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News Article
Doctors raise concerns about NICE guidelines on chronic primary pain
Patient Safety Learning posted a news article in News
Doctors in pain management have raised concerns about the National Institute of Health and Care Excellence’s guidance on treating chronic primary pain, which they said do not reflect clinical practice or current evidence. Patients could be left in “despair,” said the British Pain Society, because of the recommendation that the only drugs that doctors should prescribe are certain antidepressants. Commonly prescribed drugs, including paracetamol, non-steroidal anti-inflammatory drugs, benzodiazepines, and opioids, should not be used to treat chronic primary pain, said NICE. Instead patients should be offered exercise programmes, therapy, and acupuncture. Read full story (paywalled) Source: BMJ, 9 April 2021 -
Content ArticleIn April 2021, The National Institute for Health and Care Excellence (NICE) released new guidance on the management of chronic pain. In The British Pain Society's (BPS) initial statement on the NICE guideline, they conclude: "In summary, the new NICE guideline NG193 acknowledges that individual and indeed specialised chronic pain assessment and management is required. However, The British Pain Society feels that the guidance as it stands could lead to the withdrawal of supervised short-term therapies which can work safely in carefully selected and monitored patients with forms of chronic primary pain." Follow the link below to access the statement in full.
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Content ArticleDr Ian Carroll discusses neuropathic pain, which involves damage to the nerve. The condition causes the nerves to fire incessantly, even if the initial source of the pain has been remedied. The brain responds by creating an ongoing message of pain.
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News Article
Covid: Unpaid carers 'struggled to get pain relief' for terminally ill
Patient Safety Learning posted a news article in News
Unpaid carers looking after terminally ill friends and relatives during the pandemic struggled to access pain relief, with some patients dying in unnecessary pain, a survey has found. The survey of 995 unpaid carers by Marie Curie also found people had difficulties getting personal care and respite nursing for loved ones. Figures show the number of people dying at home rose by 42% in the past year. Nearly two-thirds of carers surveyed by the charity said their loved one did not get all the pain relief they needed when they were dying. Susan Lowe, from Solihull, cared for her mother Sheila before she died with bowel cancer in April last year, aged 74. She said caring for her mum during lockdown was hard as "the system was just under so much pressure that we had to manage largely on our own". The public health worker says she struggled to get the right pain relief medication for her mother in her final weeks and spent hours travelling to different chemists. Susan, 50, told the BBC: "My biggest regret is that my mum died in pain - more pain than she needed to be. She really wanted to be comfortable at the end. She knew she was dying." "What she really wanted - and this is what she was assured would happen - was to be comfortable. She was told she would get the drugs that she needed for it to be as bearable as possible... I remember breaking down in tears a couple of times in the pharmacy when I was told the medication mum needed wasn't in stock." Read full story Source: BBC News, 8 April 2021 -
Content ArticleThe National Institute for Health and Clinical Excellence (NICE) guideline covers assessing all chronic pain (chronic primary pain, chronic secondary pain, or both) and managing chronic primary pain in people aged 16 years and over. Chronic primary pain is pain with no clear underlying cause or pain (or its impact) that is out of proportion to any observable injury or disease. Download the full guidance from link below or click on the image for a visual summary. We have also included links to supporting evidence and to useful tools and resources.
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News ArticlePeople suffering from chronic pain that has no known cause should not be prescribed painkillers, the medicines watchdog has announced, recommending such patients be offered exercise, talking therapies and acupuncture instead. In a major change of pain treatment policy, the National Institute for health and Care Excellence (NICE) say that in future, doctors should advise sufferers to use physical and psychological therapies rather than analgesics to manage their pain. Painkillers such as aspirin 'do more harm than good' for chronic primary pain Medical teams can also consider prescribing antidepressants, the government health advisers suggest. NICE’s new guidance potentially affects the way many hundreds of thousands of people in England and Wales tackle their condition because between 1% and 6% of the population of England is estimated to have chronic primary pain. Read full story Source: The Guardian, 7 April 2021
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Content ArticleThis study, published by the Proceedings of the National Academy of Sciences (PNAS), found that Black Americans are systematically undertreated for pain relative to white Americans.
