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.
What a Pain! Hope for chronic pain sufferers as scientists discover new pain-sensing organ in the skin
Nina Massey - 16 Aug 2019
The reaction to mechanical pain – pressure, pricking, and other impacts to the skin, causes an almost universal reaction, whether it’s the wincing from the jab of a needle or the urge to pull away from stimuli such as extreme temperature.
A newly discovered organ inside the skin, dubbed the nociceptive glio-neural complex, could be one of the main factors behind this reaction, as it seems to play a key role in the perception of mechanical pain. This new organ was found to be a simple one, made up of cells, called glia cells, with multiple long protrusions, which collectively make up a mesh-like organ within the skin. It’s a discovery which completely changes the way we thought this type of pain was felt, as it was previously thought to originate in the skin’s nerve endings. This discovery could lead to a new understanding of pain and therefore new possibilities of pain management and treatment. An example of this being that the same study in which the organ was discovered scientist also found that by blocking the organ they saw a resultant decreased ability to feel mechanical pain.
As put by Patrik Ernfors, professor at Karolinska Institutet's Department of Medical Biochemistry and Biophysics and chief investigator for the study, ‘The discovery changes our understanding of the cellular mechanisms of physical sensation and it may be of significance in the understanding of chronic pain’.
Involving patients in pain management decisions significantly reduces opioid prescriptions
Reviewed by Kate Anderton, B.Sc. – 22 Oct 2019
A study conducted at the University of Michigan has found that involving patients in the decisions behind their pain management programmes helped to decrease the amount of opioids prescribed to them. Patients were shown a visual aid by their healthcare professionals regarding their pain management after surgery. They then explained the typical number of opioid tablets needed to manage pain, opioid risks and side effects and the maximum number that may be prescribed. After this, the patients were asked to choose their desired amount of painkillers to receive on discharge.
This active inclusion and education given to the patients before discharge proved effective at reducing the opioid prescriptions which previous studies have found to be prescribed from double to the maximum levels to certain patients, such as those who have undergone a hysterectomy. Lead author Annmarie Vilkins explained that the ‘simple conversation between doctor and patient helped reduce opioid prescriptions while allowing us to continue prioritizing the patient's comfort and satisfaction with pain control. Even with fewer opioids, the majority of patients described post-surgery pain as better, or much better than they expected.
Reports into chronic pain and support services released
Two reports have recently been released which look into the current services available for those living with chronic pain. Both of these reports have come to similar conclusions in regards to the quality of these services and the improvement that could be taken to improve them.
As a collaborative research survey initiative, The Arthritis and Musculoskeletal Alliance (ARMA) with Grünenthal LTD and Adelphi Research have produced a report exploring healthcare support services for managing chronic pain in the UK, from the perspective of both patient and healthcare professional.
The results of the survey found that the management of chronic pain in the UK appears to be deficient, meaning both patient and healthcare professionals find that overall support for chronic pain to be fairly poor, with mixed and inconsistent experiences from the services available in the UK.
The survey also gathered feedback and reported the suggested improvements that patients and healthcare professionals gave. The main improvements suggested were that chronic pain should be treated as a condition in its own right, with the same significance being given to it as other long-term conditions as well as how an annual pain review would be beneficial to all involved.
A similar report published by the Chronic Pain Policy Coalition (CPPC) has used gathered data and patient testimonies to explore the burden of chronic pain in England. The findings of the report say have found that ‘not only is the impact of pain on the patient’s quality of life severe, also the service provisions are not performing at an adequate level across the country’.
The report suggests that any improvement made to the current support services available will not be consistent or effective long-term without a mechanism whereby existing guidelines and tools will be accessible and implementable across the whole of the UK. They stress the importance of how interventions and improvements need to be effectively implemented or monitored and adhered to for them to be effective.
The report concludes by several recommendations on how the burden of chronic pain can be alleviated. These include the development of the framework for a national strategy on pain in England, annual pain reviews for individuals living chronic pain and policy to ensure the retention of individuals in the workplace.
We are delighted to announce that our popular booklet on neuropathic pain has been revised and reprinted, thanks to an award from Foundation Scotland. The booklet, originally written by Dr John Lee, has been revised and updated by Dr Alan Fayaz, Consultant in Chronic Pain Medicine, Anaesthesia and Perioperative Care at the University College London Hospitals NHS Trust.
This booklet starts by addressing the causes of neuropathic pain, from the more common causes, such as nerve damage and entrapment, diabetes or post-herpetic neuralgia (pain after shingles); to less common causes, such as trigeminal neuralgia (a form of facial pain), multiple sclerosis, phantom limb pain or pain related to cancer or cancer treatment.
