Managing Pain - Q2 2022

Q2 2022 | A promotional supplement distributed on behalf of Mediaplanet, which takes sole responsibility for its content

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Managing Pain

“Pain has a direct effect on mental health and relationships.”

“It is estimated that 10 million people have back pain.”

Dr Arun Bhaskar President, The British Pain Society

Sarah Rudkin Head of Research Strategy and Growth, Versus Arthritis

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IN THIS ISSUE

“Clinical trials have shown that early spinal cord stimulation treatment can improve pain.”

Dr Ashish Guive Neuromodulation Society of UK & Ireland and British Pain Society

Effective pain management needs more resources

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Pain is the leading cause of disability and is the most common reason why people access healthcare. Yet, it accounts for just 1% of national healthcare budgets.

“An optimal use of digitalisation is the availability and reliability of accurate information on pain and when to seek help.”

Deirdre Ryan Pain Alliance Europe

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“Pain management is the responsibility of healthcare providers.”

Dr Lorraine de Gray Faculty of Pain Medicine of the Royal College of Anaesthetists

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hronic pain affects more than a third of the world’s population and 93% of people experienced body pain last year. Of people living with pain, 63% suffer every month, 32% suffer weekly and 27% continues to suffer every day. Nearly 50% of women reported that their pain had a significant impact on their daily life.

Impact of pain on our lives Two-thirds of people reported that they cannot be happy when experiencing pain and it impacts on their ability to enjoy life. Pain has a direct effect on mental health and relationships. Deprivation and loneliness also contribute adversely to how people manage their pain. Persistent pain impacts performance at work and prevents people from getting back into employment.

Addressing taboo of pain Most healthcare systems are geared to address acute conditions that cause pain and manage it alongside underlying causes like arthritis, trauma, cancer and various other pathologies. However, many people suffer from persistent pain even after the underlying pathology has been successfully addressed. Most people state that their pain is still a taboo subject to discuss openly. Healthcare professionals often come across as unsupportive and sometimes even dismissive.

Delay in accessing services Patients undergo multiple and often unnecessary investigations in search of a potential cause for their pain.

Often the psychosocial and cultural aspects of pain and how it is perceived and projected are overlooked.

Patients are referred to pain management services late in their journey and by this time, maladaptive illness behaviours have been reinforced due to lack of adequate support from healthcare and social care services. People

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living with pain seldom get specific support in a timely manner and this adversely affect their physical and mental wellbeing.

Persistent pain impacts performance at work and prevents people from getting back into employment.

Greater investment needed There are no simple answers to these complex problems.

Better resource allocation and streamlining pain management services through appropriate clinical pathways would be a good start. Not only is more funding required to support the growing demands of supporting an aging population, but adequate training for the workforce is also needed to deliver effective healthcare and social care.

There are ambitious plans to deliver most of the pain management in the community through primary care services, health coaches and social prescribing. This would be successful if there is seamless integration with secondary care and specialist services so that the patient can get the right support from appropriate interdisciplinary and multispeciality input when needed.

WRITTEN BY Dr Arun Bhaskar President, The British Pain Society

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Specialist pain management is now being delivered online Online pain management consultations are enabling specialists to liaise directly with patients from across the UK without them needing to make the journey into clinics.

A INTERVIEW WITH Dr Charlotte Small Pain Management Consultant, Leva Clinic WRITTEN BY Mark Nicholls

Paid for by Leva Clinic

digital approach is offering a new dimension to chronic pain management for patients, with online consultations delivering timely guidance and advice on how people can continue with everyday activities despite their conditions.

Pain Management Consultant Dr Charlotte Small explains that most consultations do not require physical examinations, so she is able to see people from anywhere in the UK online, without them having to travel to a clinic.

“Patients can also find consultants with nationally-recognised expertise, or a special interest, in their condition,” she says.

and examinations by their GP or a specialist, they are assessed by a nursing team and triaged at the Leva Clinic.

“When they come to us, we put together a comprehensive multifactorial plan for them. That looks at medicine optimisation, which might be starting new medications for pain management, or more commonly stopping or reducing medicines such as opiates,” says Dr Small.

Education on pain can help support patients to manage their life with a long-term painful condition, guiding them through its impact on their sleep and mood, as well as looking at non-drug therapies such as acupuncture and heat and cold packs.

To do that, we have to Treatment plan understand how the pain Alongside her NHS post in Herefordshire, Survival mechanism Dr Small works for Leva Clinic, an online impacts them, their work and Consultants get to know how patients chronic pain management clinic. want to lead their life and their specific their relationships, and what She says: “We provide a multicircumstances. “We look at realistic goal sort of person they want to be. setting and reassuring, within reason, disciplinary assessment and treatment plan; working alongside specialist that what they want to do is safe and nurses, physiotherapists for musculoskeletal pain and how to do it.” psychologists.” The online service sees patients living with Dr Small explains that pain is a survival mechanism chronic pain, referred or self-referred, to the clinic for help to heal and avoid harm. However, chronic pain is an to improve their quality of life. ‘aberration in that system’ and tells people what they are “To do that, we have to understand how the pain impacts doing is harmful, when it is not. them, their work and their relationships, and what sort Her approach is patient-centred, individual and of person they want to be.” tailored. Online consultations are similar to NHS face-toface appointments, with the proviso that if a hands-on Education and support examination is required, the individual can be referred back With patients having undergone investigations, assessments to their GP or specialist.

