{"title":"Communication skills in pain medicine","authors":"Helen J Makins","doi":"10.1016/j.mpaic.2025.01.008","DOIUrl":"10.1016/j.mpaic.2025.01.008","url":null,"abstract":"<div><div>This article considers why enhanced communication techniques are particularly important in pain management consultations. Background is provided from evidence in both primary and palliative care research. The techniques are introduced and explained and include generic communication skills appropriate for all consultations and more advanced techniques. The generic skills described are empathy, allaying anxiety, breaking bad news and shared decision-making. Advanced techniques are aimed at facilitating changes in behaviour and include coaching, mentoring and motivational interviewing. The focus is on the complexities of the chronic pain presentation and a variety of potential challenges in a consultation are explored. Example scenarios are used to illustrate how aspects of each specific communication skill might be useful to prevent avoidable distress, diffuse anger and assist patients to change behaviour. The expectation is that clinicians who communicate well will help patients to make informed decisions and empower them to optimize their own pain management skills.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 5","pages":"Pages 245-248"},"PeriodicalIF":0.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143929534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The anatomy of pain","authors":"David G Gore","doi":"10.1016/j.mpaic.2025.01.006","DOIUrl":"10.1016/j.mpaic.2025.01.006","url":null,"abstract":"<div><div>Pain is a sensory and emotional experience that is personal and unique to an individual. Nociception is different from pain and considers the neural process of encoding and processing noxious stimuli. Anatomically noxious stimuli are transduced by nociceptors to an electrical signal carried by first-order neurons to the dorsal horn of the spinal cord. From the spinal cord second-order neurons project in tracts to the thalamus, where third-order neurons continue to higher cerebral centres. There is no known primary pain processing centre in the brain, instead multiple different areas activate and interact in response to noxious stimuli. The brain centres associated with pain perception overlap with those involved in depression. The brain regulates the nociceptive information it receives and can exert both anti- and pro-nociceptive influence. Pathology in the peripheral and central nervous systems can contribute to nociception and pain, as can changes in the interaction of higher cerebral centres. Appreciating the anatomical structures involved in pain and nociception affords an understanding of where different therapies may be applied to alleviate pain.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 5","pages":"Pages 229-234"},"PeriodicalIF":0.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143929570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Managing acute pain in trauma with regional anaesthesia","authors":"James A. Stimpson, Ben Cracknell","doi":"10.1016/j.mpaic.2025.01.010","DOIUrl":"10.1016/j.mpaic.2025.01.010","url":null,"abstract":"<div><div>Trauma is a significant cause of hospital presentations and admissions in the UK, comprising a diverse selection of patients with differing analgesic needs and levels of comorbidity. Pain from the initial injury and subsequent treatments such as closed reductions and surgery is often severe and can lead to discomfort, difficulty in nursing care physiotherapy, and unwanted admissions. Regional anaesthesia is perfectly placed to provide an individualized analgesic strategy for each trauma patient that gives significant pain relief, and reduces reliance on opiate medications which have a significant side-effect profile especially in the increasingly elderly population presenting to hospitals with trauma. This article explores the advantages and drawbacks of regional anaesthesia in trauma, and summarizes the specific patient considerations in some of the more common injuries that present to hospitals in the UK. We also look to the future with newer innovations and novel devices coming into more frequent use and how they may be used to benefit the trauma patient.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 5","pages":"Pages 254-259"},"PeriodicalIF":0.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143928213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Measurement of clinical outcomes in pain medicine","authors":"Nicola L Johnson, Sheila Black","doi":"10.1016/j.mpaic.2025.03.001","DOIUrl":"10.1016/j.mpaic.2025.03.001","url":null,"abstract":"<div><div>How we measure pain and patients’ responses to pain is key in developing both our understanding and treatment of it. This article outlines the application of tools for the measurement of clinical outcomes used in acute and chronic pain medicine; what makes a good outcome measurement and how this can be utilized in clinical and research practice is discussed. Various tools for outcome measurement are described including those which may be utilized in various patient groups.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 5","pages":"Pages 249-253"},"PeriodicalIF":0.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143929535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Legal and social aspects of pain medicine","authors":"Lorraine E de Gray, David R Chapman","doi":"10.1016/j.mpaic.2025.01.005","DOIUrl":"10.1016/j.mpaic.2025.01.005","url":null,"abstract":"<div><div>Pain is the most common reason for patients to see a doctor. Socio-economic issues including unemployment and difficulty accessing education are common in such patients. Pain is the third leading cause for absence from work. Patients frequently seek support from their multidisciplinary pain team for welfare support and staying in or returning to employment or education. Pain physicians perform a range of intervention procedures and need to have a clear grasp of the law of consent. They are also called on to give expert evidence in personal injury and medical negligence claims where claimants have been left with chronic pain. This paper explores the legal and social infrastructure, and useful knowledge that should be at the fingertips of all those practising in the field of pain medicine.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 5","pages":"Pages 288-291"},"PeriodicalIF":0.