Disease Knowledge Centres

  • Pain Management - Disease Topic Overview

    Pain management is the specialty that diagnoses and treats pain with the aim to reduce patient suffering. Pain occurs for many different reasons; however, these can be broken down into three main groups: somatic, visceral and neuropathic pain.1

    Somatic and visceral pain is often symptomatic of an underlying problem, either injury or illness, which reduces in line with recovery.1 The management of this pain must consider the side-effects of any treatment. Management of short-term pain is primarily through analgesics such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs). Despite being one of the most commonly prescribed drugs worldwide, NSAIDs may have serious side effects (gastrointestinal toxicity, dyspepsia and ulcers) and should not be used long-term.2

    Neuropathic pain or chronic pain does not reduce following recovery from the initial injury; this hypersensitivity is caused by plasticity of the pain pathways.3 In Europe, one in five people are affected by chronic pain and many are unable to work. Healthcare and social benefit costs are substantial making this a serious public health issue.4

    Chronic pain (osteoarthritis, rheumatoid arthritis [RA] and chronic lower back pain) is treated and managed in a variety of ways. The initial treatment for these conditions is NSAIDs, however the long term toxicity of these drugs limits the length of time for which they can be used.5 The introduction of cytoprotective drugs or proton pump inhibitors can reduce gastrointestinal toxicity and increase the length of treatment. The use of opioid drugs has been shown to be effective in the short-term; however there is little evidence for effective long-term use of these drugs, especially in RA.5

    Pain management in palliative care differs from other pain management. The aim is to reduce the suffering of terminally ill patients, therefore long-term side effects, such as problematic opioid use, are not of concern.6

    1. Hughes J. Pain Management: From Basics to Clinical Practice. Elsevier Health Sciences. 2008 : 1-5.
    2. Oviedo J. et al. Therapy and prevention of NSAID-related gastrointestinal disorders. Therapy of Digestive Disorders. Elsevier Inc. Second Edition. 2006 : 291-314.
    3. Ji R.-R. et al. Central sensitization and LTP:do pain and memory share similar mechanisms? TRENDS in Neuroscience. December 2003 ; 26 (12) : 696-705.
    4. Patal S. Barriers to Rehabilitation and Return to Work for Unemployed Chronic Pain Patients: A Qualitative Study. European Journal of Pain. November 2007 ; 11 (8) : 831-840.
    5. Stannard C. et al. Evidence Based Chronic Pain Management. Blackwell Publishing Ltd. 2010 : 69-120.
    6. Ballantyne J.C. et al. Opioid Dependence and Addition During Treatment of Chronic Pain. Pain. June 2007 ; 129 (3) : 235-255.

Latest Multi Media

An Overview of Post-Operative Pain Management

Pain Management Drug Data - A-Z English

Drug Updates

Neurontin Capsules and Tablets
Epilepsy Gabapentin is indicated as adjunctive therapy in the treatment of partial seizures with and without secondary generalization in adults and children aged 6 years and above.
OxyNorm liquid 5 mg/5 ml oral solution
For the treatment of moderate to severe pain in patients with cancer and post-operative pain.
Palladone SR capsules
For the relief of severe pain in cancer.

Latest Drug News

BioDelivery Sciences Intl licenses BEMA buprenorphine to Endo Pharma for mild to severe Chronic Pain - 12-01-2012
BioDelivery Sciences International (BDSI) has licensed the world rights of BEMA buprenorphine to Endo Pharmaceuticals. BEMA buprenorphine is a treatment for moderate to severe chronic pain which blends the opioid analgesic buprenorphine with the BioErodible MucoAdhesive (BEMA) drug delivery technology. A bioerodible polymer film about the size of a fingertip attaches to the inner lining of the cheek. The film then rapidly delivers its drug dose through the mucous membranes of the inner cheek, and completely dissolves in 15 to 30 minutes. The dug failed a Phase III trial recently but BDSI are proceeding with its development with a new nine month trial.
FDA approves Opana ER from Endo Pharma for Moderate to Severe Pain - 17-12-2011
The FDA has approved a new, harder-to-abuse formulation of Opana ER, the extended-release oxymorphone drug that is crush resistant from Endo Pharma for Moderate to Severe Pain. There have been generic versions of immediate release and extended release oxymorphone on the market for many years. The Endo Pharma version is distinguished by its "harder ro abuse " formulation which is patent protected until 2023.

