European Week Against Pain
Added: (Thu Oct 04 2001)
Pressbox (Press Release) -
For embargo until midnight 7 October 2001
“Don’t Suffer in Silence” Medical Experts Urge Patients in Pain
London – 7 October 2001 – Medical experts are urging patients suffering pain to alert the healthcare professionals caring for them about their symptoms and to ensure that they “Don’t Suffer in Silence”. The initiative by the Pain Society opens the ‘European Week Against Pain’ which will run from 8 to 13 October 2001.
“The control of pain has been relatively neglected by governments in the past, despite the fact that cost-effective methods of pain control are readily available,” commented Dr. Chris Wells, a Specialist in Pain Relief based in Liverpool, and Secretary of the British Pain Society.
“There are vast disparities in the pain management services offered around the country,” continued Dr. Wells. “Where there are energetic healthcare professionals with the drive to set up good pain management services, the provision is excellent, but there are some areas with huge waiting lists and very little provision at all. Furthermore, there is no overall structure for pain management services in this country – even though adopting best practice in pain management can help hospitals, GP practices and other healthcare facilities to reduce the overall cost of care by decreasing the number of patients readmitted, speeding up discharge from hospital, and relieving some of the pressures on healthcare professionals.”
Patients and healthcare professionals can contact the Pain Society via their re-designed web-site at www.painsociety.org.
Pain can be either acute or chronic. Chronic pain is commonly defined as pain or discomfort that persists continuously or intermittently for longer than three months despite treatment. The causes of pain range from common problems like dysmenorrhoea (period pain), back pain, headaches and migraine, or arthritis, through to pain caused by life-threatening conditions such as cancer or a heart attack.
Dr Chris Wells commented: “There are around 22 million episodes of back pain every year in the UK – yet only one in ten people seek medical help. Post-operative pain is another area where we are certain that patients don’t speak up and ask for pain relief – even when they are in a hospital.”
Acute pain is one of the most common reasons for seeking the help of a doctor and delivery of appropriate treatment is critical to the total care of patients. If pain is left uncontrolled, individuals become increasingly more sensitive to it.1 Acute pain is associated with a number of potentially harmful reflexes affecting the heart and circulation, breathing, and state of mind. These reflexes can perpetuate or exacerbate the underlying injury or illness and can prolong a hospital stay.2 In patients undergoing surgery, uncontrolled pain can increase the risk of complications, and prolonged pain can reduce physical activity to the point where the individual is at increased risk of deep vein thrombosis and pulmonary embolism2 – which in themselves are potentially fatal.
Appropriate treatment of acute pain also decreases the likelihood of progression to development of chronic pain, which can have a detrimental impact both on the lives of those affected and healthcare budgets.
A survey of patients in general practice revealed that half the respondents reported having chronic pain, and that for about half of those the pain is significant.3 4 The extent of chronic pain increased with age in women and men from about one-third of those aged 25–34 years to almost two-thirds in those older than 65 years.3 4 The two most common reasons for chronic pain were back pain, which varied little with age, and arthritis, which rose dramatically with age to afflict a quarter of people in their 60s or older.3 4 A quarter of those with chronic pain had pain that was highly disabling and at least moderately limiting, and a further quarter had pain that was of high intensity.3 4
The ‘European Week Against Pain’ aims to raise the profile of pain within the European Union and to promote the recognition that pain is not merely a symptom of disease, but an important health concern in its own right. Pain, particularly chronic pain, is a major liability in the balance of quality of life in Europe, and will become more so as the average age of citizens increases.
This communication was funded by an unrestricted educational grant to the Pain Society by Merck Sharp & Dohme Limited.
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Note to editors:
For further information or requests for interviews, please contact:
Ruth Ashton or David Turner at Galliard Healthcare Communications
Tel: 020 7420 3270 Fax: 020 7420 3271, Email: rashton@galliardhealth.com
dturner@galliardhealth.com
Further information can also be obtained from:
www.iasp-pain.org (International Association for the Study of Pain)
www.painsociety.org (British Chapter of the International Association for the Study of Pain)
www.efic.org (European Federation of IASP Chapters)
References
1. Ducharme J. Ann Emerg Med 2000; 35:592–603.
2. Charlton E. Update in Anaesthesia 1997; 7: 2–17.
3. Elliott AM et al. The epidemiology of chronic pain in the community. Lancet 1999; 354: 1248–1252.
4. Pain – There’s a lot of it about. Bandolier website, Dec 1999. Ed. Andrew Moore.
www.jr2.ox.ac.uk/bandolier/band70/b70-3.html
For Embargo until midnight 7th October 2001
Acute and Chronic Pain
Pain is an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Pain can be either acute or chronic. While acute pain signals actual or potential tissue damage – and generally remits when the underlying pathology is resolved, chronic pain is commonly defined as pain or discomfort that persists continuously or intermittently for longer than three months despite sensible treatment1.
