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Effective Patient-Physician Communication Critical to Accurate and Timely Recognition of Neuropathic Pain

Jerry Lewis's Painful Battle

New Ways to Fight the Pain;

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01/03/2007 @ 11:00

New Global Survey Shows Effective Patient-Physician Communication Critical to Accurate and Timely Recognition of Neuropathic Pain

Diagnosis Often Takes a Year or More Even After Seeing a Physician

A new seven-country global survey reveals that effective patient-physician communication is key to earlier, accurate diagnosis and treatment for patients with neuropathic pain (NeP). NeP is a debilitating condition characterised by chronic, often severe nerve pain and is often a complication of common conditions including diabetes, herpes, cancer, HIV, multiple sclerosis, stroke, traumatic injury or surgery. The survey results, released today by the Neuropathic Pain Network (NPN), a coalition of patient advocacy organisations, found that in some countries patients wait up to 19 months on average and visit as many as two or more doctors before they receive an accurate diagnosis. Countries surveyed included the United Kingdom, Germany, Italy, Korea, Mexico, Spain and Finland.

Neuropathic Pain Difficult to Recognise

Many patients need to visit more than one physician before their pain is recognised as neuropathic pain. Of physicians surveyed in the seven countries, the majority of whom were general practitioners, most do not find it very easy to recognise neuropathic pain. A majority of physicians in all countries report that a main factor in the delay is difficulty differentiating NeP from other pain conditions. This is important because treatments that may be effective in other types of pain often do not provide relief for NeP patients.

Patient and Physician Checklist: Cover Three Key Areas

According to the survey, patients wait on average between 5.7 to 19.5 months after they experience their first symptom before going to a physician; most patients believe the pain will 'go away by itself.' Once patients consult a physician about their pain, limited or ineffective communication can further delay recognition of neuropathic pain.

The survey found that physicians who recognise their patient's NeP are more likely to discuss the following three key areas with their patient. Physicians who do not ask questions covering these three key areas are less likely to identify their patient's condition as neuropathic pain.

1. Symptom Characteristics: Characterise the intensity and duration and describe how the pain feels with specific adjectives (e.g. "pins and needles," "burning," "stabbing," "numb," or "like electrical shocks")

2. Medical History: Share all medical history; NeP can be a complication of diabetes, herpes, cancer, HIV, traumatic injury or surgery

3. Location of Pain in the Body: Explain where on the body the pain is felt

"Crippling neuropathic pain affects every aspect of patients' lives, often even limiting their ability to work, and yet it is typically under-diagnosed," said Ian Semmons, Board Member, Neuropathic Pain Network and Chairman, UK Action on Pain. "The survey suggests there are things patients can do to hasten their diagnosis and treatment. By sharing their pain symptom characteristics, medical history and location of pain in their body, patients can help their physicians more readily differentiate if their pain is neuropathic. We urge all pain patients, particularly those with diabetes, herpes, cancer or HIV to discuss these topics with their physicians."

Screening Tools Not Widely Used

To help physicians screen patients with pain, researchers have developed questionnaires for patients to complete in the waiting room prior to seeing the physician. Patients answer several questions about their pain experience, including questions covering the key topics uncovered in the survey. The tools can assist physicians in making a rapid, yet detailed assessment of a patient's pain experience. Of the seven countries in the survey, only in Mexico do a majority of physicians currently use available screening tools for most or all of their patients, although in all countries, there is great interest among physicians to learn more about them.

"In many countries, physicians have increasingly limited time with patients, posing a particular challenge with neuropathic pain, which has been historically difficult to identify," said Michael Bennett, M.D., Senior Clinical Lecturer in Palliative Medicine and Honorary Senior Research Fellow, University of Leeds, Leeds, UK. "For these physicians, screening tools may be one solution, alerting physicians to the possibility of neuropathic pain in a timely manner. Whether through the use of these tools, or by simply engaging in thorough conversations, improving communication about symptoms of neuropathic pain can help us meet the needs of these long-suffering patients."

Neuropathic Pain: A Debilitating Condition

Neuropathic pain is a debilitating condition that is estimated to impact between 2.8 percent and 4.7 percent of people globally. NeP can have a significant impact on patients' lives, leaving many unable to work, walk or even wear clothes, as contact with their skin can cause an unbearable burning pain. Neuropathic pain is often under-diagnosed and under-treated. NeP is initiated or caused by a lesion or dysfunction of the nervous system (either peripheral or central). Patients often describe their symptoms as burning, stabbing or shock-like sensations. In recent years, a number of screening tools (e.g., Pain DETECT, LANSS, DN4, ID Pain) have been developed to help physicians identify this often-elusive condition.

About the Survey

In July 2006, the Neuropathic Pain Network and Pfizer Inc commissioned Harris Interactive to conduct a multi-country survey of NeP patients and the physicians who treat them. A survey of approximately 700 diagnosed NeP patients and 700 physicians was conducted in seven countries including: Finland, Germany, Korea, Italy, Mexico, Spain and UK. Fieldwork was conducted from August 18, 2006 through January 29, 2007. The results of any survey are subject to sampling variation. For a sample of 100, maximum potential sampling variation is + or - eight percentage points at the 95% confidence level. Funding for the survey was provided by Pfizer Inc.