Find out more at levaclinic.com

Communication and empathetic consultation skills are the cornerstone of effective pain assessment. ~ Dr Lorraine de Gray Vice Dean of the Faculty of Pain Medicine, Royal College of Anaesthetists

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Spinal cord stimulation can help many types of chronic pain Despite the availability of effective treatment options, neuropathic pain often remains untreated. Patient and healthcare provider awareness is essential to access these therapies.

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hronic pain is a major cause of disability worldwide. Neuropathic pain is a type of pain caused by an injury or disease of the nervous system. One in 10 people have neuropathic pain and almost half fail to get adequate pain relief with medications.

There is growing awareness and concern about the addictive potential of opioids and gabapentinoids.

In 2008, the National Institute of Health and Care Excellence (NICE) recommended spinal cord stimulation (SCS) for routine use as an effective and cost-effective treatment for severe refractory neuropathic pain. Despite the guidelines, less than 1% of people with neuropathic pain receive an SCS therapy in the UK. Benefits of spinal cord stimulation Clinical trials and patient registries, such as the UK National Neuromodulation Registry, have shown significant improvement in pain, quality of life and reduction in medication following SCS implants.

In UK practice, 75% of patients get at least 50% improvement in pain. As a consequence, they are able to reduce their opioids and gabapentinoid medications.

Improvement in quality of life There are many causes of neuropathic pain.

Persistent spinal pain syndrome (PSPS), where patients experience severe back and/or leg pain despite technically successful spinal surgery, affects more than 5,000 patients in the United Kingdom each year. There are 21,000 people who suffer from painful diabetic neuropathy in the UK and numbers are increasing.

Complex regional pain syndrome (CRPS) is a debilitating, painful condition in a limb that can result in severe disability and suffering. CRPS commonly arises after injury to that limb. However,

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there is no relationship to the severity of trauma, and in some cases there is no precipitating trauma at all (9%). Clinical trials have shown that early spinal cord stimulation treatment can improve pain, rehabilitation and function in these patients.

One in 10 people have neuropathic pain and almost half fail to get adequate pain relief with medications.

Cancer will affect one in two of us, and both the cancer itself and its treatment commonly cause pain.

Despite the excellent palliative care in the UK, one in four patients have unrelieved or partially relieved pain. Uncontrolled pain and side effects of oral or injected pain killers can significantly reduce quality of life for these patients. The NHS funds highly specialised treatments such as continuous infusion of medications in the spine via an implanted pump to alleviate this pain.

The uses of neuromodulation are wide ranging and expanding. It is set to become a far more common treatment in the future. Patients and healthcare professionals need to access these treatment options in a timely manner.

WRITTEN BY Dr Ashish Gulve President, Neuromodulation Society of UK & Ireland Honorary Treasurer, British Pain Society

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Spinal cord stimulation brings new hope to painful diabetic neuropathy

One in 10 people have neuropathic pain and almost half fail to get adequate pain relief with medications.

Improving quality of life with new pain treatment People with diabetes can often live in excruciating pain, yet spinal cord stimulation technology exists to offer them safe and effective relief.

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eople with diabetes are living with significant long-term pain that could be effectively and safely managed through spinal cord stimulation. Such people describe pain in their feet and legs as walking on broken glass. All too often, they are left to cope with ineffective painkillers. Yet, a new study, the largest of its kind, shows that highfrequency (10kHz) spinal cord stimulation can reduce this pain significantly maintained at 18 months, it also found that 63% of patients experienced improvements in motor, sensory, or reflex function in the same time period.

Technology for diabetes complications Nerve damage or neuropathy is one of the longterm complications of diabetes. Over time, high blood glucose (sugar) levels can damage the small blood vessels that supply the body’s nerves, which can then become damaged and may even disappear. In the feet, this can manifest as loss of feeling, which can lead to injury or falls, or in other people, shooting or burning pain.

In spinal cord stimulation a small device is implanted near the spine, using leads to send electrical impulses to the brain, disrupting the pain ‘signals’ caused by nerve damage.

Safe and effective pain relief Experts with experience in this technology say that those with stable diabetes living with long-term and significant diabetes pain are usually suitable to use this device to gain safe and effective pain relief without any of the risks associated with pain medication.

These experts also believe that this therapy, which is approved for use in the NHS by medicines watchdog NICE, remains off the “radar” of knowledge of most diabetic care teams, or is wrongly considered unsafe or ineffective.

