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Found 169 results
  1. News Article
    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
  2. News Article
    New 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
  3. News Article
    More 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
  4. News Article
    Women 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
  5. Content Article
    Visual summary Supporting evidence Economic analysis Acupuncture in people with chronic primary pain Exercise in people with chronic primary pain Evidence review A: Factors that may be barriers to successfully managing chronic pain (chronic primary pain and chronic secondary pain) B: Communication between healthcare professionals and people with chronic pain (chronic primary pain and chronic secondary pain) C: Pain management programmes for chronic pain (chronic primary pain and chronic secondary pain) D: Social interventions for chronic pain (chronic primary pain and chronic secondary pain) PDF 927.64 KB07 April 2021 E: Exercise for chronic primary pain F: Psychological therapy for chronic primary pain G: Acupuncture for chronic primary pain H: Electrical physical modalities for chronic primary pain I: Manual therapy for chronic primary pain J: Pharmacological management for chronic primary pain Tools and resources About the Into practice guide Impact on NHS workforce and resources Resource impact report Resource impact template Baseline assessment tool Practical steps to improving the quality of care and services using NICE guidance
  6. Content Article
    Claire was waiting for her diagnosed 14 years. Now she describes how she manages the condition. Lauren's symptoms were overlooked for many years and it wasn't until she experienced a ruptured cyst that she was diagnosed. Melissa experienced endometriosis symptoms from a very young age, before finally being diagnosed at 18. Learn how Stephanie was diagnosed with endometriosis and how she took action afterwards.
  7. News Article
    In ‘Invisible Women: Exposing Data Bias in a World Designed For Men’ author Caroline Criado Perez writes about Rachael, a woman who suffered years of severe and incapacitating pain during her period. It takes, on average, eight years for women in the UK to obtain a diagnoses of endometriosis. In fact, for over a decade, there has been no improvement in diagnostic times for women living with the debilitating condition. You might think, given the difficulty so many women experience in having their symptoms translated into a diagnosis, that endometriosis is a rare condition that doctors perhaps don’t encounter all that often. Yet it is something that affects one in ten women – so what is going wrong? Read the full article here in The Scotsman
  8. News Article
    Patients who saw a pain medicine specialist via telemedicine saved time and money and were highly satisfied with their experience, even before the COVID-19 pandemic, according to a study presented at the ANESTHESIOLOGY® 2020 annual meeting. Results of the study confirm many chronic pain patients are confident they will receive good care via telemedicine, while avoiding lengthy commutes and time spent in traffic. "This era of contactless interactions and social distancing has really accelerated the adoption of telemedicine, but even before the pandemic, patient satisfaction was consistently high," said Laleh Jalilian, M.D., lead author of the study and clinical assistant professor at the University of California, Los Angeles (UCLA). "Patients who are being evaluated for new conditions may be better off having office visits initially. But once patients establish a relationship with providers, follow-up visits can occur efficiently with telemedicine, while maintaining patient rapport and quality outcomes. We believe 50% of our visits could be conducted via telemedicine." "Now that telemedicine is more widespread, it may become a valued part of care delivery in chronic pain practices," said Dr. Jalilian. "Clearly many patients benefitted from remote consultations and follow-up appointments using telemedicine. We hope it will encourage policymakers and insurance providers to continue to support these platforms and inspire more innovation in this developing field of research and patient care." Read full story Source: EurekAlert, 5 October 2020
  9. Content Article
    As an additional option to the text below, you might like to watch the following video from Stephanie O'Donohue, Content and Engagement Manager of Patient Safety Learning's the hub: Sharing patients’ experiences on the hub In February this year, we heard from the Campaign Against Painful Hysteroscopy (CAPH) about the high numbers of women experiencing painful hysteroscopies. This prompted us to start a new Community discussion on our patient safety platform, the hub, titled ‘Painful hysteroscopy’, asking members to share their experiences with us. This has, by far, been the most popular discussion on the hub. To date, there have been close to 100 comments made, over 30 members have contributed to the discussion, and the conversation itself has received nearly 6,000 page views, with people viewing the discussion daily. Engaging with patients, clinicians, researchers and leaders Through our contact with CAPH and hearing from patients, clinicians and researchers on the hub, we’ve identified the main patient safety issues to be around consent, access to pain relief and implementation of guidance. Since identifying these issues, we have written to key political stakeholders, including Nadine Dorries MP, Minister for Patient Safety, Suicide Prevention and Mental Health, and Jeremy Hunt MP, Chair of the Health and Social Care Select Committee. More recently, we have made a request for data from the National Reporting and Learning System (the central NHS database for patient safety incident reports) to understand whether the experiences we are hearing about are being accurately captured. We believe patients’ experiences of hysteroscopy should be proactively gathered and used to evidence and inform improvements. Looking forward In 2021, we will continue calling for patients’ experiences of hysteroscopy, and their concerns about this procedure, to be heard and responded to. We want to see systems put in place to support patient safety, and evidence-based conversations occurring between clinicians and patients before procedures take place. These conversations should aim to ensure patients are well-informed of the benefits, risks and alternatives of the procedure, as well as what impact it will have on them if they choose not to proceed. You can read more about the action we believe is needed to address the patient safety issues around painful hysteroscopies.
