Failed back (surgery) syndrome: time for a paradigm shift

Summary points: 1. The group of patients with so-called ‘failed back surgery syndrome’ (FBSS) is very diverse. Published studies evaluating the outcome of surgical treatment vary widely in terms of surgical interventions that were performed. Results from these papers cannot be generally applied to all people who have persisting complaints after low back surgery. 2. The literature search t…

Aluminium foil for the prevention of post-amputation pain: a randomised, doub…

Abstract: Introduction: Phantom limb pain (PLP) is a painful sensation perceived in the missing limb after amputation. The underlying pathophysiology remains unclear. Until recently, only opioid analgesics have been proven to be effective in prospective studies. Anecdotally, patients with PLP employ self-help measures, sometimes including ‘wrapping up’ or rubbing their stump with alumini…

Case studies illustrating the management of trigeminal neuropathic pain using…

Abstract: Chronic trigeminal pain, with its severe related functional problems, is difficult to treat. Treatment is often empirically based on medications used for other chronic pain conditions. Systemic sodium channel and calcium channel blocking agents may cause a multitude of complications that are often poorly tolerated by the patient. Aim: The aim of this case report was to assess the …

Reproducibility of pain manikins: a comparison of paper versus online questio…

Abstract: Background: In epidemiological studies, pain location is often collected by paper questionnaire using blank body manikins, onto which participants shade the location of their pain(s). However, it is unknown how reliable these will transfer to online questionnaires. The aim of the current study was to determine agreement between online- and paper-based completion of pain manikins. Me…

The pain of chronic pancreatitis: a persistent clinical challenge

Abstract: The pain of chronic pancreatitis represents a major challenge to those working in the field, including pain specialists, gastroenterologists and surgeons. This article describes the different aetiologies of chronic pancreatitis and lists the models for the pathogenesis of pain, including novel ideas such as the role of the immune system in the modulation of pain. The patient profile …

Veterans and chronic pain

Summary points 1. Musculoskeletal problems are the commonest reason for medical discharge in all the British armed forces. By definition, these problems are chronic and resistant to treatment. 2. Pain is also common in veterans who have experienced severe injuries (polytrauma), often accompanied by post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) orpost concussive syndr…

Gut pain & visceral hypersensitivity

Abstract: Visceral pain is a highly complex entity whose experience is variable in health and disease. It can occur in patients with organic disease and also in those without any readily identifiable structural or biochemical abnormality such as in the functional gastrointestinal disorders (FGID). Despite considerable progress in our understanding of the culpable underlying mechanisms signifi…

The psychological impact of torture

Abstract: Many refugees in the developed world are survivors of torture and present with health needs without their traumatic experience being disclosed or identified. Chronic pain is a common problem, as are symptoms of post-traumatic stress disorder (PTSD), anxiety, depression, and other distress. Current circumstances, particularly poverty, uncertainty about asylum, separation from or loss …

Pharmacogenetics of analgesic drugs

Summary points •• Individual variability in pain perception and differences in the efficacy of analgesic drugs are complexphenomena and are partly genetically predetermined. •• Analgesics act in various ways on the peripheral and central pain pathways and are regarded as one ofthe most valuable but equally dangerous groups of medications. •• While pharmacokinetic properties of dr…

Traumatic amputations

Abstract: Traumatic amputations remain one of the most emotionally disturbing wounds of conflict, as demonstrated by their frequent use in films to illustrate the horrors of war. Unfortunately, they remain common injuries, particularly following explosions, and, in addition, many survivors require primary amputation for unsalvageable injuries or to save their life. A third group, late amputat…

Can a pain management programme approach reduce healthcare use? Stopping the …

Abstract: Patients with chronic musculoskeletal pain are frequent users of healthcare. Whilst evidence suggests that a multidisciplinary pain management programme (PMP) approach is effective in reducing patients’ levels of distress and disability, there is little research examining the cost-effectiveness of such an approach. The present study sought to address this by examining the impact a …

Endometriosis-associated pain syndrome: a nurse-led approach

Abstract: Endometriosis is an enigmatic disease and its fundamental cause is still unknown. Endometriosis associated pain syndrome is a common problem; it is underdiagnosed and patients suffering from the syndrome are rarely seen in specialist pain clinics. The correlation between the extent of the disease and pain is weak. Endometriosis-associated pain syndrome may be cyclical or persistent…

Is cognitive behavioural therapy for insomnia effective in treating insomnia …

Abstract: Aim: This paper systematically reviews clinical trials investigating the effectiveness of cognitive behavioural therapy for insomnia and pain in patients with chronic non-malignant pain. Method: A systematic search of MEDLINE, PSYCINFO, EMBASE, CINHAL and Cochrane library and register of trials was conducted. Results: Essential components of cognitive behavioural therapy for in…