However, studies show that 86% of people will see their pain reduced by 50% or more and the average pain relief at 18 months is 76%. Latest research shows that over seven in 10 individuals see significant pain relief continuing at 18 months, and at no extra risk of infection.

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Michael used to enjoy camping and wood carving, but he had to stop nearly all activities because he was in so much pain. Several nights a week, he couldn’t sleep at all. That all changed when he found a high-frequency spinal cord stimulation treatment.

In some areas of the UK waiting lists for this specialist pain therapy are as low as 18 weeks to receive an actual treatment, and candidates for SCS can often go home the same day. So why aren’t people accessing this therapy?

Finding effective treatment options Dr Sarah Love Jones, lead clinician for Spinal Cord Stimulator Service in the Pain Clinic, North Bristol NHS Trust (NBT), believes that for too long diabetics have simply accepted painful neuropathy as part of their condition and do not push their healthcare professional to consider a referral. But it doesn’t need to be so, she says: “We know patients don’t want to live with this pain.”

Dr Ganesan Baranidharan, Lead Clinician for the Pain team at Leeds Teaching Hospitals and an Honorary Associate Professor at the University of Leeds, feels that existing diabetic check appointments are a golden opportunity to raise the possibility of SCS to suitable patients. Another solution could be to add it to the health checks that GPs are paid to deliver. He says: “There will be a lot of people out there that we can help.”

INTERVIEW WITH Dr Sarah Love-Jones Consultant in Pain Medicine & Anaesthesia, Specialty Lead Pain Clinic North Bristol NHS Trust, Elected Council Member, British Pain Society

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ichael had been suffering from agonising pain in his feet and legs for 16 years. It required him to take pain medication three times a day. However, after trying HFX* for his painful diabetic neuropathy, he says: “I felt like my legs were 20 years old again!”

A relief from pain In September 2021, Michael’s had a HFX trial, which was very successful, “I didn’t even want to take the temporary device off to get the implant because I experienced such relief!” he says. HFX therapy is available on the NHS and the service can be accessed through appropriate GP or secondary care referral. Since having the implant procedure in November 2021, he has experienced nearly 100% relief in his legs, and the pain relief in his feet is at 60%.”

Michael can walk and sleep well again. He can also push his wife in her wheelchair as she undergoes chemotherapy. He no longer has any trouble welcoming his dog onto his lap.

“There’s no sense in living with the pain. I wish I’d heard about it sooner,” says Michael, who would recommend the treatment to anyone.

Scan the QR code to find a centre offering HFX near you

INTERVIEW WITH Dr Ganesan Barani Consultant in Anaesthesia and Pain Medicine, Leeds Teaching Hospitals NHS Trust, Honorary Clinical Associate Professor, University of Leeds

WRITTEN BY Ailsa Colquhoun

#NevroHFX #diabeticneuropathy *HFX is a comprehensive solution that includes a Nevro Spinal Cord Stimulation (SCS) system and support services for the treatment of chronic pain, including painful diabetic neuropathy, programmed with a frequency of 10 kHz.

INTERVIEW WITH Michael Lambert HFX for PDN patient WRITTEN BY Kirsty Elliott

Find out more at nevrohfx.com/en-gb/

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WRITTEN BY John Skinner, President, British Orthopaedic Association (BOA)

What can I do to manage my pain while waiting for my surgery?

If you are waiting for surgery, it is important to stay as active as you can in order to get the best results.

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here are currently over 700,000 patients on orthopaedic waiting lists, with at least 200,000 waiting for operations.

Research has found that patients that are healthier have better outcomes from their surgery and recover more quickly. It is therefore best to keep as active as you can, while you wait so you can stay as healthy as possible both physically and mentally - to be ready for your surgery. Keep talking to friends and family and avoid getting isolated and depressed by reduced mobility. This will help you get the best results from your treatment in the long term.

Maintaining movement and strength While you may be limited in the amount of physical activity you can do, it’s important to maintain as much movement and strength as you can.

Gaining weight can put more stress on your joints and losing weight really helps. Doing things like going for short walks will help keep you active as well as help with your mental wellbeing.

Many people find it easier to be active in the water so you could try to find a local pool in your area.

It’s also very important to eat a balanced diet to maintain a healthy weight and get all the vitamins and minerals you need. There are many online tools and resources available to help you eat well, keep active and to support your mental health.

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Many people find it easier to be active in the water so you could try to find a local pool in your area.

Finding advice and support The charities Versus Arthritis and Arthritis Action have many resources on their websites with tips on eating a healthy diet, different exercises you can do depending on your mobility and help with your mental wellbeing.

They also have other services like local support groups and helplines.

If you’re looking to lose weight, you could also try the NHS’s lose weight resource, which includes a free 12week weight loss plan.

If you are in pain, remember it’s a good idea to take pain relief medication before you are in a significant amount of pain as it takes time for the medication to work. If you feel that your pain is getting worse, you can contact your GP practice or pharmacist for advice.