  10. Content Article
    Puberty, birth control and cramps I grew up in Trinidad, in the Caribbean in a very Christian household, and attended religious primary and secondary schools. Sexual and reproductive health was discussed in a functional way in biology class. While we were taught about birth control methods (condoms, IUDs, etc), we were expected to follow the abstinence only path. The shame and stigma around premarital sex meant that a lot of incorrect information was passed from girl to girl. I was one of the lucky ones – my parents provided books, encyclopaedias and, no idea why or how we had them, medical encyclopaedias. From these books I learned about puberty and sexual differentiation With all this book knowledge I felt that I was well prepared for anything puberty threw my way. My first period was met with delight that I was finally a ‘woman’. My second was met with agonising cramps and being told, “stop being a baby, that’s life”. I learned the tricks – sleep on your side to prevent leaking (tampons were not allowed), get a hot water bottle, Buscopan tablets, always having a spare pad, count the days meticulously to avoid being embarrassed. We were taught that cramps were just a way of life and you had to just get on with it. In an all-girl school, period cramps were not considered a good excuse for PE or any physical activity. My period suddenly stopped In my second year of university (my first degree) I took on a very stressful course load and quickly became overwhelmed by the volume of work needing to be submitted every week. The stresses of university life made itself known by my period stopping. By the third month, I realised that something was definitely wrong, and I approached my mother with my concern. As soon as I’d articulated my concern my mother paled and gasped “ARE YOU PREGNANT?!” I was at a loss for words because, while I was in a relationship, it had not progressed to that point and I hadn’t even considered that my mother would think that. I immediately replied “Of course not.” This led to my first gynaecological visit, where my mother’s gynaecologist tried to insist I was pregnant and refused to accept that I wasn’t sexually active at 20. After a negative pregnancy test and a normal examination, they concluded that it was university stress, prescribed me a progesterone pill to restart my period and medication to regulate it. No further investigations were done, and without the knowledge to advocate for myself, I trusted in my doctor that he was right. My boyfriend at the time saw the medication as a gift – I could now safely have sex if I wanted to. I saw it as liberating for different reasons. I could skip a period, I knew exactly when my period would be so I could plan social activities and not be caught out, my periods were now pain-free and very light. I wished I had discovered this pill years before! As a doctor, I thought I knew what to expect with an IUD Six years later, with that relationship ended and me in another country pursuing my medical degree, I was still taking this pill to avoid periods even though I was single. However, with a varying schedule I kept missing my timing for the pill and, during my Obstetrics and Gynaecology rotation, on learning more about the copper Intrauterine device (IUD) I felt that this was a fool-proof method. Having attended clinics, been taught about the insertion of the IUD and having inserted some for patients myself, I felt confident that this was the method for me. How to insert an IUD: A properly sized speculum is inserted and adjusted to bring the cervix into view. A uterine sound is used for measuring to ensure high fundal placement of the copper IUD. The IUD is then placed. If, like me, your uterus is retroflexed, a tenaculum (device with 2 prongs) is used to grasp the cervix and straighten the uterus to avoid perforation. The above information was rattled off many times by doctors and nurses we observed as medical students, and we rattled it off to patients when we were allowed to assist. The other side of the curtain I went into that room thinking I knew everything. I had all the knowledge and experience from books and my teachers. This was going to be quick and easy. I was going to get this done, and re-join my peers for the rest of the day in clinic. The patient experience is definitely weird when you know that tomorrow you are going to come in and be face