Pain - The British Pain Society

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The Pain Society The British and Irish Chapter of the International Association for the Study Of Pain 21 Portland Place London W1B 1PY United Kingdom Telephone (020) 7631 8870 Fax (020) 7323 2015 Email info@painsociety.org www.painsociety.org Council Members and Officers 2002-2003 President Dr. Beverly Collett Immediate Past President Honorary Secretary Honorary Treasurer Honorary Assistant Secretary Nursing Anaesthesia / Pain Medicine Nursing Pain Research Nursing Psychology Pain Medicine National Occupational Therapy Pain Association The views of the IASP Chair, Patient Liaison Committee Association of Palliative Medicine Chair, Courses and Meetings Committee Editor, The Pain Society Newsletter Association of Anaesthetists of Great Britain and Ireland Chair, Local Organising Committee ASM 2003 The Pain Society Newsletter is published quarterly. Circulation 1650. The editor welcomes contributions including letters, short clinical reports and news of interest to members including notice of meetings. Comments on the format of the Newsletter are welcome. Dr. Douglas Justins Dr. Karen Simpson Dr. George Harrison Dr. Andrew Vickers Dr. Eloise Carr Dr. Kate Grady Ms. Ruth Day Dr. Andrew Rice Dr. Patricia Schofield Dr. Amanda C de C Williams Dr. Cathy Stannard Mrs. Louise Aylwin Prof. Sir Michael Bond Mrs. Jean Gaffin Dr. Paresh Gajjar Dr. Paul Watson Dr. Stephen Ward Dr. Alastar Chambers Dr. Chris Spanswick Material should be sent to: Dr Stephen P Ward Editor, The Pain Society Newsletter Pain Management Unit Brighton and Sussex University Hospitals NHS Trust Princess Royal Hospital Haywards Heath West Sussex RH16 4EX Tel 01444 892276 Email drspward@yahoo.co.uk The opinions expressed in the Pain Society Newsletter do not necessarily reflect those of the Pain Society Council. Editorial STEPHEN WARD For the most part, the ‘new-look’ newsletter has been well received and I am grateful for your kind words and encouragement. Two criticisms have been levelled though and I think both deserve attention. Firstly, I have been informed that the cover design is ‘too masculine’. Being the registered bearer of a Y chromosome, I can’t see it myself – is it the colour scheme? Not enough pink? Is the typeface too Neanderthal? The second criticism was of greater importance and relevance. More than one of you has noted that the Newsletter has become somewhat downbeat and selfdepreciating and that the content tends to favour articles of a ‘moany’ nature. What would the lay reader think of us as a Society if he were to flick through our publication? Almost certainly that we are unloved, undervalued, underfunded, stressed to breaking point and that we would much rather write about our bad experiences in pain management than our good. Ok….I agree…it’s a fair cop. Whilst I’m as much in favour of a good old whinge as the next man the content of the newsletter needs to change. I’m not saying that we pretend all is rosy in Painland as patently it is not, but let’s pat our own backs a bit more and try to appear, at least outwardly, a little less downtrodden. Say it with me…’I work in Pain Management and I’m proud!’ Allow me to start the ball rolling and address some of the popular misconceptions we and others seem to have about pain management: We are not undervalued or unloved – in fact, whenever I spend time looking at our waiting list figures I feel positively overvalued! If you believe for a moment that your patients don’t value the time and effort you invest in their wellbeing or that the local GPs and hospital consultants do not value your opinion and your expertise then you might as well give up now. Are we underfunded as a specialty? Definitely – but name a specialty that isn’t. Chronic pain has always been considered a soft target when it comes to resource allocation and allowing patients to linger on the waiting list for years has been the norm. After all, if a patient has had back pain for 25 years, what’s the rush? All fine and dandy until Big Al Milburn had the barmy idea of introducing waiting time targets…… these days if Mrs Jones isn’t seen within 17 weeks, a manager somewhere is shot at dawn. On the face of it this is madness but it can actually work very much in our favour. A week or two ago it was suggested to me that I might like another couple of pain management sessions to enable me to meet the 17 week target. Sorely tempted as I was to see my manager shot that dawn I jumped at this chance and I am happy to report that I have finally joined the ever swelling ranks of the full time pain specialist. A few years ago it was virtually