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.
With the current pandemic causing uncertainty and confusion around the world, we will continue to keep our followers and supporters updated with any news relevant to people living with pain, their friends, family and healthcare professionals. We will strive to do our best to supply all our resources (magazines, leaflets, podcasts) while we can, assuming it is safe for our staff and volunteers to do so.
First, we would like to say a massive thank you to all our friends and colleagues in the NHS. We know that many of our partners have been redeployed into frontline services during this time and those who haven't are striving hard to keep pain services running, despite a depleted workforce. We will be clapping hard on Thursday evenings along with the rest of you.
Unfortunately, we have had to make the difficult decision to suspend our telephone Helpline support for the immediate future. The Helpline is staffed by volunteers, some of whom have their own health issues. Given the current situation, we are not able to provide the Helpline service in the way that we would wish to.
We will strive to reinstate the service as soon as it is safe and viable to do so. But for now, stay safe, stay home and we will still be here on the other side, providing resources, support and advocating for those living with pain.
So what is a pandemic anyway?
by John Finch
The terms endemic, epidemic and pandemic are used to describe the way diseases (not just infections) affect populations of humans or animals. The terms epidemic and pandemic have a very similar meaning: an epidemic is a rise in the number of new cases of a disease in a population; a pandemic is simply an epidemic that occurs over a wide geographical area. The point at which an epidemic becomes a pandemic is the point at which experts start calling it a pandemic. Not all epidemics become pandemics. Some epidemics are limited by geographical boundaries especially in remote rural population who do not travel much, or they just peter out.
When a pandemic or epidemic dies down (they always do) the disease may become endemic. This means that it is always present in the population, usually causing milder disease in most people. This endemic situation is what we experience with seasonal flu, coughs and colds, sore throats, viral gastroenteritis etc. The disease fluctuates and people may notice that ‘there is a lot of it about’ but it never really causes a true epidemic – it just grumbles on year after year.
So why don’t pandemics just go on and on? Humans, like other animals, become immune to the infection. When you have a sore throat you will notice that your ‘glands are up’. If you feel your neck at the corner of your jaw, you will notice a marble-sized hard structure on either side. These are your submandibular lymph nodes (or lymph glands) and they are full of B cells that respond to any foreign material (such as a virus) by producing proteins called antibodies that attach to the intruder and allow the body to get rid of it. When you are fighting an infection the glands become swollen and painful, but the best bit is that the B cells remember the bug and the next time it comes along they are ready to produce a big surge of antibodies to kill it.
This is what being immune is. The antibodies are particular to the bug that provoked them, so being immune to one virus does not mean you are immune to another. Vaccines work by injecting a dead or a live infection that stimulates immunity, but not disease, and so makes the B cells get ready for the real thing. Only twice have vaccines been used to eradicate a disease for ever: smallpox and the cattle plague known as rinderpest. However, for most diseases the bacterium or virus lives in the population, with there being enough immunity in the population (through vaccination or natural infection) for it to be held in check with relatively mild disease in a small number of people. Scientists have borrowed the veterinary term for this state and refer to it as herd immunity.
What does all this mean for Covid-19? The virus is a member of a common family of viruses called coronaviruses. This newly discovered virus is called SARS-cov-2. That seems complicated but it isn’t: ‘SARS’ stands for severe acute respiratory syndrome, ‘cov’ stands for coronavirus, and as this is the second coronavirus to cause a severe acute respiratory syndrome: SARS-cov-2. That is the name of the virus, but the name of the disease it causes is Covid-19 (Coronavirus disease 2019). Why the pandemic? Well, one theory is that SARS-cov-2 was endemic in animals not causing any trouble, but it jumped across to humans and found it could multiply and spread very rapidly in human tissues. As this is a new virus for humans our lymph glands are not prepared and the virus was able to multiply quickly and spread, sometimes without causing disease. So it started as an epidemic in China, and quickly became a pandemic.
As herd immunity grows and especially when we develop a vaccine, then Covid-19 will hopefully become endemic in the world population. In this future state, occasional people who are already unwell will become seriously ill but, if it does become endemic in the population, mostly it will be just another thing we notice in winter as we cough in a bus queue and remark that ‘there is a lot of it about’.
