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Pain Press

September 2019

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.

 

Latest News


Global Year against Pain in the Most Vulnerable

The International Association for the Study of Pain (IASP) has made 2019 their ‘Global Year against Pain in the Most Vulnerable’. Alongside healthcare professionals, patients and other members of the public, IASP has created a campaign to highlight the needs of individuals who cannot articulate their pain in ways that health professionals can easily understand or whose pain problems are underestimated and so they are more likely to receive inadequate pain control. IASP president, Dr Lars Arendt-Nielsen, discussed how this year was created because he feels that ‘so much needless suffering could be alleviated if only the right clinical approaches were applied, the right policies adopted and the right partners engaged, including patient advocacy organizations’.

As a part of the campaign, IASP have collected a variety of resources as well as ways for people to get involved, from a collection of papers and articles taken from their magazine PAIN, to fact sheets on those vulnerable and webinars held throughout the year. The next webinar being on the topic of ‘Pain in Dementia’ on 24 September, containing presentations on Novel Developments in Opioid Use in Dementia, Novel Tools for Pain Assessment in Dementia and Novel Training to Improve Pain Detection in Dementia.

An example of one of the vulnerable groups IASP is working to highlight is children. They have made available a free download of Drawings of My Pain a book based on a Portuguese art exhibition by paediatric patients expressing their pain as well as fact sheets on a selection of issues concerning children, such as pain assessment and management, and links to ‘Management of Chronic Pain in Children and Young People Guidelines’, published by the Scottish Government. This is also a topic which Pain Concern has discussed previously in our radio show Airing Pain with episodes covering ‘Children in Pain’ and ‘Putting Children’s Pain in the Picture’.

The Airing Pain episodes that address these issues are listed below:
Programme 3: Children in Pain
Programme 4: Diet, CBT and Mindfulness
Programme 6: Pacing and Arthritis
Programme 10: Young People in Pain
Programme 18: Growing Old with Pain
Programme 22: Pain Support Groups and Facial Expressions
Programme 27: Arthritis – Challenging Perceptions
Programme 28: Challenging Pain
Programme 40: Children in Pain
Programme 44: Pain Management at Both Extremes of Life
Programme 57: Self-management, Psychology and 'Physio-terrorists', Stiff Joints and Dark Thoughts
Programme 66: Not a Burden
Programme 71: Protect our Girls
Programme 78: Putting Children’s Pain in the Picture
Programme 82: Pain, PTSD and Perfume
Programme 83: Arthritis
Programme 89: Dementia

NICE guidance on cannabis-based medicines out for consultation
 
The National Institute for Health and Care Excellence (NICE) has issued draft guidance for the use of cannabis-based medicines considering the evidence for their use in intractable nausea and vomiting; chronic pain; spasticity and epilepsy. It covers other related topics, such as prescribing, and the economic aspects. NICE guidelines apply only to England unless adopted by devolved governments. Doctors are expected to take the guidelines into account in their clinical practice. However, it is not mandatory for doctors to follow the guidelines where they believe said guidelines are not in the best interests of a particular patient. The evidence review for chronic pain runs to nearly 262 pages and reviews data from 20 trials. There are no headline grabbing conclusions. The committee noted that most of the trials were limited in scope and of poor quality. There is some evidence that some cannabis-based products reduce chronic pain in some patients. However, the benefit is small compared with the cost of the treatment. NICE noted that cannabis-based medicines would have to be 10 times more effective or 10 times cheaper to have an acceptable cost/benefit. However, the committee acknowledged the many patient reports of benefit, and has recommended further research be done, particularly in fibromyalgia and persistent treatment-resistant neuropathic pain in adults, and chronic pain in children and young people. Notes will keep an eye on developments.
 
What is Cannabidiol?
 
Cannabidiol (CBD) is a natural compound extracted from the cannabis plant. It is freely available in the UK as a food supplement, and the market for it is growing. The products for sale do not claim any medical benefit, and some products do not contain a sufficiently high dose to be likely to have any benefit. They are not cheap. Cannabidiol does not get you ‘high’, but some formulations available on the internet (from US sites for example) contain tetrahydrocannabinol (THC) which is the chemical that does make you high. Possession of formulations with THC is likely to be illegal in the UK. Synthetic cannabinoids, such as Nabiximols, are available for some conditions under medical prescription having been tested and shown to be both effective and safe. For more information, we recommend the NHS website.
           