impossible to increase pain sessions without selling your soul to Beelzebub himself – now they’re throwing them at us? Are we stressed as a group? If the ASM is anything to go by I’d say, outwardly at least, quite the opposite – have you ever come across a more relaxed, easy going and fun loving group? If this is the portrait of a group under pressure then I’m off to join the Royal Society of Transcendental Meditants. As individuals, though, we all suffer stress at some point in our careers but I suspect this is down to administrative and managerial foul play and pressure rather than the nature of the specialty or the patients we deal with. I find pain management an immensely rewarding and fascinating occupation and defy you to find any specialty more interesting, challenging, or holistic (Did you hear about the holistic orthopaedic surgeon? He thought about the whole bone). Our specialty leads the field in terms of scientific expertise and integrity and has embraced evidence based medicine in its bosom like no other. We should, quite rightly feel an immense sense of pride in ourselves as a group. By and large the patients we encounter are pleasant, well informed (apart from the dear old lady I saw recently who came to clinic clutching a box of voltarol. ‘What medication are you taking?’ I asked ‘Voldemort!’ she replied) and grateful for any help we can give them. Rarely are they 2 THE PAIN SOCIETY NEWSLETTER SUMMER 2003 EDITORIAL
6 14 THE PAIN SOCIETY NEWSLETTER SUMMER 2003 SARAH BARKER & AMANDA C DE C WILLIAMS THE PAIN SOCIETY NEWSLETTER 1-3 Months - 54% 1-3 Months - 74% Acceptable - 46% SUMMER 2003 20 THE PAIN SOCIETY NEWSLETTER SUMMER 2003 0-4 Weeks - 23% 0-4 Weeks - 17% Excellent - 17% Good - 31% 1-3 Months - 54% Always - 6% Rarely - 11% Sometimes - 11% 4-6 weeks - 11% 2-4 weeks - 54% NEWS FROM PORTLAND PLACE 0-4 Weeks - 23% Mostly - 51% 0-2 weeks - 14% FEATURES FEATURES the malingering, miserable, mad-as-a-badger malcontents that our colleagues seem to think they are. So there we are, a few musings from me. To be involved in any way in the treatment and management of pain is a privilege. To moan about the shortcomings of our specialty incessantly simply fuels the misconceptions of others that ours is a dreary, thankless world – and it simply isn’t. In this issue, you will see that I have received a handful of letters. One of these letters is, admittedly, a bit of a moan about private practice but I’ve let this one go on the grounds that I tend to agree with him. Another of the letters is from Professor Richard Dawkins and requires a brief explanation. Richard Dawkins is the Charles Simonyi Professor of the Public understanding of Science at Oxford and is, without doubt one of our most important evolutionary biologists. Having recently read his collection of selected essays entitled ‘A Devil's Chaplain’ and another of his books ‘The Selfish Gene’ I was intrigued by his firmly held Darwinist belief that genes survive or fail to survive within the gene pool of a species by virtue of their effects upon the survival of the individual organism (for example, genes coding for the various structures involved in pain pathways are important to our survival – acute pain tells us not to move so that we can heal and not to do it again!). When we consider chronic pain however, where is the evolutionary advantage? Tissue healing is complete, the message is useless and the condition a miserable one. One would have supposed that this glitch be ‘ironed’ out over a few million years but sadly not. Can it be that genetics plays no part in chronic pain? Are we more likely to survive if we are constantly reminded about an old injury – even ten years on – so that we don’t make the same mistake twice? Are our pain behaviours passed on like genes to the next generation so that they respond in the same way? Am I just rambling on? Anyway, he was kind enough to put his view forward and if any of you profess any expertise in this area I’d welcome comments. Lastly, thank you all for the submissions…please keep them coming. drspward@yahoo.co.uk Contents columns 2 Editorial 4 President’s message news 6 Glasgow ASM 2003 review 6 Pain Meetings for Health Professionals 8 Pfizer Prize Awards 10 Obituary 11 New Members 13 Results of Glasgow ASM : session evaluations features 14 Psychological Assessment and Interventions 15 A Distress Motivation Axis 18 Angina Pectoris : A Historical Perspective 20 Nottingham Pain Clinic survey THE PAIN SOCIETY NEWSLETTER PAIN MEETINGS FOR HEALTH PROFESSIONALS CELLULAR AND MOLECULAR MECHANISMS OF PAIN a satellite symposium to the International Brain Research Organization (IBRO) 7-9 July Prague, Czech Republic