to face with the nurse who is currently all up in your insides. You try to make conversation and feel less awkward about the discomfort involved in a speculum insertion, you try to follow the instructions to “relax and take deep breaths.” But nothing prepared me for the white-hot searing pain that came after the words, “now you’re going to feel a little pinch.” I screamed. And immediately felt ashamed for it. Because, this is normal, right? This is what many woman go through. Why couldn’t I just grit my teeth and bare it? Why did I have to be so weak? Through clenched teeth I endured the rest of the insertion, got off the table and dressed and stumbled out to the waiting room before collapsing on a chair. My head was spinning, my insides writhed in agony and I couldn’t form words. I was sitting there in my white coat and scrubs and being stared at by all these women in the clinic. My clothes screamed that I was on the other side of this divide, and the curious stares drove me to leave. I stood up and walked out of the clinic and went to the café next door. I quickly realised what a mistake I’d made as I fainted and was luckily caught by a café patron and placed on a chair. A kind lady brought me a drink and sat with me while I waited for the ringing in my head to stop and my vision to return to normal. When I could stand without assistance, I got a taxi home where I got into bed and cried myself to sleep. Normalisation of female pain In the weeks and years that followed that experience, and now as a practicing doctor, I find myself asking, “why do we allow female pain?” Too often female pain is dismissed as ‘normal’ and from an early age we tell girls to accept menstrual cramps. It takes years for an endometriosis diagnosis to be made, all while the girl/woman is going through pain that can be so debilitating that they cannot go to school or work. In medical school and in practice, a lot of stress is placed on testicular pain and definitive treatment as soon as possible to save a testis. Meanwhile, possible ovarian pain/torsion is made to wait. Normalisation and diminishing female pain starts from a young age, and leads to the internalisation and acceptance of this by women. Painful periods, intercourse or just pelvic pain are often dismissed or trivialised as ‘a low pain threshold’, ‘making it up’, ‘excuses’, ‘all in your head’. Women learn to apologise for their pain. I have lost count of the number of women I have seen in the A&E who start off with “I’m sorry to bother you doc, but…”. We need to understand the female anatomy better Medical textbooks abound with descriptions of male anatomy. Journals are filled with erectile dysfunction treatment. For women, the same isn’t true. Prominent obstetric and gynaecological textbooks ignore detailed female anatomy. Illustrations such as this image of the female clitoral anatomy aren’t common in medical textbooks. If, as medical professionals, we don’t know the nerve supply to an area, how can we truly say, “this won’t hurt?” In order to truly understand female pain, we need a better understanding of female anatomy and to stop thinking that if they’re not complaining, it doesn’t hurt. Improving patient knowledge also goes a long way in being able to properly communicate their pain. When a large proportion of women use the word vagina to mean the vulva, it’s difficult to effectively communicate where the pain is. Validating the patient’s experience I don’t have an easy solution, but here’s how I’m combatting it: One of the things I found that made a difference to patients (children to adults) was saying, “I believe you.” Pain is something I can experience, but I cannot see. If someone is telling me they have pain, my job isn’t to judge or dismiss it, it is to try to help to relieve that pain. Starting off a consultation validating your patient’s feelings and pain isn’t hard to do, and makes a world of difference. As medical professionals, we can make the difference for other women and help to champion better responses to female pain. Further reading Is pain a patient safety issue? (Patient Safety Learning, November 2020) ‘Women are being dismissed, disbelieved and shut out’ (Stephanie O'Donohue, November 2020) Gender bias: A threat to women’s health (August 2020) Should mismanaged pain be considered an adverse event? (March 2015) Improving hysteroscopy safety (Patient Safety Learning, November 2020)