New Classification for Chronic Pain

The World Health Organization (WHO) has updated the International Classification of Diseases. For the first time, they have included chronic pain and provided specific pain diagnoses. Under the new system, chronic pain is classified as either chronic primary pain or chronic secondary pain.

Chronic primary pain is defined as pain that persists for longer than three months, is associated with significant emotional distress or functional disability and that cannot be explained by another chronic condition. This new definition applies to chronic pain syndromes that are best conceived as health conditions in their own right. Examples of chronic primary pain conditions include fibromyalgia, complex regional pain syndrome, chronic migraine, irritable bowel syndrome and non-specific low-back pain. 

Chronic secondary pain syndromes are defined as pain that may initially be regarded as a symptom of other diseases with said disease being the underlying cause. However, a diagnosis of chronic secondary pain marks the stage when the chronic pain becomes a problem in its own right. In many cases, the chronic pain may continue beyond successful treatment of the initial cause; in such cases, the pain diagnosis will remain, even after the diagnosis of the underlying disease is no longer relevant. Examples of chronic secondary pain are chronic pain related to cancer, surgery, injury, internal disease, disease in the muscles, bones or joints, headaches or nerve damage.
 
More detail can be found in the online edition of Pain: The Journal of the International Association for the Study of Pain.

 

Pain Matters digital edition


Back by popular demand is the digital edition of Pain Matters, available via Pocketmags. If you’re thinking about the trees or want access to our catalogue at the push of a button, new and previous issues of our magazine can now be read on your mobile, tablet or computer for as little as £1.99 for a quarterly subscription or £6.99 for an annual subscription of four magazines. If you just want to dip in and out with a single issue, you can do that too, for £2.99 per issue.

For more information and to subscribe, click here.

However, if you still prefer the feel of paper, physical issues can still be bought here, either by themselves, or as part of a four-issue annual subscription.

This includes our latest issue, #72, which continues our format of inviting a guest editor and sees the Southampton Pain Team and Portsmouth Persistent Pain Team from Solent NHS Trust at the helm.

Airing Pain episode 117, available now


Our most recent episode of Airing Pain was released on 3rd September 2019 titled 'Patients as Research Partners'. In the episode Paul Evans investigates the potential for patients to play an integral role in research alongside the professionals.

This month's contributors include:
  • Louise Trewern, member of the BPS Patient Liaison Committee
  • Margaret Whitehead, past co-chair of the BPS Patient Liaison Committee
  • Julie Ashworth, Senior Lecturer University of Keele and Honorary Consultant at the Community Pain Service with Midlands Partnership Foundation Trust
  • John Norton, patient
  • Mark Farmer, patient.

To hear this and all our other Airing Pain radio programmes, click here, or subscribe via Audioboom.

Airing Pain episode 118, 'Adolescent Pain', available to listen or download October 1st


Coming in October, Paul Evans looks at how pain impacts on the lives of adolescents. Watch the trailer at https://vimeo.com/362011603.

To hear this and all our other Airing Pain radio programmes, click here, or subscribe via Audioboom.

Publication of the month


This month’s publications of the month is a series of fact sheets the International Association for the Study of Pain (IASP) and top experts have created on various aspects of vulnerable populations, as a part of their ‘Global Year against Pain in the Most Vulnerable’. These fact sheets include information on pain identification, reporting and management across vulnerable groups such as older persons (including pain in dementia), infants and children, survivors of torture and individuals with cognitive impairments.

The fact sheets are free to download and are currently available in 17 languages. They can be found on the IASP Global Year webpage.

Coming up in the next Pain Press:

  • The Neuropathic Pain team at University College Hospital London take control for issue 73 of Pain Matters, out in October.
  • Airing Pain programme 118 sees Paul Evans looking at how pain affects adolescents, available to download on 1st October.
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