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Content ArticleOn International Women’s Day 2021, feminist journalist Sarah Graham presented to the St Mary’s Women’s Network about the gender pain gap and how it harms women's health. The link below will take you to the slides and notes shared at the event.
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Content Article
Mesh: Denial, half-truths and the harms (March 2021)
Patient Safety Learning posted an article in Women's health
In this article, Sharon Hartles, a member of the Harm and Evidence Research Collaborative, critically discusses the harmful impacts of mesh medical devices against the backdrop of disempowerment, denial and half-truths. Surgical meshes have been in use since the late 19th century. In the mid-20th century the clinical usage of mesh increased. Now, in the early 21st century, procedures involving mesh implantation are common surgeries that are performed around the world. Despite the frequency and worldwide usage of mesh medical devices, the debate about whether or not the benefits outweigh the alleged harms remains highly contested. Read the full article Further recommended reading: Dangerous exclusions: The risk to patient safety of sex and gender bias Healing after harm: A restorative approach to incidents Analysing the Cumberlege Review: Who should join the dots for patient safety? Findings of the Cumberlege Review: informed consent Findings of the Cumberlege Review: patient complaints -
Content Article
Endometriosis: one woman’s story
PatientSafetyLearning Team posted an article in Women's health
It affects an estimated 176 million women worldwide, yet endometriosis can take years to be diagnosed. In this blog, published on the Boots website, Terri White, author, journalist and Editor in Chief of Empire magazine, shares her story of the pain, frustration and delays in diagnosis she has faced. She also offers advice on how to get listened to. -
Content ArticleThis is a presentation detailing the manuscript which investigated the presence of pain during hysteroscopy, delivered by pain researcher, Richard Harrison to the annual meeting of the Royal College of Obstetricians and Gynaecologists in 2021.
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News Article
Hundreds of patients with chronic pain waiting a year for first NHS appointment
Patient Safety Learning posted a news article in News
NHS clinics were still seeing just two-thirds of the number of chronic pain patients they normally would by the end of last year, with some patients having waited a year or more. In Ayrshire and Arran, 94 of the 112 chronic pain patients seen between October and December – equivalent to nearly 84% – had been on the waiting list for their first appointment for 52 weeks or longer. Only nine were seen within the 18-week target. This was by far the worst performance for any health board in Scotland. Pain relief clinics across NHS Scotland were paused for four months at the beginning of the pandemic, leading to reports that some patients with problems such as nerve damage and arthritis were paying thousands of pounds to travel to private facilities in England for medical infusions or injections to ease their symptoms. In a statement at the end of last year, Joanne Edwards, the director of acute service at NHS Ayrshire and Arran, apologised for the delays, saying the coronavirus pandemic "has had a significant impact on the capacity of the chronic pain service". Ms Edwards said the health board was increasing the number of face to face and telephone clinics that the chronic pain team can undertake, adding that an "enhanced clinical review" of the waiting list was also being carried out to prioritise patients for appointment based on clinical need. Read full story Source: The Herald, 10 March 2021 -
Content ArticleThis presentation was submitted by the patient group Campaign Against Painful Hysteroscopy, as an oral presentation to the British Society for Gynae Endoscopy’s Annual Scientific Meeting 2021. It includes patient testimonials and statistical data gathered around painful hysteroscopies and informed consent.
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Content ArticleIn this blog, pain researcher, Richard Harrison, reflects on the presentation he recently made to the Royal College of Obstetricians and Gynaecologists, based on his research into pain during hysteroscopy. Follow the link below to read Richard's blog, or you can watch the RCOG presentation here.