There is an extensive section on the drug treatments available for people with neuropathic pain, and why standard painkillers, such as paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs) (e.g. ibuprofen) and simple opioid drugs (e.g. codeine) are often not effective in treating neuropathic pain. In some cases, antidepressants like amitriptyline and antiepileptics like those in the gabapentinoid family (such as gabapentin and pregabalin) are prescribed instead, as they are found to be more effective in a lot of cases. This revised booklet does, however, mention the recent law classification changes to gabapentin and pregabalin, which are a common treatment for people with neuropathic pain, and how these changes might affect the people who find these drugs effective. This was a subject Pain Concern delved into more deeply in programme 114 of Airing Pain, ‘You, Your Drugs, and the Law: Gabapentinoids & Medicinal Cannabis’, also funded by the Foundation Scotland grant.
The final section of the booklet studies non-drug treatments for neuropathic pain. Many people with neuropathic pain find standard pain management techniques are not as applicable to their pain (a subject which Tina from livingwellpain.net goes into in a lot of detail in the current issue of Pain Matters magazine). Drs Lee and Fayaz look at pain self-management techniques for people with neuropathic pain, as well as other non-drug treatments such as physiotherapy, pain management programmes and stimulation procedures like TENS (transcutaneous electrical nerve stimulation) and PENS (percutaneous electrical nerve stimulation), where an electrical signal is used to stimulate the nerves.
The revised leaflet has been published on our website and we welcome your comments. We are extremely grateful to the Trigeminal Neuralgia Association UK and the Shingles Support Society for their support and collaboration in the publication of this leaflet.
After a successful AGM on Thursday 7 November, it was announced that Heather Wallace has stepped down from the trustee board as part of Pain Concern's ongoing restructuring at board level. She will stay on as general manager, overseeing the day-to-day running of the charity.
Elections took place for the new trustee board and the new members elected are as follows:
We will publish full biographies of the new trustee board in due course.
Back Friday and Cyber Monday will soon be here, which means digital copies of Pain Matters magazine will be 35% off between 25 December and 8 January over at Pocketmags.com.
Also, for more savings keep an eye out for additional sales coming over the next couple of months, such as a Mega Sale on our annual subscriptions which could save you 30% (26 Dec-12 Jan) and our Back Issue 99p Flash Sale later in the month (24-27 Jan).
Pain Matters back issues
Missed an issue of Pain Matters? Fear not. You can now buy a selection of back issues via our website.
Please note: these magazines are only available to people in the UK and while stocks last.
This edition of Airing Pain has been supported by a grant from the Plum Trust.
In September, the British Pain Society’s special interest group on pain management programmes held their annual conference. The workshop, “Experts by Experience”, brought together patient-volunteers and healthcare professionals from four pain management centres around the UK. This special extended edition of Airing Paincomes to you live from the conference, letting you sit in on the discussion.
Dr Nick Ambler, Consultant Clinical Psychologist of the North Bristol NHS Trust’s Pain Management Programme (PMP), facilitated the workshop; chairing a frank and empowering discussion on the psychological benefit to patients and the professional value to healthcare trusts of patient-volunteers working within pain management programmes.
Patient-volunteer Primrose opens by giving a testimony of how volunteering with her PMP has transformed and empowered her life and experience of pain. Dr Debbie Joy, Clinical Lead of Pain Services for NHS Solent Trust, addresses some of the initial anxieties she had around the introduction of patient-volunteers to a clinical setting.
The event concluded with further discussions relating to pain coaching and the work of Glasgow Community Pain Education Sessions.
The latest episode of Airing Pain is available on Apple Podcasts, Spotify or via our website here.
We're taking a little break for Christmas, but the next episode of Airing Pain, on the subject of osteoporosis, will be available in January 2020.
Airing Pain 119: Experts by Experience
Listen to the trailer here
Pain Matters 73
We are delighted here at Pain Matters HQ to have the neuropathic pain team from University College Hospital London Pain Management Centre guest-editing issue 73.This edition of the magazine takes an in-depth look at all aspects of neuropathic pain, from what it is to how best to manage and treat it, taking in points of view from those living with it to the healthcare professionals trying to help them.
Also in issue 73, writer Robert Ilson describes his half-century struggle to find an answer to his facial pain, including all the treatments – traditional and not – gone by the wayside, before concluding that, sometimes, ‘living with pain can become a way of coping with pain’.
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: