CHRONIC PAIN MANAGEMENT.

Learning objectives
By the end of this educational module you should be able to:
1. understand the importance of addressing patients' physical functionality in pain management
2. recognise and assess different types of pain
3. interpret patients’ individual needs in pain management
4. understand the holistic approach to chronic pain management and the role your specialty can play
5. know how to address the needs of patients with chronic pain during the COVID-19 pandemic

Functionality in pain management

THE BURDEN OF CHRONIC PAIN

In 2016, chronic pain was estimated to affect 35.0% to 51.3% of adults in the UK (pooled estimate: 43.5%) where prevalence and intensity varied across the country.^1,2

The impact of chronic pain on the patients' daily activities and quality of life is far-reaching, with serious repercussions observed in family life, workplace functioning, social networking and coping skills. Patients suffer from anxiety, depression, disturbed sleep and reduced mobility.³ Almost half of the people with chronic pain are diagnosed with depression, and two thirds are unable to work outside their home.⁴ Chronic pain that interferes with patients' lives is associated with an increased risk of mortality.⁵

Chronic pain negatively affects the healthcare economy as well; back pain alone is estimated to cost the UK government £5 billion/ year in disability benefits.⁶

IMPACT OF CHRONIC PAIN ON PATIENT'S LIFE, INCLUDING THEIR PHYSICAL FUNCTIONING

In the secondary analysis of a community-based comparative mixed-methods study, it was demonstrated that overall health-related quality of life (HRQoL) was poorer among patients with chronic pain compared with the general population and patients with other long-term conditions.⁷

Adapted from Hadi M A, et al, 2019⁷
The study was designed to assess the impact of chronic pain on patients' quality of life (QoL) and evaluated quantitative and qualitative data collected from patients attending a pain clinic located in the North of England. QoL was assessed using Short-Form 36 version 2.
Quantitative data were collected from 76 patients and qualitative interviews were conducted face-to-face with 19 patients.⁷
*Lower scores = greater impairment.⁷
SF-36: short-form 36.

Chronic pain is associated with poor overall HRQoL and has a strong effect on both the mental and physical aspects of HRQoL^3,7

THE IMPORTANCE OF MAINTAINING FUNCTIONALITY IN PATIENTS WITH CHRONIC PAIN

Chronic low back pain is often associated with a decreased level of mobility and a reduction in activities associated with daily living and working.⁸ The functional and psychological consequences of chronic pain have a significant effect on:⁹

patients' experience of pain
presentation to healthcare providers
responsiveness to and participation in treatment
HRQoL

Successful treatment of chronic pain should include improvement of function as well as reduction in the level of pain¹⁰

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REFERENCES

Fayaz A, Croft P et al. Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies. BMJ Open 2016;6(6):e010364
Todd A, Akhter N et al. The pain divide: a cross-sectional analysis of chronic pain prevalence, pain intensity and opioid utilisation in England. BMJ Open 2018;8(7):e023391
Duenas M, Ojeda B et al. A review of chronic pain impact on patients, their social environment and the health care system. J Pain Res 2016;9:457-467
National Institute for Health and Care Excellence (NICE). Guideline scope. Chronic pain: assessment and management. Available at: www.nice.org.uk. Accessed December 2020
Smith D, Wilkie R et al. Pain and mortality: mechanisms for a relationship. Pain 2018;159(6):1112-1118
British Pain Society. FAQs. Available at: www.britishpainsociety.org. Accessed December 2020
Hadi M A, McHugh G A, Closs S J. Impact of chronic pain on patients' quality of life: a comparative mixed-methods study. J Patient Exp 2019;6(2):133-141
Smith B H, Elliott A M et al. The impact of chronic pain in the community. Fam Pract 2001;18(3):292-299
Gordon R, Bloxham S. A systematic review of the effects of exercise and physical activity on non-specific chronic low back pain. Healthcare (Basel) 2016;4(2):22
Turk D C, Fillingim R B et al. Assessment of psychosocial and functional impact of chronic pain. J Pain 2016;17(9 Suppl):T21-49
Yasaei R, Saadabadi A. Chronic pain syndrome. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29262143. Accessed December 2020