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Pain management useful information

Acute pain

Acute pain is a normal physiological response to an unwanted and adverse chemical, mechanical or heat related trigger after surgery, trauma or any acute illness. Acute pain results from activation of the pain receptors (nociceptors) at the site of tissue damage. This type of pain is expected after surgery and anywhere where tissue damage occurs or inflammatory processes happen. Acute pain plays the important role of providing a warning signal that something is wrong and in need of further examination. Acute pain is typically self-limited and resolves over days to weeks, but it can persist for 3 months or longer as healing occurs. Acute pain can produce responses such as high BP, increased heart rate, sweating, shallow respiration, restlessness, facial grimacing, guarding behaviour and pupil dilation. Inadequate relief of acute pain can contribute to impaired immunity, leading to such complications as DVT and infections. Inadequately controlled acute pain can be a factor in the development of chronic pain, extended hospital stay, readmission, and patient dissatisfaction. In hospital, acute pain is managed by the acute pain team usually led by a consultant pain specialist and specialist pain nurses. Often a wide variety of pain relief interventions are started by anaesthetists in theatre and these may be, Spinals, Epidurals, nerve blocks and  Patient controlled analgesia of strong opioids such as morphine and oxycodone and fentanyl.

Chronic pain

Pain is considered chronic when it has persisted beyond 3 months since onset. Often we expect acute pain to resolve by this time but the mechanisms for acute pain do not switch off for many reasons. There is a significant societal burden and impact because of chronic pain and quite rightly, the Department of Health has recognised that chronic pain is a long term condition in its own right and a chronic disease in itself that must be recognised early and managed appropriately. The Chief Medical Officer’s report states that 25% of pain patients lose their jobs. 5 of the top 12 disabling conditions globally are persistent pain conditions and low back pain is ranked highest out of 291 conditions for years lost to disability.

Managing chronic (persistent) pain

Chronic pain can feel like a lonely experience but in fact, it affects fourteen million people in the UK.  Yet many people suffer needlessly, and could find relief through modern pain management treatments and a holistic approach that considers mind and body alike. This philosophy of treating the whole person is vital, as persistent  pain has a profound impact on both physical and mental wellbeing, and on your near and dear ones. Quite often, people with chronic pain are referred from one specialist doctor to another for a number of years without a proper diagnosis, adequate treatment or explanation.  If this sounds like you – or one of your patients – we can help. We start with a thorough and comprehensive evaluation to determine the cause of the pain and its effect on everyday life. The next step is to agree a treatment plan, so there are defined goals and everyone knows what to expect along the way. In line with best practice, we adopt an evidence based, multidisciplinary approach to managing and treating various pain conditions.  This may include a judicious combination of medication, injection therapy, exercise and psychological support where necessary.  We strongly believe that knowledge helps people manage their pain better. Our goal is to put our patients in the driver’s seat, allowing them to manage the pain and return to an active and enjoyable life. We provide a wide variety of therapies such as Acupuncture, Pain Management Programmes, Pacing and Mindfulness strategies, MDT consultations and other injection therapies

Pain management education and research

  • Acute pain: The pain nurses conduct a number of pain training and education sessions on PCA management, epidural training and other aspects of acute postoperative pain management to staff nurses, junior doctors and other healthcare professionals.
  • Chronic pain: There are education and training sessions on pain management for junior trainee doctors and anaesthetists twice a year in line with the changeover times.
  • Research: The pain management unit has been active in research and has been one of the sites for a multicentre drug trial for opioid induced constipation (COMPOSE).
  • Collaboration/Innovation: The Pain Management Unit has collaborated with the University of Reading and a 3 year program is ongoing with Phd Research scholars spending time with the clinicians.

Self help resources

This is an excellent short video from Australia explaining some recent research based understanding of physiology and effects of pain through the medium of white board animation. Understanding pain youtube.com/watch?v=ksNfgE3pVBw

Tedx Talks. This is an informative and highly entertaining talk from an eminent neuroscientist Lorimer mosely. youtube.com/watch?v=gwd-wLdIHjs

Low back pain: Another very good video regarding low back pain causes. whiteboard animation youtube.com/watch?v=BOjTegn9RuY

The mystery of chronic pain by Elliot Krane. A TED masterclass by an eminent Pain specialist from the USA. youtube.com/watch?v=J6--CMhcCfQ

Pain toolkit http://www.paintoolkit.org/

Pelvic pain site http://www.pelvicpain.org.uk/

Pain CD/DVD ‘Living with Chronic Pain’ – Neil Berry.  Information on various aspects of pain management, including sleep, goal-setting, medication and relaxation techniques.  This is available to download for free at paincd.org.uk, or you can buy the CD from the same website.

https://painuk.org/ This is an alliance of charities formed in 2011 catering to the needs of people in pain.

Books that have shown to be useful:

Burch, V. (2008). Living well with pain and illness: the mindful way to free yourself from suffering. London: Piatkus Books

Burch, V. (2013) Mindfulness for health: A practical Guide to relieving pain, reducing stress and restoring well being. London: Piatkus Books

Butler, D., & Moseley, L. (2003). Explain pain. Adelaide, South Australia: Noigroup Publications.

Fibromyalgia specific publications are:

  1. Managing Pain Before It Manages You by Caudill
  2. From Fatigued to Fantastic by Jacob Teitelbaum
  3. Figuring out Fibromyalgia by Ginevra Liptan
  4. Living with Fibromyalgia by Christine Craggs-Hinton

Make a donation

Anyone who would like to make a donation to the Pain Management Unit educational and research work can do so by donating to the Pain therapy fund. Please ask us for details of how to do this.  The fund is used to make small awards to members of the department to support educational and/or research work that improves our understanding of pain and treatment for our patients.



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