Evidence-based clinical practice guidelines on the management of pain in olde…

The British Pain Society and British Geriatric Society have collaborated to produce comprehensive pain management guidelines based on an extensive systematic review of the available literature by a professional multidisciplinary group. This guidance reviews the epidemiology and management of pain in older people with the aim of providing best practice recommendations for the management of pain …

Diagnosis and treatment of failed back surgery syndrome in the UK: mapping of…

Abstract: Background: Chronic back pain is a serious public health issue, associated with poor quality of life and disability. There is a specific group of chronic back pain sufferers whose pain persists despite their having undergone anatomically successful lumbosacral spine surgery. These patients are known as having failed back surgery syndrome (FBSS) and are frequently seen in pain clinics…

Opioids and endocrine dysfunction

Abstract: The endocrine effects of opioids used for the management of persistent pain are poorly understood by clinicians and patients, and hormone levels are rarely measured. It is recognized that opioids exert this effect via the hypothalamic-pituitary-gonadal axis. Additional effects on adrenal hormones, weight, blood pressure and bone density may also occur. Symptoms and signs of sex hormo…

The evidence base for managing older persons with low back pain

Abstract: It has been suggested that older persons are less likely to receive optimal care for pain, and a recent population study suggested that management of low back pain (LBP) in primary care differed with older age. Low back pain is the most commonly reported regional pain syndrome, and the objective of the current review was to determine the evidence base for managing LBP in older perso…

Equianalgesic doses of opioids their use in clinical practice

Edisi

(2012), 6(1)

ISBN/ISSN

DOI: 10.1177/2049463

Deskripsi Fisik

British Journal of Pain 6(1) 43– 46 © The British Pain Society 2012

Judul Seri

Pain

No. Panggil

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Interprofessional pain learning and working: different perspectives

After suffering a stroke Mr Martin Stephen1 decided to write about his experience, narrating a moving yet entertaining story towards recovery. Interestingly, to achieve this very recovery he felt he needed to get out of hospital and cure himself. Reading about his hospital experience I thought that the care he received did not place him at its centre and was fragmented. It consisted of healthc…

Opioids, pain and addiction – practical strategies

Summary points 1. Addiction can occur with the repeated exposure of a biogenetically predisposed person to an addictive substance or behaviour. 2. In the patient with pain on opioid therapy, use the ‘4 Cs’ to diagnose addiction. 3. Screening and risk stratification of all patients considered for opioid therapy is a key element of ‘universal precautions’ in pain management. 4. There …

Failed back surgery syndrome: a suggested algorithm of care

Abstract: Failed back surgery syndrome (FBSS) is a complex condition which can be very difficult to treat. In this article, we propose a pragmatic algorithm for the management of the syndrome. The management of this condition should include a comprehensive initial assessment to rule out treatable cause, pharmacological optimisation, psychological techniques and neuromodulation. There is good e…

Neuraxial (epidural and intrathecal) opioids for intractable pain

Summary Points 1. Neuraxial opioids are considered for use in patients who have resistant intractable pain that fails to respond to other treatment options or pain that responds to analgesia but for which the doses required result in unacceptable side-effects. 2. Neuraxial opiods can be considered for both chronic non-malignant pain and chronic cancer related pain. 3. Effectiveness in chroni…

Education as part of wider health policy and improvement strategies

Summary points 1. The majority of people living with persistent pain will receive treatment for the pain from nonspecialists in pain management who may not have received the necessary training to deliver highquality care. 2. There is now a wide range of learning platforms and packages available, but these may struggle to reach beyond those with a specialist interest. Addressing this will requ…

Reducing the distance: providing challenging and engaging online postgraduate…

Summary points: 1. Health professionals need access to flexible, high-quality, advanced education in pain management. 2. There are multiple pedagogical distances to be negotiated in the delivery of effective postgraduate education. 3. A critical consideration in the design and delivery of effective online learning for postgraduateeducation in pain management is how to: actively engage studen…

Interprofessional pain education: definitions, exemplars and future directions

Summary points1–6 1. The management of pain frequently requires healthcare professionals (HCPs) to work together; thus, educational preparation should afford them opportunities to learn about the management of pain together. 2. Survey data suggest that most HCPs’ curricula do not provide opportunities for learners to come together to learn about pain and understand their professional rol…

