Some forms of pain are short lived, and customers will be able to deal with them quickly and get on with their lives. But how can pharmacy teams help when pain is longer lasting?
Everyone experiences pain at some point in their life, to varying degrees. Fortunately, most pain disappears after a few days or weeks, once the underlying cause is resolved. If pain doesn’t go away after more than three months, it is classified as chronic pain. Long-lasting pain like this can cause significant discomfort and distress.
According to National Institute for Health and Care Excellence (NICE) guidance on chronic pain in the over-16s published in April 2021, chronic pain affects between one third and one half of the UK population.
Chronic 'secondary' pain is caused by an underlying condition, such as arthritis, a digestive problem or endometriosis. Chronic 'primary' pain, such as fibromyalgia or chronic primary headache, has no clear underlying cause. The prevalence of chronic primary pain is unknown, but NICE estimates it to be between one and six per cent of the English population.
According to the Versus Arthritis report Chronic pain in England: Unseen, unequal, unfair, which was published in June 2021, chronic pain affects 53 per cent of people aged 75 years and older, compared with only 18 per cent of those aged 16 to 34. This is most likely because long-term musculoskeletal conditions such as osteoarthritis tend to affect older people.
However, more young adults are now reporting high impact chronic pain, possibly because of increased sedentary lifestyles, rising obesity rates or adverse socioeconomic trends over the last decade.
"Social disadvantage, deprivation and psychological stress can increase people’s risk of developing chronic pain in the first place, and some groups are more affected than others," says Dr Benjamin Ellis, senior clinical policy advisor to Versus Arthritis and consultant rheumatologist. "The Chronic pain in England: Unseen, unequal, unfair report found that chronic pain affects nearly twice as many women in the most deprived areas (45 per cent) as men in the least deprived areas (27 per cent)."
Understanding is key
Chronic primary pain, in particular, can be difficult to manage as medical treatments are not always helpful.
According to the Versus Arthritis report, 5.5 million people in England (12 per cent of the population) have high impact chronic pain, the most disabling form. This means they struggle with everyday activities and taking part in family life and hobbies. Their pain can disrupt sleep and lead to severe fatigue and poor mental health.
"Unfortunately, people with chronic pain are likely to have recurrent symptoms throughout their lives," says Dr Naomi Newman-Beinart PhD, chartered psychologist and chronic pain expert. "When your brain filters pain signals coming from your body, it’s not just about the feelings of pain – feelings and emotions get involved here too. How you think about your pain can often make it feel worse. This is why people often find that a combination of different approaches might work best to help improve their pain and also their quality of life."
According to Dr Ellis, if someone comes to the pharmacy for support for chronic pain, the first step is to understand what’s causing it. "Ask about their diagnosis," he says. "If they know what it is, then tailor advice using the relevant NICE guideline.
"For example, people with osteoarthritis may not have tried topical NSAIDs or given capsaicin cream a go. There’s also NICE guidance on rheumatoid arthritis, back pain and chronic primary pain, including conditions such as fibromyalgia. All healthcare professionals should be familiar with these guidelines and take the time to read up on them."
“People often find that a combination of different approaches might work best to help improve their pain”
If a customer’s pain isn’t being well managed, their GP may be able to refer them to a pain management clinic that offers a holistic treatment approach. This may involve medication, counselling, relaxation, electrical stimulation devices, physiotherapy, exercise, dietary changes, acupressure and massage.
"Management of pain is not a simple or one-dimensional process," says Dr Ashish Shetty, pain medicine consultant at the National Hospital for Neurology and Neurosurgery at University College London Hospitals, and NuroKor’s chief medical officer. "Origins and causes of pain are often highly personal to every patient. Pain management clinics provide those affected by chronic pain with an expert-guided service to find solutions that suit their needs and lives best."
The charity Crohn’s & Colitis UK launched its 'Pain Collaborative Network' in 2019, with the aim of improving how pain associated with inflammatory bowel disease is managed as well as the quality of life for people who experience it. "We know pain is a debilitating symptom of Crohn’s and Colitis," says Rachel Ainley, head of research and evidence at Crohn’s & Colitis UK. "This can be constant and relentless, and current treatment options are not good enough. We’re optimistic that the work of the Pain Collaborative Network can drive research into this area."
Since medical treatments for chronic pain are limited, customers may come into the pharmacy for over the counter products and self care advice.
"People with chronic pain often (quite reasonably) just want something to make their pain go away, or at least to reduce it," says Dr Ellis. "But for many types of chronic pain, pharmacological treatments just don’t help that much with pain itself. We owe it to people with chronic pain to be honest about this.
"That doesn’t mean there’s nothing that can be done. Far from it. Chronic pain can affect every aspect of a person’s life. People may need support with mental health and sleep, mobility and home aids and adaptations, employment rights and benefit payments."
Of course, regardless of its duration, pain can have many different causes. Let’s take a look at some of the most common causes of long-term pain.
Common causes of long-term pain
Learn more about pain
The charity Pain Concern produces leaflets on chronic pain management, as well as a podcast and a quarterly Pain Matters magazine for people living with chronic pain. These may be useful learning resources for the community pharmacy team.
For information on specific types of chronic pain, you can contact national charities such as:
- Versus Arthritis: email email@example.com
- Fibromyalgia UK
- The Migraine Trust
- The IBS Network
Pharmacist Mark Hopkins from Cardiff has supported and launched a growing network of more than 20 community pharmacy-led pain clinics across the UK. "The ‘Change Grow Live – Dependence Forming Medications’ team support those who are prescribed strong painkillers and would like help in reducing their use," he says. "Liaise with local GPs, orthopaedics, chiropractic consultants and physios. Many primary and secondary care services provide local training courses and resources to support pain management, and CPPE offers an online training and educational course on pain management to contribute to improving patient care."
You can contact the Change Grow Live – Dependence Forming Medications team on email at firstname.lastname@example.org
For more on CPPE programmes.
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