Email:palecek@biomed.cas.cz / wdwillis@utmb.edu Web: http://www.biomed.cas.cz/IBRO-PAIN/ BATH PAIN FORUM - CATASTROPHISING ABOUT CHRONIC PAIN 29 July, Royal National Hospital for Rheumatic Diseases, Bath Contact: Dr. Chris Eccleston Director, Pain Management Unit, University of Bath Email: pain@bath.ac.uk PAIN IN EUROPE IV - 4TH CONGRESS OF THE EUROPEAN FEDERATION OF IASP CHAPTERS (EFIC) 2-6 September, Prague, Czech Republic Contact: Congress Business Travel Email: pain2003@cbttravel.cz Web: www.pain2003.cz 9TH NATIONAL CONFERENCE ON PAIN MANAGEMENT PROGRAMMES Organised by the Pain Management Special Interest Group of the Pain Society 11-12 September, John Innes Centre and University of East Anglia Contact: Elaine Wellingham Conference Secretariat, Field End House Bude Close, Nailsea Bristol BS48 2FQ Tel/Fax: 01275 853311 Email: Confsec@blueyonder.co.uk THE FUTURE OF PAIN THERAPUTICS 2003 15-16 September 2003, London Email: sara.peerun@visiongain.com http://www.visiongain.com/futurepaindrugs.html PROVING OUR WORTH! Specialist Nurses & Nurse Consultants Conference 25 September, Post Graduate Medical Centre, Worthing Hospital, West Sussex THE PAIN RELIEF FOUNDATION 4TH ANNUAL LECTURE 2003 Pain & Central Nervous System Reorganisation” Friday,17th October at 7:00 pm The Pain Research Institute, Clinical Sciences Centre, University Hospital Aintree, Liverpool Professor Troels Jensen, Danish Pain Research Centre, University of Åarhus, Denmark AN UNRECOGNISED PAIN CHALLENGE a one-day conference on Joint Hypermobility Syndrome 21 October 2003, 9.30 - 4.40, Postgraduate Centre, Gassiot House, St Thomas' Hospital Psychological Asessment and Interventions Having a converted cupboard for an office makes psychological consultation at our hospital a cosy affair. Despite this, a patient’s first appointment with the clinical psychologist can seem scary, associated with psychiatric labels and ‘all in the mind’ statements, which mark the end of the pain being taken seriously by doctors. Psychological assessment is a real deterrent for some who don’t attend the initial meeting. But there is no avoiding this meeting for the patient wanting a spinal cord stimulator or a peripheral nerve stimulator: psychological assessment is mandatory. Many patients spend the first minutes emphasising their sanity, the reality of their pain, and their entitlement to neuromodulation to make life worth living again. The aversive and chronic nature of patients’ pain makes the hope of a cure alluring. So what does the assessment consist of, and is it really essential? Nottingham Pain Clinic survey Although it is widely acknowledged in pain field that pain is a psychological experience as well as a physical one, the relationship between pain and psychological factors remains the subject of differences and debate. It would be encouraging to think that dualistic models are losing their hold, and that the attribution of pain in some patients to psychogenic factors is understood as an hypothesis not a finding, but this way of thinking still leads to stigmatisation and discrimination in many areas of health care. Although professionals working in the field of pain hopefully now have a broader perspective, misunderstandings can still occur about the role of psychology and how it can best be integrated with medical treatments. First: what requests can’t psychological assessment satisfy? It can’t establish the relative contributions of organic and psychological factors (nor can any other method, as the underlying model is erroneous), What do GPs’ want from the pain clinic and do we provide it? The pain department at City Hospital provides a one-day series of lectures and practical workshops for local GPs. 49 GP’s attended the pain day and 35 returned completed the questionnaire. The response rate was 71%. nor can it establish ‘cause and effect’ relationships between psychological problems and pain (Doleys, 2000). The other purposes for which assessment is requested is to exclude patients with gross mental health problems, which is reasonable although we do not know that they would not benefit from neuromodulatory methods; and to improve outcomes in by identifying predictors of poor outcome (e.g. North et al, 1996, Nelson et al, 1996). Suggested candidates for this include ‘somatisation disorder’, ‘major uncontrolled depression/anxiety’, ‘severe sleep disturbances’, ‘serious drug or alcohol problems’ and ‘lack of social support’; other factors which the psychologist is advised to consider include ‘ history of abuse or other dysfunction’, ‘unusual pain ratings’, ‘certain personality disorders’, ‘unresolved compensation’ and ‘lack of support from spouse’ (Olsen, 1996). As you can see from this list, virtually every patient will present one or more of these ‘warning’ factors. While the search for predictors of outcome seems at first a reasonable scientific pursuit, it does not stand up to scrutiny. The only way to discover such SUMMER 2003 Glasgow ASM 2003 : Overview Breakdown of delegates There were a total number of 1,066 Delegates registered at the Meeting; an increase of 264 from the 2002 Meeting in Bournemouth. 