US RESEARCHERS GENERATE OBJECTIVE PAIN INDICATORS FOR FIRST TIME

“Effective, personalised care should include shared decision-making with patients and regular reviews of whether treatment is working. Patients who want to stop using a medicine must be able to access appropriate medical advice and treatment and must never be stigmatised.”

It also cautions, however, that it is important to recognise that the reverse is also true, that the “effective personalised care with shared decision-making with patients and regular reviews of treatment” will also reveal a group of patients where medications associated with dependence or withdrawal symptoms will be providing a significant degree of pain relief and improvement in overall function and quality of life. That group of patients must also never be stigmatised and/or taken off their medication inappropriately, the FPM says.

The FPM “advocates personalised care and shared decision-making with each patient suffering from chronic pain, using multi-modal evidence-based pain management appropriately, and may often include using such medication. It is vital that such medication usage is regularly reviewed and only continued if there is evidence of improvement in pain, quality of life and level of function, always balanced against a clear understanding of potential risks or side effects associated with such medication.”

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ONE OF THE perennial problems in determining compensation for pain is the subjective nature of the experience of pain and the hitherto impossibility of objectively assessing pain.

Recent research carried out at the University of California in San Francisco and published in Nature Neuroscience promises to make objective assessment of pain a possibility for the first time.

The researchers explain: “Pain severity is often measured through subjective report, while objective biomarkers that may guide diagnosis and treatment are lacking.”

According to a digest of the report: “Researchers have used a device implanted in the brain to record, for the first time, objective signs of chronic pain. Several times a day for up to six months, the implant recorded four people’s brain activity, which scientists matched to their self-reported symptoms.

“One participant had phantom pain from an amputated leg; the rest had unexplained sensations after a stroke. When participants felt chronic pain, brain activity in the orbitofrontal cortex was detected. A different region of the brain was active when they experienced pain from touching a hot object.”

One of the authors of the report, Prasad Shirvalkar, is reported as saying: “Chronic pain is actually its own separate disease that is not simply an extension of pain in general.” q

The faculty argues that the document “rightly advocates other treatment modalities, including exercise, self-management and psychological therapies to replace inappropriate medication”.

“It also highlights the need for services to help patients who may have developed drug dependence to be supported appropriately. Significant investment, workforce increase and upskilling of NHS health professionals will be essential to meet this demand.” q