British Pain Society Research Articles

Cancer Pain: Part 2: Physical, Interventional and Complimentary Therapies; Management in the Community; Acute, Treatment-Related and Complex Cancer Pain: A Perspective from the British Pain Society Endorsed by the UK Association of Palliative Medicine and the Royal College of General Practitioners: Table 1

This discussion document about the management of cancer pain is written from the pain specialists' perspective in order to provoke thought and interest in a multimodal approach to the management of cancer pain, not just towards the end of life, but pain at diagnosis, as a consequence of cancer therapies, and in cancer survivors. It relates the science of pain to the clinical setting and explains the role of psychological, physical, interventional and complementary therapies in cancer pain. This document has been produced by a consensus group of relevant healthcare professionals in the United Kingdom and patients' representatives making reference to the current body of evidence relating to cancer pain. In the second of two parts, physical, invasive and complementary cancer pain therapies; treatment in the community; acute, treatment-related and complex cancer pain are considered. It is recognized that the World Health Organization (WHO) analgesic ladder, whilst providing relief of cancer pain towards the end of life for many sufferers world-wide, may have limitations in the context of longer survival and increasing disease complexity. To complement this, it is suggested that a more comprehensive model of managing cancer pain is needed that is mechanism-based and multimodal, using combination therapies including interventions where appropriate, tailored to the needs of an individual, with the aim to optimize pain relief with minimization of adverse effects.

Palliative Care and Pain Medicine Come Together to Optimally Treat Cancer Pain: What We Can Learn from the British Pain Society

“We don't beat the Reaper by living longer. We beat the Reaper by living well.” Professor Randy Pausch declared this statement during his famous last lecture at Carnagie Mellon University prior to his death from pancreatic cancer in 2008 [1]. As opposed to the widely practiced WHO approach of utilizing opioids in a stepladder fashion, many now advocate a mechanism-based approach to cancer pain treatment. Old dogma treated cancer pain as a problem mainly toward the end of life situation in the context of metastatic, progressive disease, whereas new data show pain to be problematic throughout the cancer care cycle [2]. The effective management of these acutely painful surgeries and related treatments may limit the development of chronic pain states in long-term survivors [3]. Effective treatment strategies include multidisciplinary, multimodal care utilizing 1) combinations of long-acting opioids for constant pain with short-acting opioids for incidental pain; 2) “adjuvant” co-analgesics including nonsteroidal anti-inflammatories, anticonvulsants, antidepressants, and topical agents to optimize analgesia and minimize opioid doses, thereby reducing concomitant opioid-related side effects; 3) prophylactic treatment of constipation, nausea, and other common troublesome symptoms; 4) interventional …

Cancer Pain: Part 1: Pathophysiology; Oncological, Pharmacological, and Psychological Treatments: A Perspective from the British Pain Society Endorsed by the UK Association of Palliative Medicine and the Royal College of General Practitioners

This discussion document about the management of cancer pain is written from the pain specialists' perspective in order to provoke thought and interest in a multimodal approach to the management of cancer pain, not just towards the end of life, but pain at diagnosis, as a consequence of cancer therapies, and in cancer survivors. It relates the science of pain to the clinical setting and explains the role of psychological, physical, interventional and complementary therapies in cancer pain. This document has been produced by a consensus group of relevant health care professionals in the United Kingdom and patients' representatives making reference to the current body of evidence relating to cancer pain. In the first of two parts, pathophysiology, oncological, pharmacological, and psychological treatment are considered. It is recognized that the World Health Organization (WHO) analgesic ladder, while providing relief of cancer pain towards the end of life for many sufferers worldwide, may have limitations in the context of longer survival and increasing disease complexity. To complement this, it is suggested that a more comprehensive model of managing cancer pain is needed that is mechanism-based and multimodal, using combination therapies including interventions where appropriate, tailored to the needs of an individual, with the aim to optimize pain relief with minimization of adverse effects.

British pain society wants online survey respondents

British pain society wants online survey respondents

Guidance for the assessment of pain in older adults: a literature review

This paper presents guidance for the assessment of pain in older adults, which was developed as a collaborative project by the British Pain Society and the British Geriatric Society. The guidance was published in November 2007 and was designed to provide health professionals with practical skills to assess pain as the first step towards its effective management. The guidance did not seek to differentiate between acute and persistent pain as the literature relating to pain in older people renders such distinction impractical. The next stage will involve the development of guidance for the management of pain in older adults, which will commence this year.