At the British Orthopaedic Association, we have compiled more resources together that we hope will help patients to make life more bearable while waiting for surgery. You can find these on our website at www.boa.ac.uk/patients

WRITTEN BY Sarah Rudkin Head of Research Strategy and Growth, Versus Arthritis

How can a smartphone app help diagnosis of spinal fractures?

A new tool is being developed to assist healthcare professionals in exploring back pain and spotting vertebral fractures in people with osteoporosis, which may have otherwise been missed.

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t is estimated that 10 million people have back pain, which costs the UK economy billions of pounds each year (Versus Arthritis The State of MSK Health 2021). We are currently starved of the diagnostic tests needed for early detection, prevention and treatment of musculoskeletal (MSK) conditions like arthritis and osteoporosis.

Versus Arthritis funds research that will bring us closer to making MSK conditions preventable, treatable and ultimately curable.

Recently, we prioritised investment in pain research, making a significant investment in the £24 million funding collaboration supporting the Advanced Pain Discovery Platform to drive step changes in the understanding and treatment of chronic pain across a wide range of conditions.

Osteoporosis is a common condition in which the structure of bones becomes more spongy and less strong.

Anyone can get osteoporosis, but risk increases with age and women are about four times more likely than men to develop it.

Bone is a living tissue that is constantly renewing itself. Old bone tissue is broken down by cells called osteoclasts and is replaced by new bone material produced by cells called osteoblasts.

Osteoporotic vertebral fractures (broken bones in the back due to osteoporosis) are particularly important because they increase the chances of more fractures.

Improving diagnosis To help diagnosis of osteoporosis, researchers funded by Versus Arthritis, led by Emma Clark at the University of Bristol, have developed the Vfrac tool.

This tool consists of a checklist in a smartphone app which includes asking questions about the type of back pain the person is experiencing.

It is designed to help doctors decide who needs to be referred for an X-ray.

The app has been shown to improve the diagnosis of vertebral fractures, by helping medical professionals to make referral decisions based on how people are experiencing back pain.

Research findings In newly published work, researchers tested the 15-question checklist in a group of women with back pain, some who have vertebral fracture and some who don’t.

They found that nearly all people with more than one vertebral fracture are diagnosed correctly using the Vfrac tool, and two-thirds of those with one fracture. This is a significant improvement compared to usual care.

Being able to now test this tool in a clinical setting brings us a huge step closer to supporting quicker diagnoses, and ultimately better targeted treatments for people with osteoporosis.

This article was originally published on the Versus Arthritis website https://www.versusarthritis.org/news/2022/ march/how-can-a-smartphone-app-help-diagnosisof-spinal-fractures/

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Robotic assisted technology is helping surgeons operate knee surgery with high accuracy compared to traditional surgery

The patient and clinician testimonials in this article represent the individuals’ own opinions, findings and/or experiences.

Individual results will vary.

How smart apps can support early detection

Technology is ushering in a new era of surgery where robotic-assisted software is driving personalisation.

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nee surgery should offer patients a new lease of life. However, research published in The Bone and Joint Journal suggests that 50% who undergo conventional surgery report some movement limitation,1 while around 20% are not completely satisfied.2,3,4,5 Those statistics raised concerns for 62-year-old Roger Smith who, after decades of arthritic agony, saw knee replacement as his only option. “Physically and mentally, the pain completely drains you,” says Smith.

With the potential to be unsatisfied with the possible outcomes of conventional surgery, Smith sought alternatives which led him to computer-aided robotic surgery and the support of Dinesh Nathwani, Consultant Knee Surgeon at Imperial College Healthcare NHS Trust London and Cleveland Clinic.

Robotic-assisted surgery helps provide accuracy and personalisation Robotics certainly doesn’t abdicate responsibility to machines. Instead, it uses technology, as we do in so many other areas of life, to enhance the surgeon’s ability to precisely plan and execute personalised knee replacements.9,10,11 The CORI◊ Surgical System is designed to help surgeons achieve more accuracy in bone resection and alignment through intraoperative planning, smart mapping (no CT, MRI, or preoperative imaging required) and full range-of-motion data collection.

The system allows the surgeon to collect patientspecific anatomic and kinematic data, and the system provides a 3D model of the patient anatomy.

The surgeon can size, orient and align implant components virtually on a 3D model.

“Conventional systems have all been designed around averages, but there is natural variation among patients that is not addressed with conventional instrumentation,”6,7,8,12,13,14 confirms Mr Nathwani.

INTERVIEW WITH Mr Dinesh Nathwani, MBChB, MSc, FRCS (TR & Orth) Consultant Orthopaedic Surgeon, and President of CAOS UK (Computer Assisted Orthopaedic Surgery UK)

Paid for by Smith+Nephew

Once the reflective markers are placed, the surgeon registers anatomical landmarks and begins to personalise a plan for the patient using an intraoperative software. The precision milling process uses a bur guided by the system to reshape damaged bone. The system maintains high levels of accuracy by preventing the surgeon from going too deep from the proposed plan.