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Latest Clinical Trials

A multicentre, double-blind, randomised, active- and placebo-controlled clinical trial on the pain relieving effects of the modfied-release formulation of flupirtine in patients suffering from moderate to severe chronic low back pain
The primary objectives of this study are to demonstrate either non-inferior pain relieving effects of the modified-release formulation of flupirtine (400mg OD in the evening) in comparison to extended-release tramadol (200mg OD in the evening) as well as a superior analgesic efficacy of flupirtine MR (400mg OD in the evening) in comparison to placebo in patients suffering from moderate to severe chronic low back pain (CLBP) after a four week treatment course.
Effect of Duloxetine 60 mg to 120 mg Once Daily in Patients with Chronic Low Back Pain
The primary objective of this study is to assess the efficacy of duloxetine 60 mg once daily (QD) to 120 mg QD compared with placebo on the reduction of pain severity as measured by the weekly mean of the 24-hour average pain scores in patients with chronic low back pain (CLBP) during a 13-week, double-blind acute treatment period using an 11-point Likert scale and an electronic patient diary.

Latest Journal Publications

Annuals of Rheumatic Diseases
Objective: Low back pain (LBP) is a common musculoskeletal disorder, but it is still unclear which individuals develop it. The authors examined the contribution of genetic factors, lumbar disc degeneration (LDD) and other risk factors in a female sample of the general population. Material and Methods: A cross-sectional study was conducted among 2256 women (371 and 698 monozygotic and dizygotic twin pairs and 29 sibling pairs and 60 singletons) with a mean age of 50 years (18–84). A self-reported validated questionnaire was used to collect back pain data. Risk factors including body weight, smoking, occupation, physical exercise and MRI assessed LDD were measured. Data analysis included logistic regression and variance decomposition. Results: The major factors associated with LBP included genetic background, with OR approximately 6 if the monozygotic co-twin had LBP, or 2.2 if she was a dizygotic co-twin. In addition, LDD and overweight were highly significantly (p<0.001) associated with non-specific LBP. The single most important risk factor was the amount of LDD. After adjustment for other risk factors, the individuals who exhibited advanced LDD (90% vs 10%) had 3.2 higher odds of manifesting LBP. The data also showed a significant (p<0.001) genetic correlation between the LBP and LDD measurements, suggesting that approximately 11–13% of the genetic effects are shared by LDD and LBP. Conclusions: The main risk factors for reported episodes of severe and disabling LBP in UK women include the degree of LDD as assessed by MRI, being overweight and genetic heritability.
Medical hypotheses
Less than 20 years after Herrick described the first case, the cold was proposed as having a role in precipitating pain in sickle cell disease. Numerous publications focus on weather changes, in particular exposure to the cold, and their association with vaso-occlusive (painful) episodes. Whereas several theories have been proposed to explain the association, a plausible hypothesis based on our current understanding of the pathophysiology of pain has not been offered. We hypothesize that the pain evoked by these weather changes are allodyinic (pain with stimulus not typically painful) and hyperalgesic (heightened pain with painful stimulus) responses due to the presence of neuropathic pain. This hypothesis represents a paradigm shift in understanding, as well as explaining at least some of the pain experience in sickle cell disease, and should be the impetus to further determine the characteristics of those patients who develop allodynia and hyperalgesia to cold weather. Whereas some researchers have suggested that those with sickle cell disease may have neuropathic pain, including a report from our own ongoing study [1], it has not been well accepted nor has it been applied in understanding pain associated with sickle cell disease. The conceptual shift and new understanding is important to develop preventive strategies, apply pain therapies new to the sickle cell population, and view pain in sickle cell disease in the context of a chronic disease.

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Pain Management