Evaluating the impact of pain education: how do we know we have made a differ…

Summary points 1. Education is a core activity for most healthcare professionals working in pain management and an effective evaluation strategy should assess its impact. 2. Evaluation may have one or more purposes: accountability, development or knowledge generation. Other key principles include making evaluation integral to the education process, reflecting with learners on progress, self…

A decade of improvement in pain education and clinical practice in developing…

Summary points: 1. Epidemiological studies, in the late 1990s and early 2000s, on the extent of pain in the community of western countries revealed a prevalence of around 18%, with significant effects on work and social activities despite 30 years of pain education programmes. 2. A survey by the International Association for the Study of Pain (IASP) Developing Countries on the extent of pain …

Assessing knowledge, perceptions and attitudes to pain management among medic…

Abstract Introduction: Chronic pain results in significant personal, societal and economic burden. Doctors and nurses have a pivotal role in patient pain management. In order to determine the effectiveness of current pain education on knowledge, attitudes and perceptions of medical and nursing students, there needs to be a valid measure to assess and quantify these domains. We reviewed the lit…

Clinical effectiveness of a residential pain management programme – compari…

Abstract: Objective: Observational studies using routinely collected data indicate that pain management programmes (PMPs) based on cognitive-behavioural principles are associated with clinically meaningful improvements for individuals with chronic pain. This study evaluated change across functional measures in a sample of chronic pain patients attending a 4-week residential PMP between 2006 a…

Towards a pain free hospital: an in-depth qualitative analysis of the pain ex…

Abstract: Background: Treatment for head and neck cancer can frequently be a painful experience with implications for patients in terms of quality of life, nutrition and ultimately treatment outcomes. Pain may arise for a number of reasons in this patient group including the influence of localised tissue damage from radiotherapy, the effects of chemotherapeutic agents as well as the disease pr…

Brief psychologically informed physiotherapy training is associated with chan…

Abstract: This study aimed to investigate the impact of a brief psychologically informed physiotherapy training (PIPT) course on physiotherapists’ attitudes and beliefs towards working with people with chronic pain. Specifically, the training aimed to help the participants better recognise the role of psychosocial factors in chronic pain and to better target the key processes of the psycholo…

Introducing Acceptance and Commitment Therapy to a physiotherapy-led pain reh…

Abstract Background: Recent developments in pain rehabilitation emphasise the importance of promoting psychological flexibility. Acceptance and Commitment Therapy (ACT) is one approach that has been shown to be effective for the treatment of chronic musculoskeletal pain. However, studies have shown that introducing innovative approaches such as ACT into established health care can cause some a…

A systematic review of prognostic factors for distal upper limb pain

Abstract: Background: Musculoskeletal pain in the distal upper limb is relatively common, can be a cause of disability, presents a high cost to society and is clinically important. Previous reviews of prognostic factorshave focused on pain in the proximal upper limb, whole upper extremity or isolated regions of the distal upper limb. Aim: To identify factors that predict outcome of distal upp…

The development and delivery of a female chronic pelvic pain management progr…

Abstract: Context/Background: Chronic pelvic pain (CPP) is a physically and psychologically debilitating condition. European Association of Urology (EAU) Guidelines (2013) and Royal College of Obstetricians and Gynaecologists (RCOG) guidelines (2012) place strong emphasis upon multi-speciality assessment and liaison, as well as interdisciplinary assessment and intervention in reference to the …

‘It makes you think’ – exploring the impact of qualitative films on pai…

Abstract Background: Researchers need to consider the impact and utility of their findings. Film is an accessible medium for qualitative research findings and can facilitate learning through emotional engagement. Aim: We aimed to explore the usefulness of a short film presenting findings from a published qualitative synthesis of adults’ experience of chronic musculoskeletal pain for pain ed…

An exploration of opioid medication management for non-malignant pain in prim…

Abstract: The present study aimed to explore how prescription of opioid medication for chronic non-malignant pain (CNMP) is managed in primary care. We used audit as a research tool, and one general practitioner (GP) practice in West London acted as an exemplar. Of the practice population with CNMP, 1% had repeat prescription of at least 12 months duration for opioid analgesics at the time of …

Interpretative phenomenological analysis as a useful methodology for research…

Abstract: Interpretative phenomenological analysis (IPA) is a qualitative approach which aims to provide detailed examinations of personal lived experience. It produces an account of lived experience in its own terms rather than one prescribed by pre-existing theoretical preconceptions and it recognises that this is an interpretative endeavour as humans are sense-making organisms. It is explic…

