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Pain Channel

Declaration of sponsorship Novartis Pharma AG
Read time: 30 mins
Last updated:17th Nov 2020
Published:17th Nov 2020

In this section, listen to two podcast episodes with Dr Tong Gan and Professor Serge Perrot where they discuss how the coronavirus disease 2019 (COVID-19) pandemic has impacted the management of acute and chronic pain, as well as an in-depth look into post-operative and rheumatic pain management.

Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage1. It is often described as neuropathic or nociceptive pain and categorised as either acute or chronic.

Highlighted as one of the most prominent causes of disability2, global estimates suggest that pain affects around 20% of adults3 and each year 10% are newly diagnosed with chronic pain3. In the UK alone, it is estimated that chronic pain affects around 28 million adults4 with 10.4% to 14.3% experiencing moderate to severely disabling chronic pain4.

Acute and chronic pain are often defined by their duration. Chronic pain is described as pain that has been present for more than twelve weeks; beyond the expected time of wound healing5.

Acute pain is typically seen following trauma, surgery, and various diseases. It is caused by injury and the local activation of nociceptive transducers at the site of tissue damage. While medical interventions can be utilised to prevent or reduce pain, acute pain differs from chronic pain in that the body’s reparative mechanisms are able to repair the local damage, allowing the pain to subside.

Chronic pain can be described as nociceptive, where pain is caused by inflammation or tissue damage, or neuropathic, where it is caused by damage or malfunction of the nervous system. This damage can be through various mechanisms such as extensive trauma, scarring, amputation, or nervous system damage. Notably, analgesia does not resolve the underlying pathological process and will only provide transient relief for chronic pain.

These different types of pain are inherent to the human experience; they affect everyone at various stages of their life and are a part of the human life cycle. They also have a huge impact on quality of life by reducing physical function, disturbing sleep, disrupting employment and negatively effecting social and family life6. Depression is also a common comorbidity, which can require additional treatment7.

Chronic pain management has the aim of reducing this impact. Although achieving this is challenging as responses to analgesia can vary considerably13 and some types of pain, such as neuropathic, are harder to treat and respond poorly to conventional analgesics5. Optimal pain management consequently relies on a comprehensive history, objective findings, social concerns, co-morbidities, non-medical factors and pain severity assessment10. With the right treatment approach and implementing the best strategy, HCPs can improve the lives of many patients with chronic pain.

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Pain Podcasts

Keeping you up to date on the latest COVID-19 news, learn from the personal experiences of Dr Tong Gan and Professor Serge Perrot as they discuss how the coronavirus disease 2019 (COVID-19) pandemic has impacted the management of acute and chronic pain.

Episode 1: GP advice for acute and chronic pain management

As countries around the world progress through the second wave of the COVID-19 pandemic, Dr Tong Gan and Professor Serge Perrot explore how the pandemic has introduced challenges to the management of acute and chronic pain. Find out about the psychological effects, continuing the use of medications such as opioids and NSAIDs, out-of-the-box management strategies, guideline updates, and more.

Episode 2: Specialist advice for post-operative and rheumatic pain management

How is the COVID-19 pandemic impacting specialists? Join Dr Tong Gan as he explains the crossroads of the opioid epidemic, continuing treatments such as NSAIDs, the impact on post-operative pain management, and the dangers of immune suppression. Also hear from rheumatic pain expert Professor Serge Perrot on the major issue of pain in rheumatic disease, the difficulties of a multimodal approach to treatment, and the risk of severe outcomes caused by rheumatic diseases.

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  1. IASP Task Force on Taxonomy. Part III: Pain terms, a current list with definitions and notes on usage. In: Merskey H, Bogduk N, editors. Classification of Chronic Pain (Revised). 1994. Seattle. IASP Press: 209–214.
  2. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2163–2196.
  3. Goldberg DS, McGee SJ. Pain as a global public health priority. BMC Public Health. 2011;11. doi:10.1186/1471-2458-11-770.
  4. Fayaz A, Croft P, Langford RM, Donaldson LJ, Jones GT. Prevalence of chronic pain in the UK: A systematic review and meta-analysis of population studies. BMJ Open. 2016;6:DOI: 10.1136/bmjopen-2015-010364.
  5. National Institute for Health and Care Excellence (NICE). Chronic Pain treatment summary. https://bnf.nice.org.uk/treatment-summary/pain-chronic.html. Accessed 17 July 2020.
  6. Dueñas M, Ojeda B, Salazar A, Mico JA, Failde I. A review of chronic pain impact on patients, their social environment and the health care system. J Pain Res. 2016;9:457–467.
  7. Holmes A, Christelis N, Arnold C. Depression and chronic pain. Med J Aust. 2013;199(S6):S17–S20.
  8. Coluzzi F, Valensise H, Sacco M, Allegri M. Chronic pain management in pregnancy and lactation. Minerva Anestesiol. 2014;80(2):211–224.
  9. Conaghan PG, Peloso PM, Everett S V, Rajagopalan S, Black CM, Mavros P, et al. Inadequate pain relief and large functional loss among patients with knee osteoarthritis: evidence from a prospective multinational longitudinal study of osteoarthritis real-world therapies. Rheumatology. 2015;54(2):270–277.
  10. Hollingshead NA, Meints S, Middleton SK, Free CA, Hirsh AT. Examining influential factors in providers’ chronic pain treatment decisions: A comparison of physicians and medical students Career choice, professional education and development. BMC Med Educ. 2015;15(1). doi:10.1186/s12909-015-0441-z.
  11. Fillingim RB. Individual differences in pain: Understanding the mosaic that makes pain personal. Pain. 2017;158(4):S11–S18.
  12. Studenic P, Radner H, Smolen JS, Aletaha D. Discrepancies between patients and physicians in their perceptions of rheumatoid arthritis disease activity. Arthritis Rheum. 2012;64(9):2814–2823.
  13. Packiasabapathy S, Sadhasivam S. Gender, genetics, and analgesia: Understanding the differences in response to pain relief. J Pain Res. 2018;11:2729–2739.
  14. Casale R, Symeonidou Z, Bartolo M. Topical Treatments for Localized Neuropathic Pain. Curr Pain Headache Rep. 2017;21(3). doi:10.1007/s11916-017-0615-y.
  15. Altman RD, Barthel HR. Topical therapies for osteoarthritis. Drugs. 2011;71(10):1259–1279.
  16. Poeran J, Memtsoudis SG. Chronic opioid use and long-term mortality: a global problem. Br J Anaesth. 2020;124(1):17–19.

  17. Onwuchekwa Uba R, Ankoma-Darko K, Park SK. International comparison of mitigation strategies for addressing opioid misuse: A systematic review. J Am Pharm Assoc. 2020;60(1):195–204.

  18. WHO’s cancer pain ladder for adults. WHO. 2013. https://www.who.int/cancer/palliative/painladder/en/ (accessed 30 September 2020).

  19. Pak SC, Micalos PS, Maria SJ, Lord B. Nonpharmacological interventions for pain management in paramedicine and the emergency setting: a review of the literature. Evid Based Complement Altern Med. 2015;8.
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