“I can work within a degree of accuracy which we have never had with conventional instruments,” says Mr Nathwani.

Increased demand for robotic surgery Due to the improved accuracy, robotics-assisted partial knee surgery has been shown to result in fewer revisions and better patient outcomes compared with traditional surgery.15,16,17,18,19,20,21 “Within three and a half weeks of surgery I was on a bike and within seven weeks I was bowling for Sussex over 60s,” says Smith who underwent a robotic partial knee replacement.

In Australia, the proportion of total knee arthroplasty operations conducted using computernavigation rose from 2.4% in 2003 to 32% in 2019, according to the Australian Orthopaedic Association National Joint Replacement Registry.

In the UK, it’s just 4%, with cost and resistance to change being the major barriers.22 However, with a new generation of tech-savvy healthcare professionals coming through and patients who are actively asking for robotics, the best kept secret in orthopaedic surgery is finally getting the attention it deserves.

Find out more at robotics-surgery.com

INTERVIEW WITH Mr Roger Smith Knee Replacement Patient SPREAD WRITTEN BY Kate Sharma

Healthcare providers are turning to technology to proactively support patients’ recovery and anticipate problems before they arise.

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ain is the body’s alarm system that prompts us to seek help, but imagine being able to anticipate a problem and respond before the pain becomes unbearable.

Dr Arrash Yassaee is Clinical Director of global health technology company, Huma, which builds evidence-based apps used by clinicians to remotely monitor patients recovering from surgery, such as Orthopaedic surgery, or with ongoing health conditions, such as diabetes.

“Using our smartphone app, patients input health data such as symptoms, questionnaires and vital signs. It can also make use of data that your smartphone is already gathering, like step count, to help clinicians make quicker, better decisions about their patients’ care,” explains Dr Yassaee.

Data-informed care Patients may gain an added sense of empowerment as they can see and track the impact that changes in exercise, diet and medication or procedures have on their body.

The app data helps ensure interactions with healthcare professionals are more meaningful and can make accessing care more convenient.

It also gives clinicians timely, real-world insights so they can assess a patient’s care plan based on what the data presents.

Find out more at info.huma.com/periop-solution

INTERVIEW WITH Dr Arrash Yassaee Clinical Director, Huma

All references can be found via the QR code

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Keeping active is key to managing your osteoarthritis An active patient was so badly affected by arthritis pain that he couldn’t carry out important rehab exercises. Luckily, his life improved with a new treatment option.

E INTERVIEW WITH Charlie Goodchild Bsc (hons) MSc MCSP Specialist Musculoskeletal Physiotherapist and Head of Rehabilitation, Pure Sports WRITTEN BY Tony Greenway

xercise is a hugely important was stuck in this vicious cycle,” says way for people to manage their Goodchild. osteoarthritis. “That’s because “Every time we tried to progress and keeping active strengthens do something different, his knee pain muscles and protects joints,” explains would stop him in his tracks.” Apart Charlie Goodchild, a physiotherapist at from being physically debilitating, the London-based Pure Sports Medicine. situation began to take a toll on his But what if osteoarthritis pain is so mental wellbeing too. acute that it makes physical movement The patient had tried steroid impossible? This was the frustrating injections to reduce the inflammation issue for one of in his knee, but these Goodchild’s patients: only provided pain a 38-year-old semirelief for a couple of pro footballer and weeks. However, the aspiring bodybuilder. patient’s consultant Every time we tried “This person mentioned a new, had always been single injection of to progress and do extremely fit and non-biodegradable something different, his active but needed hydrogel that could knee pain would stop him provide longer term a major operation on his knee after an relief. in his tracks. injury,” remembers A few weeks after Goodchild. “Posthaving the injection, surgery all seemed well until pain the patient saw remarkable results. started to develop at the front of his Because the pain cycle was broken, he knee, caused by early onset arthritis.” could get back to a vital programme of rehab and exercise which, in Long term pain relief turn, promoted better arthritis At this point in his recovery the management. “He is now living a patient should have been exercising normal life and playing football with to improve the movement in his joints his children,” says Goodchild. “He has — but this wasn’t possible because minimal pain, can move normally and the pain was so excruciating. “He isn’t feeling restricted anymore.”

Are you living with Knee Osteoarthritis?

Take the next step in controlling your pain When injected into the knee, Arthrosamid® cushions the joint and reduces pain, providing safe and sustained relief — all with one injection.1 Want to learn more? Scan the QR code to find the centre closest to you via our website or contact us directly at enquiries@arthrosamid.com.

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Non-surgical options may be beneficial for osteoarthritis patients Not everyone with advanced osteoarthritis may be suitable for a surgical intervention.

So, what are their alternative treatment options — and how effective are they?

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ur risk of developing osteoarthritis — a painful condition where joints become stiff and sometimes swollen — increases with age.