The cause of pain ranges from common problems like dysmenorrheoa (period pain), back pain, headaches and migraine, or arthritis through to pain caused by life-threatening conditions such as cancer or a heart attack.
Acute Pain
Acute pain is one of the most frequent reasons people seek help from a doctor and delivery of appropriate treatment is critical to the total care of patients.
If pain is left uncontrolled, individuals become increasingly more sensitive to it.2 Acute pain is associated with a number of potentially harmful reflexes – including rapid beating of the heart, increased cardiac output, high blood pressure, decreased gastric activity, constriction of blood vessels, increased breathing rate, excessive perspiration, enlarged pupils and anxiety. These reflexes can perpetuate or exacerbate the underlying injury or illness. Subsequent effects on the gut and urinary tract can result in nausea, vomiting, and urinary retention – which are unpleasant and can prolong a hospital stay.3
In patients undergoing surgery, uncontrolled pain can increase the risk of complications, and prolonged pain can reduce physical activity to the point where the individual is at increased risk of deep vein thrombosis and pulmonary embolism3 – which in themselves are potentially fatal.
Appropriate treatment of acute pain also decreases the likelihood of progression to development of chronic pain, which can have a detrimental impact both on the lives of those affected and healthcare budgets.
Acute Pain in Primary Care
· A 1998 UK survey showed that 40% of adults suffered from back pain lasting more than one day during a 12-month period, and nearly 40% of these present at General Practice4. More recent estimates suggest that 5 million adults consult a doctor about back pain every year.5 While chronic back pain increases with age, it appears that younger people are more likely to have brief acute episodes of back pain than older adults – 34% of those aged 16-24 years old reported between one and six days of back pain during a one year period compared with only 13% of people aged 65 years and over. 4
· Primary dysmenorrhoea (menstrual pain) affects 40-70% of women of reproductive age, disrupts the daily activities of 10% to 12% of women6,7 and can cause one to three days of significant incapacitation each month.7 The acute pain associated with dysmenorrhoea is described as crampy, spasmodic and similar to labour pains, and the common accompanying symptoms include nausea, vomiting and diarrhoea.7 US research has shown that 45% of adolescent females with dysmenorrhoea miss school or work – yet only 15% had used any prescription medication, and only 15% could name any non-steroidal anti-inflammatory agent (except aspirin) that could help relieve the pain of their dysmenorrhoea.8
Acute Pain Management in Secondary Care
· The Acute Pain Service, usually involving nursing, medical and pharmacy staff, provides the framework for acute pain management in secondary care. The most recent (1996) survey on acute pain services showed that they are available in all regional health authorities – although the provision and structure of these services varies greatly from hospital to hospital.9
· Patient satisfaction with acute pain management remains mixed: of 100 consecutive patients admitted to an Orthopaedic and Trauma Unit in the UK, 54% described their pain before treatment as ‘severe’ or the ‘worst possible pain’, and 36% said they would have liked more analgesia prior to surgery.10
· Many studies have shown that under-treatment of acute post-operative pain occurs because doctors and nurses overestimate the length of action and the strength of opioid drugs, and they have fears about possible side effects e.g. respiratory depression, vomiting and sedation.3
Drug Treatment for Acute Pain
· In contrast to chronic pain, where non-pharmacological treatment options may be pursued, most acute pain is managed solely with drugs. In England in 1995, 32 million prescriptions for non-opioid drugs were written (mainly paracetamol and its combinations), 17 million for non-steroidal anti-inflammatory drugs (NSAIDs) and 4 million for opioids.11
· The WHO Analgesic Ladder, introduced to improve the management of cancer pain, can be applied to acute pain. The ladder represents a stepped approach to pain management, which has three rungs. Analgesics (aspirin, paracetamol and NSAIDs) are followed by weak opioid drugs such as codeine. If pain control is not achieved, the final option is to introduce strong opioid drugs such as morphine.3
