor lives with persistent pain and is from Albany, Ohio, USA
This article is the lead article from Pain Matters 76, guest-edited by the Flippin' Pain™ campaign, a public health campaign that aims to raise awareness about the problem of persistent pain and encourage people to change the way they think about it, talk about it, and treat it. For more information visit flippinpain.co.uk.
Definition of pain updated for the first time since 1979 Live Well with pain - 27 July 2020
After 40 years, the globally accepted definition of pain originally developed by the International Association for the Study of Pain (IASP) in 1979, has been revised and updated to reflect advances in our understanding of pain.
The resulting new definition will have far-reaching impact on the world of pain management. The IASP’s full report on how the new definition came to be adopted can be downloaded here.
Revised IASP definition of pain (2020):
Pain: An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.
For key notes about this new definition and the etymology of the term, click here
Endometriosis: No cure, but diagnosis could avert surgery ScienceDaily - 8 September 2020
Endometriosis affects approximately 10 per cent of women worldwide and occurs when tissue like that which lines the uterus (endometrial tissue) grows outside of the uterus, forming legions on the ovaries, bowel and pelvis -- sometimes spreading to other organs. It causes severe pain, typically with periods but also with sex, passing urine and bowel movements. It can also cause heavy or dysfunctional menstrual bleeding.
Keyhole surgery is the standard option to reliably diagnose the three types of endometriosis (peritoneal, ovarian and deep infiltrating endometriosis), but comes with risks, delays, and sometimes a negative result.
"Undergoing an invasive procedure is stressful, even more so if it proves unnecessary" says University of South Australia (UniSA) researcher Alison Deslandes, who is exploring alternative diagnosis options for women with deep infiltrating endometriosis (DIE), the most severe and challenging type to manage.
"In recent years, transvaginal ultrasound (TVUS) has begun to play a role in the diagnosis of DIE and ovarian endometriosis, but it's typically only offered by specialised gynaecologists," Deslandes says.
The UniSA researcher is investigating the accuracy of TVUS and whether sonographers could perform the procedure in an outpatient facility, making it more accessible to women who are experiencing symptoms of endometriosis.
Compassionate imagery helps suppress physical pain response, research finds MedicalXpress - 9 September 2020
Using imagery focused on compassion can help people suffering from stress associated with physical pain, a new study from the University of Derby has shown.
The research is the first of its kind to monitor physiological responses to "affiliative" imagery—which is intended to make people feel loved or cared for—by asking them to imagine being the recipient of acts of compassion, such as kindness and wisdom.
Monitoring physical reactions associated with sensations and suppression of physical pain under controlled conditions with a group of 37 participants at the University of Derby's Human Sciences Research Center, Dr. Frances Maratos, Associate Professor and Reader in Emotion Science, and fellow psychologist Professor David Sheffield, established that using compassion-focused imagery (CFI) "can curtail a physiological stress response to pain."
Further information on the topic of compassion-focused therapy can also be found in Pain Matters 75.
To buy issue 75, click here
For a digital version, click here
Study unravels why people with knee osteoarthritis experience varying pain patterns
by Emily Henderson, B.Sc., News Medical Life Sciences - 5 September 2020
Osteoarthritis is the most common form of arthritis worldwide, affecting more than 300 million people. It causes substantial pain, functional limitations, and disability in patients.
The pain experience in patients with knee osteoarthritis changes over time. People initially experience primarily weight-bearing related pain, such as with jogging and stair-climbing. Over time, the pain becomes more persistent and can flare unpredictably.
To better understand why this change in the pain experience occurs, researchers from the Boston University schools of Medicine (BUSM) and Public Health reviewed data from the Multicentre Osteoarthritis Study about the pain experience of 2,794 older adults with or at risk of knee osteoarthritis. They found that people with more pain sensitization were more likely to suffer from constant and unpredictable pain, rather than just intermittent pain.
By understanding the different mechanisms that contribute to the pain experience of knee osteoarthritis, healthcare providers can begin to personalize pain management to each patient.
We have extended the deadline for you to have your say in our evaluation of Pain Matters magazine. Evaluation is a key factor in securing funds, not just for future issues of Pain Matters, but to fund all the work we do here at Pain Concern.
We have included a short questionnaire with the current issue of Pain Matters and we would be extremely grateful if you could complete and return it to us. This is not just for people with chronic pain, we are looking for responses from all our readers. Alternatively, you can visit survey.painconcern.org.uk and complete the online version. It should only take about five minutes and your responses will help us to continue producing the wide variety of resources for people living with pain.
HELP US TO HELP OTHERS
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
Pain Matters 76OUT NOW!
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.
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