Yet osteoarthritis can develop at any time in our lives, explains Mr Sean Curry, Consultant Orthopaedic Surgeon, The London Orthopaedic Clinic, King Edward VII’s Hospital. “In the younger age group, it’s usually as a result of injury,” he says. “One of the worst knee X-rays I ever saw was a 27-year-old — although he was an ex-international rugby player who had suffered a ligament injury but carried on playing.”

Main challenges in osteoarthritis care Osteoarthritis can develop in any joint, including hips, knees, hands and feet.

Symptoms include aching, swelling and stiffness, which may start off as a twinge and becomes progressively painful.

If joint pain is stopping you from enjoying the things that give you pleasure in life, it’s important to see your GP, notes Mr Mark Webb, Consultant Orthopaedic Surgeon, The London Orthopaedic Clinic, King Edward VII’s Hospital.

There are, however, challenges to consider. For instance, if your osteoarthritis is so advanced that you need a hip or knee replacement, or other surgery, you may have to wait a considerable time for it. “NHS wait times are currently the longest I have known in my career,” admits Mr Webb.

“These were long before the pandemic, but worse now.

That’s not good for people who are in pain.”

Although treatment is considered on a case-by-case basis, the under 60s may find it harder to reach the suitability

threshold for hip and knee replacements. “Hip and knee replacements don’t last forever,” says Mr Curry. “Therefore, a younger patient may need two or three replacements in their lifetime. The trouble is these are progressively harder to accomplish from a technical point of view and the results may not be as satisfactory.”

Considering effective non-surgical alternatives Thankfully, other non-surgical options are available.

Physiotherapy and exercise are important in osteoarthritis management. Plus, corticosteroid injections can ease symptoms, although any relief only lasts for a matter of months.

However, a new injection of nonbiodegradable hydrogel is now available, with controlled studies suggesting that it could offer benefits lasting two years or more. At the present time, though, this treatment is not available on the NHS. “Data shows that most people who have the injection do not need further injections or surgery” says Mr Webb. “That’s exciting, however, it would be wrong to suggest that any injection – including this one – will significantly reduce waiting lists. The main goal is to keep people active so the need for surgery is lower, which will reduce waiting lists.”

“It isn’t a magic bullet,” agrees Mr Curry. “It’s not going to work for everyone and it’s not going to replace knee replacement. But if it keeps more of our patients active and doing the things they enjoy, then that’s our primary aim.”

If joint pain is stopping you from enjoying the things that give you pleasure in life, it’s important to see your GP.

INTERVIEW WITH Mr Sean Curry MB BS FRCS (Tr&Orth) Consultant Orthopaedic Surgeon, The London Orthopaedic Clinic, King Edward VII’s Hospital

INTERVIEW WITH Mr Mark Webb MBBS MSC FRCS (Tr&Orth) Consultant Orthopaedic Surgeon, The London Orthopaedic Clinic, King Edward VII’s Hospital WRITTEN BY Tony Greenway

www.arthrosamid.com/patients @ConturaLtd

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1. Bliddal H, Overgaard A, Hartkopp A, Beier J, Conaghan PG, et al. (2021) Polyacrylamide Hydrogel Injection for Knee Osteoarthritis: A 6 Months Prospective Study. J Orthop Res Ther 6: 1188.

Arthrosamid is a registered trademark of Contura International A/S. © copyright 2022 Contura International Ltd. OUS/ARTHRO/MAY2022/075.V1

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New osteoarthritis therapy harnesses the power of human blood Plasma therapy has the potential to reduce painful osteoarthritis and delay knee replacement surgery.

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ainful knee problems are often the reason why older adults give up exercise or their favourite daily activities – and in the process often bring on more serious physical and mental health conditions. Yet, technology is now available to keep people moving and in less pain for longer.

Osteoarthritis (OA) is a painful joint condition commonly affecting the over50s that causes swelling, tenderness, grating or crackling sounds when moving, most commonly in the fingers, thumbs, hips, knees, neck and lower back. At its most serious, OA will be treated by joint replacement surgery, from which full recovery can take several years.

New emerging treatment options However, a new treatment is gradually gaining momentum in the UK that offers people with OA the hope of more pain-free years. In platelet-rich plasma (PRP) therapy, the patient’s own blood is manipulated to create a platelet-rich plasma “soup”, which is then injected into the injury site. Within the body, growth factors that naturally occur in these platelets work with stem cells to repair damaged tissue.

According to specialist knee surgeon Oliver Templeton-Ward, most people see significant improvements in pain and mobility after treatment. “With so few downsides, the vast majority of people are really pleased to have it done,” he says.

With a strong heritage of successful use in the USA, PRP is slowly finding its place within forward-thinking UK healthcare commissioners. In an ideal scenario, PRP is delivered in tandem with physiotherapy, providing a “first-stop” treatment option for people with arthritis that supports them towards improved joint health.

Templeton-Ward says: “I would like to see primary care groups think of arthritis treatment as a journey along a pathway – rather than all or nothing.”