Shingles vaccine: prevention made possible

AbstractPain specialists discuss the key issues around vaccination against shingles and postherpetic neuralgia (PHN) at the Sanofi Pasteur MSD‐sponsored Satellite Symposium at the British Pain Society Meeting, Liverpool. Copyright © 2008 John Wiley & Sons, Ltd.

Education and training of pain nurse specialists in the United Kingdom

Summary Background The role of PNS in the United Kingdom has evolved piecemeal. This survey updates work done by the British Pain Society to identify roles and education preparation of PNS. Method A questionnaire was designed based on the BPS findings and was sent to all nurse members of the BPS. Returned questionnaires were analysed descriptively using SPSS statistical software. Results The majority of nurses’ previous experience was in acute care areas (63%). Nurses registered with certificate level training and progressed to diploma or degree later. Forty-one percent of the sample completed a short course in pain management, 12% had a nurse prescribing qualification, 49% were currently studying for or had completed a Masters level degree, and 7% had gained a PhD or were studying at doctoral level. The nurses were clinically autonomous, most working across both acute and chronic pain sub-specialities. Teaching of other staff and students was a universal function (95%) and most nurses took part in or lead research. Conclusion There are concerns raised by this survey as to whether nurses can access appropriate education for the diversity of the role that they undertake.

Opioids in persistent non-cancer pain

Strong opioid drugs are among the most effective analgesics available. Their use in the treatment of acute pain is well established and the World Health Organization endorses them for the treatment of cancer pain. However, their use in the treatment of persistent non-cancer pain remains controversial. Despite this, the use of opioids in this setting is growing. For example, in Denmark, which is the world’s largest consumer of prescribed opioids, the majority of opioid prescriptions are for noncancer pain. Evidence for growth in opioid consumption in England is available from the Department of Health prescribing data. The number of prescription opioids dispensed via community pharmacies increased from around than 5.5 million in 1998 to almost 9.5 million in 2004. This growth has been partly fuelled by efforts (and successes) within the pharmaceutical industry to gain marketing licences for opioids that include treatment of non-cancer pain. The effects and efficacy of long-term opioid treatment remain uncertain, and this, along with the fear that more widespread use might lead to an increase in problem drug use, continues to cause concern within the healthcare profession and the general public. The British Pain Society, in conjunction with the Royal College of General Practitioners and the Royal College of Psychiatrists, has recently published recommendations for the use of opioids in benign non-cancer pain.

Provisional guidelines for applying the Department of Health (England) 18-week-patient pathway to specialist rheumatology care

The Government Department of Health (England) has set a target that by 2008 patients on pathways that do or may involve medical or surgical consultant-led care should wait no longer than 18 weeks from referral to start of definitive treatment. Department of Health guidance must be interpreted and applied to patients with rheumatological problems. Provisional guidelines have been prepared in collaboration between the British Society for Rheumatology, British Pain Society, Department of Health (England) and other key stakeholders. Definitive rheumatological treatment comprises a package of care rather than a single action. The care package usually requires input from a multidisciplinary team using several modalities in parallel. Actions within the care package that must be taken before treatment can be said to have started, are definitive actions. Definitive actions should be based on evidence of cost-effectiveness, tailored to the individual patient and offered irrespective of local availability or accessibility. They should be agreed between partners in the patient's care. This requires face-to-face consultation between the patient and a health care professional with appropriate expertise and knowledge. All definitive actions specified at the outset of management within specialist care must be initiated or removed by agreement from the patient's care package before the clock can be stopped in the 18-week-patient pathway. Service redesign may be necessary in order to achieve an 18-week-patient pathway for all patients. A consistent and appropriate definition of clock-stops should ensure that patients will benefit from excellent rheumatology specialist care without unnecessary delay.

British Neuroscience Association (BNA) and British Pain Society joint 1-day symposium

The clinical manifestations of pain affect millions of people worldwide and are therefore a huge focus of neurological research. In order to maximize the clinical effect of new pathophysiological findings, it is vital for basic science researchers to communicate closely with clinicians. This BNA and Pain Society joint symposium therefore provided an excellent forum for interesting discussions which focused on the molecular mechanisms of nociception and LTP in relation to sensory and psychological themes.

Shipman and the Anaesthetist

Shipman and the Anaesthetist