Keeping informed during COVID-19
The Faculty of Pain Medicine of the Royal College of Anaesthetists has developed a live resource capturing key challenges, relevant guidance and information to support local decision-making for pain services during COVID-19.
This resource will continued to be updated as and when required and is an excellent guide for the challenges facing pain services, as well as providing solutions wherever possible.
Managing Patients with Chronic Pain during the COVID-19 Pandemic
Across the world pain treatment centres have closed their doors. Due to the COVID-19 pandemic, healthcare providers are abruptly changing their care delivery to protect patients and staff from infection, and to reallocate resource towards the greatest acute needs.
Before the pandemic, telemedicine and eHealth approaches were being developed and tested in a gradual fashion with many studies focusing on lessons learned and barriers to using digital solutions. Overnight, however, treating or supporting people with non-urgent and long-term conditions at a distance from healthcare providers has become imperative.
A new paper, published in PAIN, the journal of the International Association for the Study of Pain, has studied how pain services might be forced to change during this pandemic, and how this may affect the delivery of such services in the months and years to come.
We are going to be performing an evaluation of our magazine, Pain Matters, over the course of the next few months. 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.
If you are a Pain Matters reader - whether you are a person living with pain, a healthcare professional or just have an interest in chronic pain - we would be extremely grateful if you can complete and return the short questionnaire which will be included with the next magazine. Alternatively, you can visit survey.painconcern.org.ukand complete the online version. It should only take about five minutes and your responses will help us to continue producing the variety of resources we produce.
HELP US TO HELP OTHERS
Airing Pain during lockdown
During the coronavirus outbreak, being able to self-manage pain becomes even more important than usual, as NHS resources are redeployed to support frontline services and GP consultations move to over-the-phone and online. So this month, we are showcasing some Airing Pain episodes which could help.
First up, episode 11: Music and Knitting, from way back in 2011, where Paul Evans gets a knitting lesson when he visits the Stitchlinks group in Bath, where people use craft activities to manage their pain.
Next, a more recent programme from 2018, episode 107: Easing Appointments with the Navigator Tool. It is often hard enough to overcome the barriers faced by patients in one-to-one appointments with healthcare professionals. Now that fewer and fewer face-to-face appointments are being performed due to coronavirus, these barriers can become larger. Pain Concern's Navigator Tool was designed to address these barriers, and this episode delves into the tool, speaking to the researchers who developed it and the GPs involved in the first trial.
And finally, why not check out some of our playlists. Ideal for this situation, our Mindfulness, Creativity and Other Ways of Managing Pain playlist is full of episodes designed to help you manage your own pain.
Subscribe to Airing Pain via Apple Podcasts, Spotify or wherever you get your podcasts
Pain Matters 74
In our first Pain Matters of the new decade, we have invited the Chronic Pain Team from NHS Borders in the south of Scotland into the guest-editor’s chair for issue 74. In a jam-packed issue, they have looked at everything from the Pain Management Jigsaw, which tries to bring together all the different aspects of managing pain, to the role of occupational therapy and how laughter can be a tool in the pain management toolbox.
Also in issue 74, Vidyamala Burch returns with her Being Mindful column, giving her three reasons why mindfulness is helpful for ‘living well with pain’.
Airing Pain 121: Living with Persistent Pain in Wales
Discussing the future of chronic pain services across Wales
This edition ofAiring Pain has been partially funded by an educational grant from Grünenthal Limited, donated for this purpose
In April 2019, the Minister for Health and Social Services in Wales launched the guidance document Living with Persistent Pain in Wales. Later, in December, the Chronic Pain Policy Coalition brought together some of Wales’s leading pain experts at the home of the Welsh parliament (or Senedd Cymru) in Cardiff, at an event chaired by Neil Betteridge, co-chair of the Chronic Pain Policy Coalition, a group which brings together a wide range of chronic pain stakeholders including professional bodies, patient organisations, parliamentarians and industry representatives from across the UK.
This edition of Airing Pain was recorded live at the event, where clinicians, academics, policy-makers and people living with pain came together to discuss both the new document and the future of chronic pain services across the region.
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