However, wider use of PRP remains handicapped by outdated experience of early-stage technology or lack of knowledge of its benefits. “There is a lot of good evidence out there for the use of PRP in mild to moderate arthritis. It is time to allay fears that this is hocus pocus,” he says.

INTERVIEW WITH Oliver Templeton-Ward Orthopaedic Surgeon WRITTEN BY Ailsa Coqhoun

Paid for by Arthrex PRP Find out more at arthrex.com

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Preventing individuals’ needs being overlooked in big data and digitisation One in four persons in the UK and one in five in the EU are living with chronic pain. What impact will the digitisation of health services and an EU data space have for people in pain?

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inding timely and accurate diagnosis is a challenge for many patients with most suffering for years before diagnosis and treatment. One surprising issue is that many people wait almost a year before seeking medical help with their pain.

An optimal use of digitalisation is the availability and reliability of accurate information on pain and when to seek help. Literacy, health literacy and digital literacy must be addressed. It’s crucial that basic and non-judgemental language is used at all touchpoints in addition to the healthcare setting i.e. online and within the community.

The diversity of individuals, their pain and their needs must not be lost in datasets and statistics.

Digital health records, patient registries and data quality The adoption of borderless digital health records empowers people to control their own health data.

The WHO’s International Classification of Diseases (ICD-11 2022) includes coding for primary chronic pain for the first time. It is imperative each country implements ICD-11 and companion International Classification of Functioning, Disability & Health (ICF) to inform accurate diagnosis, treatment and capturing morbidity data internationally.

While large datasets are important for research and planning, pain is subjective and personal.

The diversity of individuals, their pain and their needs must not be lost in datasets and statistics.

Individualised interventions show the best outcomes.

Therefore, it is tantamount that patients are engaged at each stage of development and rollout of digital interventions and policy.

Learnings of COVID-19 adaptations Fortunately, many digital developments were implemented or fast tracked in response to the pandemic. However, how that looks at national level is inconsistent, as digital infrastructures vary greatly.

When surveyed, 49% of patients received telephone consultations or information during 2020/2021.

Despite 40% preferring a video consultation only 10% had access to this solution. Overall, 27% prefer in-person interactions and another 27% said they had zero access to digital solutions. Each health system is facing challenges of backlogs and the impending tsunami of treating pain in long COVID, will digitisation truly mitigate this?

The digital world enables us to connect globally with others and feel less isolated especially while dealing with a health condition like chronic pain. Most of us will experience an episode of severe pain at some point in our lives. It is in all our interests to invest and support each other in adapting to digital changes.

WRITTEN BY Deirdre Ryan President, Pain Alliance Europe

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A universal language is needed to define and explain chronic pain Chronic pain exerts an enormous personal and societal burden from an emotional and economic perspective and is believed to affect around 30% of people worldwide.1

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xperiencing acute pain is an evolutionarily valuable phenomenon in triggering a healing process in response to the damage incurred and protecting from future harm, through the process of learning.

In contrast, chronic pain, typically lasting longer than three months, serves no recognised biological function. It is associated with longer term negative health outcomes including potential physical disability and poor mental health.

Significant burden

Unfortunately, perhaps in part due to its commonality, particularly in elderly populations, the experience of chronic pain is often normalised and simply perceived as a natural part of an ageing process.

As there are no objective tests for establishing the causes of most forms of chronic pain – physicians are nearly entirely reliant on patients’ description of their symptoms in terms of location, intensity and characterising descriptors defining the experience in order to make a diagnosis.

For the patient, understanding that their chronic pain is not normal but is unique to them is invaluable. Characterising their pain using clear language is an essential step.

Patients should also define the exact extent to which it is affecting their life, including loss of sleep, changes in mood through to missing work or social events.

Together this holistic picture will give the doctor the best opportunity to design a treatment plan specific for each individual’s type of pain.

Working together

On establishing a correct diagnosis, it may be necessary to work with a multi-disciplinary team of healthcare professionals to optimise outcomes.

Professionals and patients using a common language that all parties understand helps to build empathy and trust. Additionally, it’s important physicians manage patient expectations around the level of pain control that can be achieved, and support lifestyle changes around weight management and increasing activity levels that may also be necessary.

Above all, it’s really important that the patient is fully engaged in this entire process to maximise their opportunity to realise real health gains and lead as full and productive a life as possible. Knowing how to describe your pain can be difficult, so please see the infographic next to this article to help explain some of the symptoms you may have.

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To treat chronic pain effectively it is important that each of the three elements that contribute to pain are considered by the patient and physician alike.

The biology underlying the patient’s pain can trigger negative changes in a patient’s sleep patterns, which can lead to psychological challenges (negative mood/depression) that can worsen the pain experience.

Possessing good coping strategies can help to counter the above challenges. Patients will also probably need the support of friends and family members. Many older patients may lack this support framework and social isolation is a common problem.

