Central Nervous System Targets: Supraspinal Mechanisms of Analgesia
In the run up to Dr Kirsty Bannister’s Home Brew we will be sharing her work with you!
Pain care needs to understand and be able to integrate current discoveries in lab-based science.
Check out this article and drop your thoughts in the comments!
“Central Nervous System Targets: Supraspinal Mechanisms of Analgesia”
Call for an Urgent Action on Forced Opioid Tapering
Opioid tapering guidelines were created, in part, to decrease harm to patients resulting from high-dose opioid therapy for chronic pain. However, countless “legacy patients” with chronic pain who were progressively escalated to high opioid doses, often over many years, now face additional and very serious risks resulting from rapid tapering or related policies that mandate extreme dose reductions that are aggressive and unrealistic.
There are major concerns:
rapid, forced opioid tapering among outpatients;
mandated opioid tapers that require aggressive opioid dose reductions over a defined period, even when that period is an extended one.
We are delighted to have had the brilliant Morten Hogh on Le Pub. Morten took us on a journey through the ins and outs of pain in the workplace, looking at the real reasons why people of working age are the most affected by musculoskeletal pain and if our traditional approaches to addressing the problem do more harm than good.
It has previously been thought that pain caused at work was a result of poor working practices and inadequate equipment and that the solution was to adjust the way we work. New research suggests that this may not be case and that the most effective approach is to continue to work, despite the pain, and that in some instances the traditional solutions may actually cause more harm than good.
This talk discussed the arising paradigms in the management of work-related pain.
Key messages about work-related pain from the perspective of a person in pain:
- “Work” is about meaningful occupation, not just remuneration, and by changing the way we view (and reward) work, we can include more people in the workforce.
- The most important question to ask (from John Loeser): “What does the pain prevent you from doing that you need or want to do?”
- The decision to RTW (return to work) should be made by the patient, because (and when) it’s the right thing to do for that person, and not under duress.
- “Work is therapy!” – working can offer huge benefits to health and well-being. How can we make work more therapeutic?
- We too often centre the economic costs of absenteeism. What would happen if we instead centred the person, and their needs/wants/goals?
Key messages about work-related pain from the perspective of a healthcare professional:
- Every person who has pain is either employed or unemployed. Therefore, work-related pain is relevant for everyone.
- Should we use the term work-related pain? Most people with chronic pain experience pain in all areas of their lives, not just when they’re at work.
- Getting a professional athlete back to their respective sport is work-related. Can we change the perspective of clinicians and employers to realise the importance of facilitating a return to work for all people in pain?
- It’s better to work painfree but if this is not possible (which may be true for many people) it is better to work with pain than not work at all.
- The cost of not working is huge for the person in pain (not just the employer). Find ways to make this happen that fit the individual. Be creative, make adaptations, create flexibility and above all open a constant dialogue between person in pain and employer (and clinician if appropriate).