 

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April 7 2004

Jerry Lewis, King of Comedy, Gets Serious About Chronic Pain

To complement his lifelong career providing comic relief, the original 'Nutty Professor' is now travelling the world giving lectures about pain relief. Having raised millions in previous charity work for muscular dystrophy and having won his own long battle with chronic pain, Jerry is here to spread the word about the importance of seeking the right help, rather than suffering in silence.

Jerry battled chronic pain for 37 years, having damaged his back performing pratfalls in comedy classics with the likes of Dean Martin, Sammy Davis Junior and Frank Sinatra. Today, the pain is under control for the first time in decades - thanks to what he calls a "pain pacemaker," an implantable medical device that sends mild electrical impulses to the spinal cord to block pain signals as they travel to the brain. Jerry explains, "I was about ready to walk in front of a train or blow my brains out and I didn't think I would make it another year. Now I feel reborn. I get up every morning and say, 'Thank God,' I can open my eyes without pain."

No laughing matter, chronic pain affects 14.1 million people in the UK - almost one in four of the population(1) - and a third of them suffer severe pain on a regular basis.(2) There is no doubt that chronic pain can have a devastating impact on people's lives. In the Pain in Europe (PIE) survey,(2) a quarter of sufferers questioned had been in pain for five to ten years, one in four had lost a job because of it, almost half would spend everything they had on treatment to end their suffering and a staggering one in six were even tempted to take their own life.

Chronic pain has enormous financial implications for both the NHS and the economy as a whole. Back pain alone accounts for 206 million lost working days per year.(3) It costs the UK GBP12.3 billion -- GBP1.6 billion to the NHS and GBP10.7 billion in lost productivity and other indirect costs - one of the most costly medical conditions.(4)

When it comes to managing pain, the PIE survey revealed that more than two-thirds of the 46,000 people surveyed considered that the medication they were being prescribed was not sufficient to manage their pain. Not only did survey respondents want more effective treatment, they also expressed a need for greater understanding from healthcare professionals. A quarter of those questioned complained that their GP never asked them about their pain, and 39 per cent believed their physicians were more focused on their illness than their discomfort.

"Doctors and politicians need to listen to what patients are saying," comments Dr Beverly Collett, President of The Pain Society, the UK chapter of the International Association for the Study of Pain, and consultant in pain management and anaesthesia at the University Hospitals of Leicester NHS Trust. "Recent research into pain services has clearly demonstrated that pain is under-managed and that too many patients are suffering unnecessarily."

Ian Semmons, Chairman of national charity Action on Pain, agrees: "Whilst the government has carried out an audit of pain management(5), this means little unless they move rapidly to ensure equal access to effective pain management services across the whole of the NHS."

References:

1. Elliott, et al. The epidemiology of chronic pain in the community. Lancet 1999.

2. Pain in Europe. NFO World Group 2003.

3. Arthritis Research Campaign. Arthritis: The Big Picture. 2003

4. Maniadakis N, Gray A.The economic burden of pain in the UK. Pain (84) 2000; 95-103.

5. Department of Health. National Specialised Services Definition Number 31 Specialised Pain Management Services; December 2002.

Read Jerry's story

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13th July 2006

PLEASE RELIEVE ME
New Ways to Fight the Pain
By Charlotte Haigh 13/07/2006

WE ALL have pain from time to time, from blinding headaches to cramping periods or the agony of broken bones and other injuries.

For most of us, the discomfort is only temporary. But, according the Europen Pain Survey 2005, for one in seven of us long-term agony is a life sentence.

GP Dr Catti Moss says: "This is the hardest type of pain to deal with emotionally, as there's no cure, and often no realistic prospect of it going away."

But experts are finding new ways of coping with pain and helping sufferers lead normal lives.

Acute vs chronic

SOME pain has a purpose. Acute pain is the body's alarm system warning you that something's wrong - like when you put your hand in a bowl of scalding water - and you need to take action. And a new, continuous pain in your body may be a sign of disease.

But whatever the cause, acute pain should begin to ease once you start treating it.

Chronic pain isn't useful and sometimes there isn't even an underlying cause.

"Pain becomes chronic if it's been going on for a long time - usually at least six months," says Dr Moss. "It is chronic not necessarily because the condition that caused it doesn't go away, but because the nerves 'remember' the pain, and become unable to switch it off.

"Whatever originally started the pain may have completely vanished, and all the X-rays, scans and clinical tests may draw a complete blank. The pain, however, remains very real."

Ian Semmons, chairman of support group Action on Pain explains: "It can be hard to identify the cause, as the pain originally started as the result of something else - but now the pain itself is the issue."

What doctors can do

ONCE chronic pain is diagnosed, pills are usually the first port of call.

"Even ordinary over-the-counter painkillers can be extremely effective," Dr Moss says. "But you need to take them on a regular basis, before the pain breaks through, rather than waiting until it gets unbearable."