Biological • Age/sex • Magnitude of injury or disease • Sleep

Psychological • Coping skills • Depression and anxiety

Social • Degree of isolation • Functional/dysfunctional relationships

Everyone should feel comfortable and capable in communicating their pain. Please speak to your healthcare professional for advice and support.

Reference: 1. Content adapted from: The Lancet: Chronic pain: an update on burden, best practices, and new advances. Steven P Cohen, Lene Vase, William M Hooten

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Addressing your chronic pain – a human right not a commodity There is a significant and much needed requirement for training pain specialists doctors and upskilling non-specialist doctors to ensure pain services are available in the community.

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ain management is the responsibility of healthcare providers. The UK has a significant shortage of doctors trained as pain medicine specialists, with less than one specialist per 100,000 people.

The Faculty of Pain Medicine (FPM) of the Royal College of Anaesthetists is responsible for the training, assessment, practice and continuing professional development of specialist pain doctors in the UK. Currently, most UK pain medicine specialists are anaesthetists. Recruitment from anaesthesia alone is not expected to meet the predicted workforce shortage in the next 20 years; anaesthetists also work in anaesthesia, perioperative and intensive care medicine.

Communication and empathetic consultation skills are the cornerstone of effective pain assessment, ensuring the biological, psychological and social aspects of pain are identified and managed.

Pain doctors work in multidisciplinary teams including nurses, physiotherapists, occupational therapists, clinical health psychologists and pharmacists to help patients manage and live with their longterm pain condition.

Creating credentials for pain management Together with the General Medical Council, we are at an advanced stage of developing credentialing for pain medicine specialists – the paramount reason is patient safety, clearly identifying doctors trained in the holistic practice of pain medicine. It is planned to facilitate doctors from other specialties training as pain medicine specialists.

We are also in discussions with Health Education England and NHS Education Scotland to develop a Credential for Advanced Health Care Practitioners in Pain Management. This will expand the workforce to deliver multidisciplinary community-based pain services, addressing patients’ needs at an earlier point in time, improving triage, access, appropriate communication, referral and integration with specialist pain services, with better and more cost-effective outcomes for the NHS and society at large.

The FPM is developing a patient focused Four Nation Pain Strategy to provide an overarching framework to deliver improved pain management across the whole healthcare sector including support to live well with pain. The aim is an integrated national, regional and local delivery system ensuring equality of gold-standard care for all, wherever they live.

WRITTEN BY Dr Lorraine de Gray Vice Dean of the Faculty of Pain Medicine of the Royal College of Anaesthetists

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Increasing patient awareness to reduce opioid harm

Scan the QR code to access the document.

Better patient education will help people use, store and reduce their opioids more safely.

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pioids such as morphine and oxycodone are strong and effective pain medicines for pain after surgery. They are best used in combination with other ways of managing pain. Opioids are not without risk, with excessive opioid prescribing on discharge from hospital contributing to the community opioid burden.

Improving patient education The British and Irish Pain Societies have collaborated with patient and professional organisations to develop a patient information booklet which supports patients to safely manage their pain once they have left hospital.

The information covers the whole surgical pathway, describing what patients can do to before their surgery to increase fitness and to set expectations about pain and recovery afterwards. It explains how medicines – both opioid and non-opioid drugs - work to relieve pain and gives suggestions for nondrug techniques for managing pain such as using distraction and exercise. It also provides a personal pain management plan that is jointly agreed by the patient and their healthcare team to achieve their recovery goals.

Where patients are prescribed more opioids than they need, there is the broader societal risk of diversion of unused opioids.

Immediate opioid risks include “opioid-induced ventilatory impairment” which results from slow breathing, drowsiness and a loss of muscle tone in the airway. If left untreated this can result in death.

Later opioid risks involve the continued use of opioids after the anticipated recovery period – “persistent postoperative opioid use” – which can result in dependence and addiction. The booklet guides patients to reduce and stop their opioids as the acute postoperative pain settles.

Further, where patients are prescribed more opioids than they need, there is the broader societal risk of diversion of unused opioids; or the devastating impact of accidental ingestion and overdose by children or pets if not stored out of sight and reach.

Raising awareness of harm By informing patients and their carers about the risks and benefits of opioid medicine for acute postoperative pain it is hoped to reduce adverse events. The five key safety messages are: 1. Lock opioids safely away. Keep them out of reach of children.

2. Reduce and stop opioids as your pain decreases.

3. Take unused medicines to a pharmacy for disposal.

4. Tell your carers to call 999 if they can’t wake you up or if your breathing is very slow. Ensure they tell doctors or paramedics you take opioids for pain.

5. Do not drive while taking postoperative opioids.

WRITTEN BY Felicia Cox FRCN MSc RN Nurse Consultant, Pain Management, Royal Brompton & Harefield Hospitals, Part of GSTT

WRITTEN BY Dr Jane Quinlan FRCA FFPMRCA Consultant in Anaesthesia and Pain Management, Oxford University Hospitals Trust, Honorary Senior Clinical Lecturer, University of Oxford

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