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News ArticleNew stats from Endometriosis UK this week for Endometriosis Awareness Month reveal that 62% of women (aged 16-54) would put off going to a doctor with symptoms of endometriosis. Reasons include they don’t think it’s serious enough to bother a doctor with, they’d be embarrassed, they don’t think they’d be taken seriously, or they think symptoms including painful periods are normal. This statistic rises to 80% of 16-24-year-olds. 1.5 million UK women are currently living with endometriosis, with average diagnosis time standing at an unacceptable 8 years Endometriosis UK says it is vital that Governments, society, the NHS and workplaces wake-up and recognise the symptoms and impact endometriosis can have, and afford those with the condition the support and access to treatment they need to manage their symptoms. Commenting on the new research, Emma Cox, CEO of Endometriosis UK said: “Endometriosis is a long-term chronic health condition affecting 1.5 million in the UK, yet it still all too often considered a taboo or not important due to links with the menstrual cycle. Symptoms including chronic pelvic pain, painful periods, painful bladder and bowel movements, and infertility, can have a major, life-long impact, physically and mentally. But far too many find their symptoms are not believed nor taken seriously." “Myths such as “chronic period pain is normal” or “you must have a low pain threshold” manifesting in society, workplaces, schools, and even healthcare settings contribute to those experiencing symptoms being put off from seeking medical advice and contribute to diagnosis taking on average a shocking 8 years. “The impact of delayed diagnosis on people’s physical and mental health can’t be overstated. If undiagnosed, the disease may progress, and negatively impact people’s careers, education, relationships and all aspects of their life.” Read full story Source: Endometriosis UK, 1 March 2021
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Content Article
Getting diagnosed with endometriosis: personal stories
Patient Safety Learning posted an article in Women's health
Women share their personal experiences to Endometriosis UK of getting diagnosed with endometriosis. -
Content ArticleIn this blog Patient Safety Learning reflects on responses received from Robin Swann MLA, Minister of Health (Northern Ireland), Jeane Freeman MSP, Cabinet Secretary for Health and Sport (Scotland) and Vaughan Gething MS, Minister for Health and Social Services (Wales), regarding concerns about painful hysteroscopy procedures in the NHS.
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Content Article
The Pain Toolkit
PatientSafetyLearning Team posted an article in Pain management
Many people with pain say they feel trapped or stuck in a persistent pain cycle. On good days they do more and on bad days less. The Pain Toolkit is for people who live with persistent pain and Healthcare teams who support them. This website hosts a range of resources including:Online workshopsPain ToolkitsResearchWebinarsPodcastsUnderstanding painHow to get the most out of your appointments. -
Content Article
Through the hysteroscope: Reflections of a gynaecologist
SairaS posted an article in Women's health
At Patient Safety Learning, we’ve been working with others to understand the issues surrounding painful hysteroscopies. In this interview, we talk to Obstetrics and Gynaecology consultant, Saira Sundar, about the process. She offers her clinical insight and highlights some of the challenges involved when it comes to managing pain during hysteroscopies. Saira also offers advice to colleagues and patients seeking to reduce anxiety and improve the patient experience.- Posted
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Content ArticleIn this blog, Patient Safety Learning reflects on a recent response from Nadine Dorries MP, Minister of State for Mental Health, Suicide Prevention and Patient Safety, regarding concerns about painful hysteroscopy procedures in the NHS. Towards the end of last year, Patient Safety Learning published a blog outlining five calls to action that could be taken to improve the safety of hysteroscopy procedures in the NHS.[1] This has been an issue raised by patients, campaign groups and politicians in recent years, highlighting concerns that women having been suffering avoidable harm from hysteroscopies. We wrote to several key stakeholders in healthcare across England, Northern Ireland, Scotland and Wales, to raise awareness of this issue and call for urgent action to prevent future harm. While we welcome the Minister in her response supporting the general principles of informed consent and good practice guidance for hysteroscopy, we know that many women are still not being offered a choice of pain relief or given adequate information before consenting to the procedure. It remains unclear from her response whether the Government will take action to investigate the frequency of these experiences and respond to improve hysteroscopy safety.