50 were Anaesthetic Research Delegates. Of the 1066, 70% were members of the Society. The specialty of the delegates continues to mirror the membership of the Society, with anaesthetists making up the largest group of delegates, followed by nurses, psychologists, physiotherapists, occupational therapists and general practitioners. Venue The Glasgow Scottish Exhibition + Conference Centre was an excellent venue for this year’s ASM and perfectly suited the Society’s needs in terms of quality of plenary hall, number of break-out rooms and size of exhibition area. The support staff was excellent and the additional facilities at the Centre i.e. café bar, restaurant and business desk all added to the success of the meeting. Scientific Programme Overall, the view from the evaluation forms was that the scientific programme was varied and very well balanced, with excellent quality of speakers. predictors would be to assess all patients, to treat them all blind to the assessment process, and then to compare the outcome with those assessments. Instead, lists of problems such as those above are used to be very selective about candidates for neuromodulation, so that if any predictors are found retrospectively, they can only apply within the limits of those selection procedures, which of course vary from clinic to clinic. These exclusion criteria easily become proxies for refusing patients who are already underserved and disadvantaged. A close look at the literature on psychological screening for neuromodulation shows generally poor methodologies and a strong influence from insurance based health funding which characteristically focuses on shortcomings in the patient/claimant. Given the unpredictable success of neuromodulation and the distress caused by pain and unsuccessful treatment, what should psychological screening aim to achieve? There is certainly benefit in eliciting patients’ understanding (or misunderstanding) both of their pain problem and of neuromodulation procedures Which one of the following statements best describes the way that you would like the pain clinic to be organised? (Tick one option) 1- More new patient appointments with a short follow up period and discharge back to GP care. 2- More new patient appointments with a treatment plan that is carried out and maintained by the GP. No routine follow up in the pain clinic. 3- Fewer new patient appointments with long term follow up by the pain clinic. regulars Demographic data Mean Range Number of partners 5 1-14 list size 8000 1800-34000 12 training practices and 22 non-training practices were represented. Organisational issues A number of participants were from outside Nottingham so gave responses related to experience with their local provider of pain services. How long do your patients have to wait for a routine pain clinic appointment? Option 1 70% Communication Do you expect to receive a letter after each outpatient episode in the pain clinic? How often does this happen? 12 Letters to the Editor 16 Special Interest Groups 22 Reflections from the coalface What do you think is an acceptable waiting time for a routine pain clinic appointment? In order to reduce the waiting time for a new patient routine appointment at the pain clinic it would be necessary to reduce the number of follow up appointments. How would you rate this change? How long does it take for a letter to arrive at your practice after the patients’ pain clinic consultation? Comments “A brief letter with a treatment plan is all that is needed.” “The letters are very important because chronic pain patients are very demanding and frequent attendees who always want information from the hospital.” CONTENTS THE PAIN SOCIETY NEWSLETTER SUMMER 2003 3
Page 4 and 5: President’s message DR.BEVERLY CO
Page 6 and 7: PAIN MEETINGS FOR HEALTH PROFESSION
Page 8: The Society wishes to congratulate
Page 11 and 12: New Membership Applicants Mrs J Bar
Page 13 and 14: employers interpret this document l
Page 15 and 16: and effects, and various members of
Page 17 and 18: handful of centres resourced to man
Page 19 and 20: form there is no disease of the hea
Page 21: Have you ever tried to phone a pain

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