· As analgesia from peripherally acting drugs is additive to that from centrally acting opioids, the two can be given together.3
Chronic Pain
· A survey of 3,600 patients in Scottish general practice revealed that half the respondents reported suffering with chronic pain, and that for about a quarter of those, the pain is significant.12,13 The extent of chronic pain increased with age in women and men from about one-third of those aged 25–34 years to almost two-thirds in those older than 65 years.13 The two most common reasons for chronic pain were back pain, which varied little with age, and arthritis, which rose dramatically with age to afflict a quarter of people in their 60s or older.12,13 Pain from injury and unknown causes was constant with age at 4.5%.12 A quarter of those with chronic pain considered it highly disabling and at least moderately limiting, and a further quarter had pain that was of high intensity.13
Treatment of Chronic Pain
· The same analgesics, from NSAID through to opioid, are used in treating chronic and acute pain, although these are not the only pharmacological options. Drugs known as unconventional analgesics can be used to treat chronic pain. These are drugs which are commonly used in other medical settings, but not normally thought of as analgesics – and include certain types of antidepressants (used at a lower dose than for treating depression), and anticonvulsants (which are commonly used to treat epilepsy).14
· Blocking nerve transmission with a local anaesthetic is another option for chronic pain management, which is typically used in the secondary care setting, and it appears that the duration of pain relief can far outweigh the duration of action of the local anaesthetic action, and that prolonged relief can be obtained from several nerve blocks.14,15
· TENS (transcutaneous electrical nerve stimulation) and acupuncture are often classified as alternative therapies, and, as yet, there has been little work comparing these complementary approaches with mainstream therapies. The rationale for TENS is based on the Gate Control Theory of Pain: if the spinal cord is bombarded with impulses from the TENS machine then it is distracted from transmitting the pain signal.14
· Pain Clinics are run from secondary care and offer a variety of approaches to pain management. Their approach is usually based on rehabilitation for people with enduring, chronic pain and they usually provide a combined approach, including fitness training, activity scheduling, relaxation and cognitive therapeutic approaches, that enable patients to take a more active role in controlling their pain.14
This communication was funded by an unrestricted educational grant to the Pain Society by Merck Sharp & Dohme Limited.
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For further information, please contact:
Ruth Ashton or David Turner at Galliard Healthcare Communications
Tel: 020 7420 3270 Fax: 020 7420 3271
Email: rashton@galliardhealth.com
dturner@galliardhealth.com
Further information can also be obtained from:
www.iasp-pain.org (International Association for the Study of Pain)
www.painsociety.org (British Chapter of the International Association for the Study of Pain)
www.efic.org (European Federation of IASP Chapters)
References
1. Turk D, Okifuji A. Pain Terms and Taxonomies of Pain, p 17 in Bonica’s Management of Pain, 2001. Ed. Loeser
2. Ducharme J. Ann Emerg Med 2000; 35(6): 592-603
3. Charlton E. Update in Anaesthesia 1997; 7 Article 2: pages 2-17
4. Department of Health. The prevalence of back pain in Great Britain in 1998
5. Maniadakis N. Pain 2000; 84:95-103
6. Zhang WY, Li Wan Po A. Br J Obstet Gynaecol 1998; 105(7): 780-789
7. Dawood MY. The Endometrium 1995; 6(2): 363-377
8. Johnson Joann. J of Adolescent Health Care 1988; 9: 398-402
9. Davies K. Nursing Times 1996; 92(17): 31-33
10. Morgan-Jones R. J R Coll Surg Edinb 2000: 371-372
11. McQuay H. BMJ 1997; 314:1531-1535
12. Tramer M. Pain 2000; 85: 169-182
13. Elliott AM et al. The epidemiology of chronic pain in the community. Lancet 1999; 354: 1248–1252.
14. Pain – There’s a lot of it about. Bandolier website. Ed. Andrew Moore. Dec 1999.
www.jr2.ox.ac.uk/bandolier/band70/b70-3.html
15. McQuay H. Pain and its control. Bandolier website. www.jr2.ox.ac.uk/bandolier/booth/painpag/wisdom/C13.html
16. Arner et al. Prolonged relief of neuralgia after regional anesthetic blocks. A call for further experimental and systematic clinical studies. Pain 1990; 43: 287-297.