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One Neuroscience and Pain Learning Zone
Declaration of sponsorship Novartis Pharma AG

Pain

Declaration of sponsorship Novartis Pharma AG
Read time: 450 mins
Last updated:15th Dec 2020
Published:15th Dec 2020
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, England, UK
  • Professor Nicholas Moore is Director of the Pharmacology Department at University Hospital of Bordeaux, University of Bordeaux, France

  • Dr Helena Marzo-Ortega is a Consultant Rheumatologist for the Leeds Teaching Hospitals NHS Trust and Honorary Clinical Associate Professor at the NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, England, 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
  • Professor Uwe Reuter is a professor of neurology and Managing Director at Charité University Hospital of Berlin, Germany
  • 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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 Introduction

Pain is often poorly managed1,2

In this section of the learning zone, leading clinicians share clinically relevant case studies that address the challenges posed by optimising and individualising pain management throughout the patients’ life.

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Pain references

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  2. 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.
  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.
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  6. Hawker GA, Croxford R, Bierman AS, Harvey PJ, Ravi B, Stanaitis I, et al. All-cause mortality and serious cardiovascular events in people with hip and knee osteoarthritis: A population based cohort study. PLoS One. 2014;9(3):e91286.
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  8. Solomon DH, Rassen JA, Glynn RJ, Lee J, Levin R, Schneeweiss S. The comparative safety of analgesics in older adults with arthritis. Arch Intern Med. 2010;170(22):1968–1978.
  9. Allegri M, Montella S, Salici F, Valente A, Marchesini M, Compagnone C, et al. Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Research. 2016;5:DOI: 10.12688/f1000research.8105.2.
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  11. 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.
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  46. van Walsem A, Pandhi S, Nixon RM, Guyot P, Karabis A, Moore RA. Relative benefit-risk comparing diclofenac to other traditional non-steroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors in patients with osteoarthritis or rheumatoid arthritis: A network meta-analysis. Arthritis Res Ther. 2015;17(1):66.
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The One Neuroscience and Pain Learning Zone has been developed by EPG Health for Medthority in collaboration with Novartis Pharma AG, with content provided by Novartis Pharma AG. The views presented in the videos are those of the presenters and not necessarily those of the industry sponsor, Novartis Pharma AG. Any data on non- Novartis products are based on publicly available information at the time of content update. Prescribing information may vary depending on local health authority approval in each country. Before prescribing any product, always refer to the SmPC or product information approved in your local country. CNS Learning Zone: FUSE ID: 8503, 104429, 127972, 136154 and Pain Learning Zone: FUSE ID:11501.