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143929540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The development of occupational therapy-led groups for people with fibromyalgia","authors":"Wendy Hill, Michelle Macartney","doi":"10.1016/j.mpaic.2025.02.001","DOIUrl":"10.1016/j.mpaic.2025.02.001","url":null,"abstract":"<div><div>Fibromyalgia is a complex condition which can provide a challenge to healthcare professionals. Sufferers experience widespread body pain and debilitating fatigue in addition to cognitive difficulties and sleep disturbance. Group pain management programmes are an evidenced-based approach to providing pain management for people living with chronic pain. Occupational therapists are uniquely placed to provide a holistic approach to patients with chronic pain and a group programme specifically targeted at patients with fibromyalgia has been found to provide an additional benefit of meeting the wide range of challenges they experience. Patient education is an important part of the content of these groups. This article describes the background and development of the ‘Living Well with Fibromyalgia’ group programme.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 5","pages":"Pages 281-283"},"PeriodicalIF":0.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143929538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Self-assessment","authors":"Vijayanand Nadella","doi":"10.1016/j.mpaic.2025.03.005","DOIUrl":"10.1016/j.mpaic.2025.03.005","url":null,"abstract":"","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 5","pages":"Pages 292-293"},"PeriodicalIF":0.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143929541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Rehabilitation and quality of life transformation: specialist physiotherapy in management of chronic pain","authors":"Chetali Khadye, Judith Semmons","doi":"10.1016/j.mpaic.2025.01.009","DOIUrl":"10.1016/j.mpaic.2025.01.009","url":null,"abstract":"<div><div>Physiotherapy is one of the lesser understood but an integral part of chronic pain (CP) management. The complex nature of CP warrants a multidisciplinary approach, addressing the biopsychosocial (BPS) aspects of well-being. This often requires a team of several specialists to assess the burden of individual BPS domains and devise a tailored management programme. Physiotherapy management is based on 3Es – <em>Educate, Empower and Exercise/Movement Interventions</em>. Fear of causing further harm, disability and anxious/low mood associated with it are a common presentation among those living with CP. Rebuilding patient confidence, reducing fear of movement and restoring function are the objectives of physiotherapy in CP. This is accomplished using several ‘<em>tools’</em> as a part of psychologically informed physiotherapy (PIPT) practice. PIPT includes – cognitive behavioural physical therapy (CBPT), graded exposure/activity, psychomotor physical activity, physiotherapy-related acceptance and commitment therapy (PACT) and group-based physiotherapy-led behavioural psychological interventions (GPBPIs). PIPT along with education about CP, input like activity pacing and relaxation aids to shift the patient mindset from that of fear avoidance to confident and informed motivation to move again. Movement and exercise are known to improve quality of life in this population and help restore function along with providing sustainable self-management strategies.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 5","pages":"Pages 284-287"},"PeriodicalIF":0.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143929539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Non-opioid medication in pain medicine","authors":"Bharti Seth","doi":"10.1016/j.mpaic.2025.03.003","DOIUrl":"10.1016/j.mpaic.2025.03.003","url":null,"abstract":"<div><div>The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in such terms of such damage.” Analgesics can be broadly classified according to their role primarily on nociception as well as pain perception, both of which are intimately integrated to the pain experience. An understanding of the pain pathway is inherent to a good understanding of how therapeutic targets can act as analgesics. An overview is discussed in this article to understand the rationale for therapeutic intervention. Opioids are substances that act on opioid receptors to produce morphine-like effects. All other analgesics that do not produce analgesia through a primary effect on opioid receptors can be labelled as non-opioid analgesics (NOAs). Opioids increase the risk of addiction and overdose and there is limited evidence supporting their long-term use for chronic pain management. This article will aim to provide an overview of the pain pathway in relation to the therapeutic targets for providing analgesia, commonly used NAOs and their brief introduction.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 5","pages":"Pages 267-271"},"PeriodicalIF":0.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143929536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Medicines optimization in acute and chronic pain","authors":"Richard Berwick, Bernhard Frank","doi":"10.1016/j.mpaic.2025.01.003","DOIUrl":"10.1016/j.mpaic.2025.01.003","url":null,"abstract":"<div><div>Pain is a complex condition and warrants a multidisciplinary approach based on a bio-psycho-social model. Whilst often successful in acute pain, pharmacological treatment is rarely successful on its own in the management of chronic pain due to the high number of patients needed to treat to achieve a clinically meaningful improvement in function, quality of life and pain scores. There are also significant side effects in the short and long term. Recent re-analysis of clinic trial data focused on individual responder rates, showed that there is a cohort of patients who achieve 50% pain relief with subsequent improvement in physical function. To avoid intolerable side effects from medication used for chronic pain, titration needs to be slow and aimed towards the agreed risk benefit between patients and treating physician with a clear plan for weaning and cessation if these goals are not achieved. Pain-orientated physiotherapy, either on its own or as part of a pain management programme, should be offered and medication reduced or weaned after restoration of function has been achieved.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 5","pages":"Pages 272-280"},"PeriodicalIF":0.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143929537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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