Exercise is recommended to help prevent the development of pain and as a treatment for those with chronic pain. However, the act of exercising can be extremely painful for some. So why should we do it?
Professor Kathleen Sluka is joining us on Thursday 18th February to discuss how physical activity can increase and decrease pain, revealing the underlying neurobiology. She will also discuss how we can integrate exercise into the bigger healthcare picture.
We are SO excited to welcome Dr. Kirsty Bannister to Le Pub
Kirsty will be talking about the reality of discovering novel and effective pain-relieving treatments through performing bench to beside translational research.
Chronic pain affects up to 20% of the adult population and can occur in the presence or absence of any past injury or evidence of body damage. ‘Nothing is more unique than our experience of pain and the idea that the same stimulus could evoke a different pain sensation in different individuals has always fascinated me’.
‘There have been great improvements in our understanding of pain physiology and pathophysiology over the years, but why hasn’t this translated to a met clinical analgesic need? By discussing the ways in which we currently assess nociception and pain in non-human and human experimental models, we will slowly unravel the intricacies and challenges of treating persistent pain in varied patient groups’.
This is going to be an incredible Le Pub Homebrew!
World Event Times
London, Thursday, 18 March 2021, 20:00 GMT
Amsterdam, Thursday, 18 March 2021, 21:00 CET
New York, Thursday, 18 March 2021, 16:00 EDT
Dr. Kirsty Bannister
Kirsty Bannister is a Lecturer in the Institute of Psychiatry, Psychology and Neuroscience at Guy’s campus, King’s College London. Kirsty does research in neuropharmacology.
Kirsty leads the Bannister lab group, where she focuses on the biological, pharmacological and anatomical basis of pain pathways and their plasticity in chronic pain states. Modules that she teaches on include Physiology and Pharmacology of the Central Nervous System, Pharmacology of Neurological and Psychiatric Disorders, Core Year One Fundamentals of Pharmacology, and Neuroscience.
Places can be cancelled and refunded up to 48 hours before the start of the event. Within 48 hours of start time no refund.
Please note that Le Pub Home Brew is a LIVE EVENT. We are looking at options for giving access to recordings in the future, but right now, we are doing what we are best at – bringing you awesome live and interactive learning events!
Opium, morphine and other opioids are famous for their ability to relieve pain and cause pleasure. These mythical effects may however be just that: mythical.
In recent years, systematic, well-controlled studies of opioid analgesics suggest little benefit from opioid treatment of chronic pain or even of acute musculoskeletal pain. In addition to reducing pain, opioid drugs change a cascade of other feelings, such as increased nausea, constipation and sedation that limit their clinical utility. The numerous unpleasant opioid effects are also thought to substantially dampen any opioid-induced pleasure.
In healthy people who do not regularly use opioids, the sum total is frequently a disliking of opioid drug effects. Healthy people will sometimes even pay money to *avoid* getting another opioid! I will discuss the evidence on how opioids change how people feel, and discuss how some of these opioid-related myths have become so persistent in science and society.
World Event Times
London – Tuesday 11 May 2021, 19:00 GMT
Oslo – Tuesday 11 May 2021, 20:00 CET
Amsterdam – Tuesday 11 May 2021, 20:00 CET
New York – Tuesday, 11 May 2021, 14:00 EDT
Adelaide – Wednesday, 12 May 2021, 03:30 ACST
Prof. Siri Leknes
Siri Leknes is a Professor of Social and Affective Neuroscience at the University of Oslo, Norway and Senior Researcher at Oslo University Hospital. She completed her D.Phil. at Oxford and postdoctoral research at Gothenburg University. Her lab in Oslo, the Leknes Affective Brain lab (LAB lab), studies how the brain and body give rise to pleasurable and painful feelings. One interdisciplinary project centred on benefits of acute pain and was awarded The Daniel M. Wegner Theoretical Innovation Prize in social/personality psychology. Currently, LAB lab specialises in drug studies. Through psychopharmacology in healthy humans, Leknes’ team charts how the brain’s neurochemical systems shape hedonic feelings, decisions and behaviour. LAB lab also conducts studies in drug-treated clinical populations. Leknes is currently funded by an ERC grant to study state-dependent effects of opioids and their relation to social support, stress and dopamine, as well as by the Regional Health Authority to study mood, stress and pain in clinical groups treated with opioid agonists and antagonists.