If the pain persists you should see your doctor who can prescribe stronger drugs or refer you to a pain clinic.

Help yourself

UNFORTUNATELY, what's on offer from the NHS doesn't help everyone. "Callers to our helpline have often tried all sorts of drugs, and nothing has worked," says Semmons.

The future of chronic pain is pain management. Here's what you can do to help yourself:

1. ACCEPT YOUR PAIN

"This may sound tough, but coming to terms with the fact that you have chronic pain, which may be with you for the rest of your life, is often half the battle," says Semmons.

Dr Moss agrees: "People often go to their GPs convinced there is an underlying condition that's been missed and which, once diagnosed, would mean the doctor could wave a magic wand and make their pain disappear. But that's often not the case and until the patient can accept that it's virtually impossible to start treating them as the body's constantly in 'what is wrong with me?' mode, and switching on all its pain circuits frantically."

2. TALK TO SOMEONE

"People can become very depressed," says Semmons. "They often become obsessed with finding a holy grail - the cure - and become very low when they realise there isn't one.

"When their pain continues for a long time, others can start to think of them as malingerers - chronic pain-sufferers often have to take time off work - and they often feel very isolated."

Talking to someone who's been through the same thing can make a big difference, he says. "It helps people realise there are ways to live with pain." If you've become depressed some sessions of counselling can also be helpful.

"Although chronic pain is not a psychological condition, being very stressed about it and focusing on it may make things worse," points out Semmons.

3. LEARN TO MANAGE

"Different things work for different people, so put together your own pain management programme," says Semmons.

"Things worth trying include Tens machines, which give low-grade electrical stimulation to pain nerves, and acupuncture, which can be surprisingly effective," adds Dr Moss.

Exercise, relaxation techniques and dietary changes can help people cope, and certain herbs have also been shown to be effective.

"Devil's claw extract can be excellent for relieving chronic pain, but it doesn't work like conventional painkillers, and needs to be taken for at least six weeks before there's an effect," says Dr Dick Middleton, chairman of the British Herbal Medicine Association. "And Feverfew can be helpful for chronic headache."

Try Medic Herb Devil"s Claw (£9.99 for 40 tablets) and Boots Feverfew (£5.99 for 30 capsules). Some people swear by Willow Spring Water which contains salicin, known to relieve muscle and joint aches. It costs £1.29 for a 1.5-litre bottle from Waitrose. But you would need to drink lots of it and wouldn't expect to see an improvement for several weeks if at all.

Finally, you could try switch on your stereo - recent research from America showed listening to music - any kind - for an hour a day could ease pain by 20 per cent.

The future for pain

SCIENTISTS are always working on ways that may improve life for chronic pain sufferers. These recent studies may give some clues:

A US study last year found placebos don't just have a psychological effect - they activate pain-relieving chemicals in the brain.

TRIAL at the University of Bath found when pain sufferers looked in mirrors which only showed the pain-free parts of their bodies, and were told to imagine that was a true depiction of them, their pain quickly disappeared.

With continuing mirror therapy, six out of eight had a full recovery. Scientists think the therapy works by retraining the brain's perception of the body.

NEW pain-blocking drugs are currently on trial, one drawn from a toxin found in the highly poisonous puffer fish, and one based on capsaicin, the substance that gives chilli peppers their kick.

JUST this week, a painkiller based on venom from deadly sea snails was launched for patients who become resistant to their conventional drugs.

Developed by Japanese scientists, Prialt is so potent that it's only used as a last resort for longterm pain.

A STUDY in the British Medical Journal showed that magnets could ease pain in people with osteoarthritis.

The theory is that the magnet helps draw fresh blood to the painful area, encouraging healing. You can find magnet products from eye masks to insoles at your local chemist.

A botched operation left me in constant agony

MEDICAL secretary Julie Mason had her appendix taken out four years ago but weeks later she was still in pain - although of a different sort.

The 42-year-old recalls: "The doctors were baffled - they couldn't find anything wrong. But eventually I discovered the surgery had damaged the nerves in the area, leaving me with severe, constant pain."

For the next two years she tried everything. She was referred to a pain clinic and had Botox injected into her nerves to try to deaden the pain but nothing worked.

Julie says: "I ended up on a cocktail of drugs - three types of morphine, night-time pain relief, paracetamol, and anti-depressants as I had become extremely low." The drugs meant she could get by but 14 months ago the mum-of-three discovered a devastating side-effect.

Julie, from East Grinstead, W Sussex, reveals: "My third child was born addicted to morphine. My older children, aged 18 and 16, have suffered too. Having a mum in constant pain and crying has been very tough on them." Earlier this year Julie was referred to a pain clinic at a bigger hospital in London and doctors explained it might be with her for the rest of my life.

She says: "Strangely, it helped - I could stop searching for a cure and start learning to live with it. I've enlisted as a volunteer with Action on Pain's helpline, which takes my mind off my own pain. Focusing on my job and my baby helps me keep going too. And my husband's been brilliant.

"It can be very hard, especially as people don't always believe I'm really suffering, but I'm far more upbeat about things these days."

Read more about Julie's experience