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Content ArticleGeneral anaesthesia for obstetric surgery has distinct characteristics that may contribute towards a higher risk of accidental awareness during general anaesthesia. The primary aim of this study from Odor et al. was to investigate the incidence, experience and psychological implications of unintended conscious awareness during general anaesthesia in obstetric patients. Researchers discovered that one in 256 women going through pregnancy-related surgery are aware of what was going on — a far higher proportion than the one in every 19,000 identified in a previous national audit. If a patient is conscious at some point while under general anaesthetic, they may be able to recall events from the surgery such as pain or the sensation of being trapped, the researchers said.
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News ArticleMore women may suffer pain due to being conscious while undergoing caesareans or other pregnancy-related surgery under general anaesthetic than realised, a troubling new study has found. The report, conducted by medical journal Anaesthesia, found being awake while having a caesarean is far more common than it is with other types of surgery. Researchers discovered that one in 256 women going through pregnancy-related surgery are aware of what was going on — a far higher proportion than the one in every 19,000 identified in a previous national audit. If a patient is conscious at some point while under general anaesthetic, they may be able to recall events from the surgery such as pain or the sensation of being trapped, the researchers said. While the experiences generally only last for a few seconds or minutes, anaesthetists remain highly concerned. Women also felt tugging, stitching, feelings of dissociation and not being able to breathe - with some suffering long-term psychological damage that often involved characteristics of post-traumatic stress disorder. Read full story Source: The Independent, 13 January 2021
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EventuntilChronic pain following trauma and surgery is recognised but at the same time is incredibly difficult to manage once it is established. Part 2 of this Royal Society of Medicine (RSM) two-part webinar series will focus on the impact of early post-operative and critical care management of trauma patients. Join us to explore ways to minimise the severity of acute pain as well as the transition to persistent pain states. Register
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EventuntilMany clinicians are involved in the complex care of the trauma patient from the pre-hospital arena through the Emergency Department and often into theatre and critical care. Interventions at all these stages could reduce Nociception and pain in order to facilitate recovery and rehabilitation for survivors. In this two-part Royal Society of Medicine (RSM) webinar series, hear about innovative approaches that cover the entire patient journey rather than only focusing on a single specialty. This thought provoking webinar is an opportunity for 'traumatogist' as well as the generalist to learn how to limit the long-term burden of painful trauma and its early treatment. Register
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News ArticleWomen are undergoing “painful and distressing” diagnostic tests as doctors use the COVID-19 pandemic as an excuse not to offer them their choice of pain relief, HSJ has been told. At least 70 women who have had hysteroscopies this year in English NHS hospitals said they were left in extreme pain following the procedures, with many suffering trauma for several days, according to a survey by the Campaign Against Painful Hysteroscopies group. Some women claimed doctors used COVID-19 as an “excuse” not to offer sedation or general anaesthetic. Others said they were offered an inpatient appointment with general anaesthetic, but were also told it would be a long wait and would likely be cancelled due to covid pressures. Women also said they were told an outpatient procedure would reduce the time spent in hospital and consequently reduce the risk of contracting covid. The only pain relief on offer was often just ibuprofen and some women said facilities like recovery rooms were unavailable. The vast majority of the women surveyed — more than 90% — said they were traumatised for a day or longer by the pain from the procedure, A RCOG spokeswoman said: “We are concerned to hear that women are going through painful and distressing hysteroscopy procedures and that they feel COVID-19 is being used as an excuse not to offer a choice of anaesthetic." “The covid-19 pandemic has put incredible strain on the health services, and the risk of transmission of the virus has meant they’ve had to adapt their procedures. Whilst all women should be offered a choice of anaesthesia and treatment settings for hysteroscopic procedures, an outpatient setting avoids hospital admission and reduces the risk of exposure to the virus." “The RCOG guidance on this is very clear — all pain relief options should be discussed with women, as well as the risks and benefits of each. Women should be given the choice of a local or general anaesthetic. If the procedure is still too painful, no matter what anaesthetic options are chosen, it must be stopped and a further discussion of pain relief options should then take place. It’s vital that women are listened to and their choice is fully supported.” Read full story Source: HSJ, 21 December 2020