Establishing the characteristics for patients with chronic Complex Regional P…

Abstract: Objective: The long-term prognosis of patients with Complex Regional Pain Syndrome (CRPS) is unknown with no reported prospective studies from the United Kingdom longer than 18 months. The CRPS-UK Network aims to study this by use of a Registry. The aims of this article are, to outline the CRPS-UK Registry, assess the validity of the data and to describe the characteristics of a samp…

Qualitative systematic reviews: their importance for our understanding of res…

Abstract: This article outlines what a qualitative systematic review is and explores what it can contribute to our understanding of pain. Many of us use evidence of effectiveness for various interventions when working with people in pain. A good systematic review can be invaluable in bringing together research evidence to help inform our practice and help us understand what works. In addition …

How do people with chronically painful joint hypermobility syndrome make deci…

Abstract: Background: The model of activity avoidance prompted by fear of increased pain and/or harm dominates understanding and research into activity limitation in chronic pain. Yet, the accounts of people with chronic pain on decisions about activity limitation are rarely heard beyond the confines of fear and avoidance questionnaires. Methods: We used semi-structured interviews to explore …

Comparison of the effects of intra-articular sole ropivacaine and combined k…

Abstract: Introduction: Effective pain relief is important after arthroscopic knee surgery to permit initiation of daily activities of life. This study is performed in order to investigate the effect of multi-model therapy for pain control after surgery. This clinical, randomized and double-blind trial is conducted on patients who get knee arthroscopy surgery. Methods: Of these patients, 40 w…

Using qualitative methods to access the pain experience

Abstract: Qualitative methods provide us with techniques to access the pain experience of patients in ways that provide explanation for apparent contradictions and idiosyncrasies that are difficult to access. In this article, I review three such strategies and the application of qualitative research to practice: (1) the analysis of the ways participants speak about agonizing pain using narrati…

Ethnographies of pain: culture,context and complexity

Abstract: This article briefly introduces and discusses the value of ethnographic research, particularly research hailing from the discipline of social and cultural anthropology. After an introduction to ethnography in general, key ethnographic studies of pain are described. These show that ethnography provides a set of techniques for data collection and analysis, as well as a way of thinking …

Epidural analgesia provides effective pain relief in patients undergoing open…

Abstract Background: Epidural analgesia has been the reference standard for the provision of post-operative pain relief in patients recovering from major upper abdominal operations, including liver resections. However, a failure rate of 20–32% has been reported. Aim: The aim of the study was to analyse the success rates of epidural analgesia and the outcome in patients who underwent liver …

Prevalence of chronic non-cancer pain in a UK prison environment

Abstract: Chronic non-cancer pain (CNCP) is significant global health issue, accounting for a substantial increase in prescription analgesics worldwide, in recent decades. This clinical burden is evident in the UK prison population, where the prevalence of CNCP has never previously been determined. This study, conductedin June/July 2013, used prescribing data and a systematic review of clinica…

Can pictorial images communicate the quality of pain successfully?

Abstract: Chronic pain is common and difficult for patients to communicate to health professionals. It may include neuropathic elements which require specialised treatment. A little used approach to communicating the quality of pain is through the use of images. This study aimed to test the ability of a set of 12 images depicting different sensory pain qualities to successfully communicate tho…

Is intramuscular morphine satisfying frontline medical personnels’ requirem…

Abstract: Background: All deployed British Army personnel carry intramuscular (IM) morphine auto-injectors to treat battlefield casualties. No other nation supplies parenteral opiate analgesia on individual issue. Studies highlight this agent’s inefficacy and safety issues, but are limited by a relative lack of inclusion of frontline personnel. We aimed to determine the opinions of frontlin…

Prescribing opioid analgesics for chronic non-malignant pain in general pract…

Abstract: Background: This study replicates a previous postal survey of general practitioners (GPs) to explore whether attitudes to opioid prescribing have changed at a time when the number of opioid prescriptions issued in primary care has increased. Methods: With permission, a 57-item survey instrument previously utilised with GPs in the South-west of England was circulated to 214 GPs in ci…

How can qualitative research be utilised in the NHS when re-designing and com…

Abstract: Patient experience is acknowledged as a key quality metric of healthcare quality and can be used to identify problems with healthcare delivery, to drive quality improvements and to inform commissioning of services that promote patient choice. In this article, the contribution of qualitative research studies to inform the redesign and patient-focussed commissioning of services is con…

Influence of ethnicity on the perception and treatment of early post-operativ…

Abstract: Background: Previous studies indicated that patients from Black, Asian and minority ethnic (BAME) groups tend to receive less analgesics compared to Caucasian (White) patients after similar surgical procedures. Most such data originated from North America and suggested that health-care professionals may perceive the expression of excessive pain by BAME patient groups as an exaggerate…