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.
Implementing models of care for musculoskeletal conditions in health systems to support value-based care
Recognition is growing that to create patient‐centred care, health‐care organizations need to more directly engage patients across the spectrum of health‐care design and quality improvement. We highlight two papers that emphasize the necessity of implementing models and frameworks for research and the clinical setting. From: Abstract
Models of Care (MoCs), and their local Models of Service Delivery, for people with musculoskeletal conditions are becoming an acceptable way of supporting effective implementation of value-based care. MoCs can support the quadruple aim of value-based care through providing people with musculoskeletal disease improved access to health services, better health outcomes and satisfactory experience of their healthcare; ensure the health professionals involved are experiencing satisfaction in delivering such care and health system resources are better utilised. Implementation of MoCs is relevant at the levels of clinical practice (micro), service delivery organisations (meso) and health system (macro) levels. The development, implementation and evaluation of MoCs has evolved over the last decade to more purposively engage people with lived experience of their condition, to operationalise the Chronic Care Model and to employ innovative solutions. This paper explores how MoCs have evolved and are supporting the delivery of value-based care in health systems..
This study demonstrated the feasibility and benefits of including a roughly equal number of patients and clinical providers/staff in design events and ensuring that the patients represent diverse perspectives.
The evidence is clear that the development, implementation and evaluation of MoCs must rely more on the involvement of those with the lived experience. Their involvement must be in collaboration with those who provide care, their managers and funders.
What can patients contribute and why it is needed?
If patient-oriented research is intended to focus on priorities that are important to patients and produce information that is truly taken up and used to improve health care practice, therapies and policies, a strong foundation for ensuring successful collaboration must be laid.
The Canadian vision:
“Patients are active partners in health research that will lead to improved health outcomes and an enhanced health care system.”
Patients bring the perspective as “experts” from their unique experience and knowledge gained through living with a condition or illness, as well as their experiences with treatments and the health care system. Involvement of patients in research increases its quality and, as health care providers utilize research evidence in their practice, increases the quality of care. “Engaging patients in health care research makes (investments in) research more accountable and transparent, provides new insights that could lead to innovative discoveries, and ensures that research is relevant to patients concerns. The international experience with engaging citizens and patients in research has shown that involving them early in the design of studies, ideally as early as at the planning stage, leads to better results.”Footnote 1 By encouraging a diversity of patients to tell their stories, new themes may emerge to guide research. Patients gain many benefits through their involvement including increased confidence and master new skills, access to information they can understand and use, and a feeling of accomplishment from contributing to research relevant to their needs.
Investigating Trust, Expertise, and Epistemic Injustice in Chronic Pain
Investigating Trust, Expertise, and Epistemic Injustice in Chronic Pain
Trust is central to the therapeutic relationship, but the epistemic asymmetries between the expert healthcare provider and the patient make the patient, the trustor, vulnerable to the provider, the trustee. The narratives of pain sufferers provide helpful insights into the experience of pain at the juncture of trust, expert knowledge, and the therapeutic relationship. While stories of pain sufferers having their testimonies dismissed are well documented, pain sufferers continue to experience their testimonies as being epistemically downgraded. This kind of epistemic injustice has received limited treatment in bioethics. In this paper, we examine how a climate of distrust in pain management may facilitate what Fricker calls epistemic injustice. We critically interrogate the processes through which pain sufferers are vulnerable to specific kinds of epistemic injustice, such as testimonial injustice. We also examine how healthcare institutions and practices privilege some kinds of evidence and ways of knowing while excluding certain patient testimonies from epistemic consideration. We argue that providers ought to avoid epistemic injustice in pain management by striving toward epistemic humility. Epistemic humility, as a form of epistemic justice, may be the kind disposition required to correct the harmful prejudices that may arise through testimonial exchange in chronic pain management.
