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Neuroscience and Pain Learning Zone


Read time: 305 mins
Explore how pain management can be optimised by combining careful assessment, employing non-pharmacological approaches and balancing the relative and absolute risks and benefits of each analgesic. Learn that while pain is almost universal, one size of treatment doesn’t fit all patients.

Pain is common and often poorly managed1,2. Globally, it has been estimated that 1 in 5 adults suffer from pain and that another 1 in 10 adults are diagnosed with chronic pain each year3. Apart from acute pain associated with surgery or tissue damage, approximately 28 million adults in the UK live with chronic pain 4,5. ). Indeed, between 10.4% and 14.3% of adults experience moderately to severely disabling chronic pain4. Pain can markedly undermine quality of life – affecting activities of daily living, employment and prognosis – dramatically increase use of health resources and is associated with increased mortality6–8. For instance, up to 84% of adults experience chronic low back pain, the second leading cause of disability worldwide and the most common musculoskeletal disease9. Indeed, 5 of the 11 conditions that impose the greatest global health burden are pain-related10.

Meet the experts

  • Dr Dominic Aldington is Clinical Lead for Pain Management, Hampshire Hospitals NHS Trust, UK 
  • Maxime Dougados is Professor of Rheumatology at the René Descartes University – Paris and Cochin Hospital, Paris, France 
  • Ayman Ebied is Professor of Orthopaedics at Menoufia University Hospitals, Al Minufya, Egypt 
  • Professor Hartmut Göbel is Medical Director for Neurology and Behavioural Medicine in the Pain Clinic, Kiel, Germany 
  • Professor Marc Hochberg is Division Head, Rheumatology and Clinical Immunology at the University of Maryland School of Medicine, Baltimore, US. 
  • Professor Andrew Moore is Director of Pain Research, Nuffield Department of Anaesthetics at the University of Oxford, UK 
  • Professor Seza Özen is Head of the Department of Paediatric Rheumatology, Hacettepe University Faculty of Medicine in Ankara, Turkey 
  • Professor José Pereira da Silva is Head of the Rheumatology Department, University Hospital Coimbra, Portugal 
  • Dr Meeta Singh is a Gynaecologist and Obstetrician at Tanvir Hospital, Hyderabad, India 

Understanding pain

When evaluating and treating a patient presenting with pain, taking a comprehensive history and accurately assessing pain severity are essential. Determining patient comorbidities, such as cardiovascular and renal disease, depression and anxiety, along with factors such as age and pregnancy, will help inform treatment decisions and individualise therapy. 


There are a number of treatment options available for pain, including non-pharmacological approaches, non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol and opioids.  

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Pain management

Despite numerous analgesics and non-pharmacological treatments, pain is often poorly managed. Poor pain management is, in turn, associated with an increased risk of mortality2,34,35. This section of the Learning Zone considers, in more detail: 

non-pharmacological pain management; treatment of acute pain; the role of paracetamol and opioids; how HCPs can reduce the risk of gastrointestinal complications; and the importance of NSAID formulation.

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Top tips in pain management

This section includes helpful videos exploring the effect of NSAID formulation, a brief summary of the evidence, the interpretation of network meta-analyses, controversies in pain management and an Ask the Expert session.

Importance of NSAID formulation

Should diclofenac potassium be preferred over diclofenac sodium for acute pain relief?

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Pain references

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Anwar A, John Anwar I, and Delafontaine P. Elevation of cardiovascular risk by non-steroidal anti-inflammatory drugs. Trends in Cardiovascular Medicine. 2015;25:726-735

Ashburn MA and Fleisher LA. Perioperative opioid management — An opportunity to put the genie back into the bottle. JAMA Surgery. 2018;153:938

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Chappell AS, Desaiah D, Liu-Seifert H, Zhang S, Skljarevski V, Belenkov Y et al. A double-blind, randomized, placebo-controlled study of the efficacy and safety of duloxetine for the treatment of chronic pain due to osteoarthritis of the knee. Pain Practice. 2011;11:33-41

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Machado GC, Maher CG, Ferreira PH, Pinheiro MB, Lin C-WC, Day RO et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: Systematic review and meta-analysis of randomised placebo controlled trials. British Medical Journal. 2015;350:h1225

Marks JL, Colebatch AN, Buchbinder R, and Edwards CJ. Pain management for rheumatoid arthritis and cardiovascular or renal comorbidity. Cochrane Database of Systematic Reviews. 2011;DOI:10.1002/14651858.CD008952.pub2

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Moore A, R., Derry S, Taylor RS, Straube S, and Phillips CJ. The costs and consequences of adequately managed chronic non-cancer pain and chronic neuropathic pain. Pain Practice. 2014;14:79-94

Moore RA, Cai N, Skljarevski V, and Tölle TR. Duloxetine use in chronic painful conditions – individual patient data responder analysis. European Journal of Pain. 2014;18:67-75

Moore RA, Derry S, Aldington D, and Wiffen PJ. Single dose oral analgesics for acute postoperative pain in adults - an overview of Cochrane reviews. The Cochrane Database of Systematic Reviews. 2015;2015:CD008659-CD008659

Moore RA, Derry S, Simon LS, and Emery P. Nonsteroidal anti-inflammatory drugs, gastroprotection, and benefit–risk. Pain Practice. 2014;14:378-395

Moore RA, Derry S, Wiffen PJ, Straube S, and Aldington DJ. Overview review: Comparative efficacy of oral ibuprofen and paracetamol (acetaminophen) across acute and chronic pain conditions. European Journal of Pain. 2015;19:1213-1223

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Wadensten B, Fröjd C, Swenne CL, Gordh T, and Gunningberg L. Why is pain still not being assessed adequately? Results of a pain prevalence study in a university hospital in Sweden. Journal of Clinical Nursing. 2011;20:624-634