The first challenge relates to the conflicting obligations HCPs face in providing care for patients living with pain, especially when the pain sufferer is also living with addiction and mental illness.
The second challenge is that epistemic humility re- quires the HCP to be empathic and compassionate in inviting the pain sufferer to tell their story.
A third challenge in motivating epistemic humility is that caring for patients with pain can be demand- ing. Many providers are overworked and overburdened
We would strongly recommend you to read this paper. You can find a full text here
A bioethicist who did his PhD on stigma in chronic pain:
‘I view stigma as the combination of difference plus deviance: An in-group marks an out-group as different on the basis of a shared demographic characteristic, then judges the out-group as deviant. This is precisely what happens too many people in pain. They are marked as different because of their pain, and then have that pain denied, invalidated, and delegitimized. This is more likely to happen to women and racial or ethnic minorities than to white men.’
To alleviate pain stigma, we also have to decouple it from the stigma directed toward opioid use. While these two types of stigma often occur in the same spaces, they are not identical. We stigmatize people in pain, like my friend Andrea, who neither take nor desire opioids. And we stigmatize individuals who take opioids even if they do not live with chronic pain. A focus on opioid stigma is welcome and important, but it is not equivalent to intervening specifically to address pain stigma. Both of these terrible burdens deserve our attention and efforts.
We have tools to effectively and fairly treat people who live with chronic pain. We have the power to help them live better. We should do so, and without stigma.
Daniel S. Goldberg is a faculty member in the Center for Bioethics and Humanities at the University of Colorado Anschutz Medical Campus, associate professor of family medicine at the University of Colorado School of Medicine, and associate professor of epidemiology at the Colorado School of Public Health. He is the principal investigator of an epidemiologic study related to addiction stigma funded by The Well Being Trust, a 501(c)(3).
Why Do We Fear Co-Producing Health with Patients?e
This blog is posted on the website of the Institute for Healthcare Improvement on November 12th, 2020:
Helen was a nurse who believed her role was to help make things better. Wherever there was a problem, she was determined to help “fix it.” When Helen started working as a nurse in the community, she realized she was no longer “protected” by the status conferred by the uniform she had worn in the hospital setting. She was now in her regular clothes, a guest in someone’s home. This shift in the power dynamics initially made her feel vulnerable. Helen wondered if people felt this way when they were in the hospital.
In health care, outcomes are not created by health care professionals on their own. Health outcomes are co-produced with patients. As leaders and clinicians, we bring a wealth of “learned experience” to the table when working on quality improvement (QI), but it isn’t enough if people with relevant “lived experience” aren’t included as equal partners. Only by partnering with patients can we understand the whole story and see what matters. Only then can we co-design and co-produce improvements together.
During her physiotherapist/physical therapist training, Aimee was taught that her role was to be the “expert” when working with patients. Meeting Bob challenged this view. Aimee was responsible for talking with Bob about whether he was ready for a knee replacement. Practicing shared decision making, Bob and Aimee co-produced a plan that included not only talking about his knee and the surgery, but also how to address his needs as a whole person to optimize his experience and outcomes.
Clinicians are not often taught to co-produce care. Instead, we often struggle with feeling out of our comfort zones. Instead of asking people what matters and improving with them, with the best of intentions we presume to know what is best and improve for them. In her book Dare to Lead, researcher and thought leader on vulnerability, Brené Brown, describes the situation this way:
When something goes wrong, individuals and teams are rushing into ineffective or unsustainable solutions rather than staying with problem identification and solving. When we fix the wrong thing for the wrong reason, the same problems continue to surface. It’s costly and demoralizing.
The literature (see the list below) highlights many benefits of co-producing quality improvement:
Creates a sense of urgency among staff and connects them to their core purpose
Results in often simple and low-cost change ideas
Co-produced improvement projects are set up for success, ensuring ideas are robust and based on quality and practical experience