By David Vaux
Chronic pain affects some 28 million adults in the UK – that’s almost one in two people – and this figure is likely to increase in line with the ageing population. In the short term, pain usually alerts us that something is wrong, such as an injury. However, in the long term, pain can become unhelpful (Ramachandran and Blakeslee 1998, Saaba and William 2003).
In some individuals, long term exposure to pain can increase the sensitivity of their pain system, as can emotional or life events. It has long been suggested that a relationship exists between mental and physical states, with Charles Darwin (1872) discussing “fear and physiological changes involving the sympathetic nervous system”.
This would support the theory that in some cases, anxiety decreasing strategies can improve perceived pain by modulation of stress hormones upon spinal pain inhibitory neurones (McAllister 2012, Liebenson 1999). This perhaps explains the effectiveness of a multidisciplinary approach to pain management, and the importance of community based socially-focused movement and exercise classes within an individual’s pathway, to achieve better pain outcomes.
It is ironic that pain has been seen as light relief by some journalists from recent European events, including Public Health England’s report focusing on pain, and the Chief Medical Officer’s updated advice for physical activity.
However, it is not in Westminster or in the laboratories of big pharmaceutical companies that the human experience of dispensing of pain medication is played out. It is the community pharmacy that is the front line of this debate. These two major reports from separate departments draw into sharp contrast their many areas of overlap with the need for a joined-up approach to pain, physical activity levels, medication and the ageing population.
As a registered osteopath, I am well aware of the effect pain can have on an individual. I am also aware that medication often has an important part to play in the management of pain with many patients. However, I also encourage and see the merit of non-pharmacological pain management techniques. As part of my role at Arthritis Action, I also lead their manual therapy and exercise projects aimed at helping people self-manage their long-term conditions.
Recently there seems to be a concerted effort between allied health professionals, nurses, medics and those from the third sector to openly share their experiences, concerns and ideas around pain management.
At Arthritis Action we are passionate advocates of promoting a self-management approach which includes social prescribing to community activity classes, access to physiotherapy and osteopathy appointments, nutritional consultations, and self-reliance through strength and conditioning. The importance of strength training for an ageing population has also been highlighted in the latest physical activity guidelines from the Chief Medical Officer.
All of us who deal with the public including GPs, pharmacists, nurses, or allied health professionals need to be more pragmatic about how we think about our own roles in order to cope with the challenges highlighted in the Public Health England report. Is it time to become more comfortable with the blurring of the lines around each health profession in order to provide a more flexible response to often complex highly individual experiences of pain?
The local community pharmacist is ideally placed to be a provider of not only medication but also the most useful pain education. What we do know from the evidence is that any joint pain will increase if the muscles around a joint are detrained.
Experience has also confirmed that if we can help an individual overcome their fear of pain during exercise, then they can escape the detraining cycle that often leads to dependency upon medication and care. In many cases, only small increases in functional strength can have significant impact upon quality of life and independence. However, it does not have to be about strength advice alone. When trying to guide those who live with long-term pain, it seems that any activity which gets that person moving or experiencing something new has the potential to help with pain levels.
Prescription drugs have a role to play in the management of pain. Along with other interventions, they form part of the jigsaw that will be potentially different for many. Perhaps it is time for more of us to decide upon more flexible treatment approaches and reframe the language we use for the modern era. Exercise, like medication, should not be feared or dreaded. Instead, it should form part of the landscape around this discussion, especially with an older person in mind.
Perhaps the community pharmacist, as with other healthcare professionals, can undertake appropriate training in dispensing not only medication but also physical activity and strength and conditioning advice. This advice, aimed at enabling the individual to regain function, would then lead to signposting and helping people access local community activities. These strategies, along with medication, might form the framework of a new community pain management pathway.
Perhaps community pharmacies can also start lending VR headsets featuring pain-reducing programmes. Anything but Brexit, sign me up!
David Vaux is Therapies Manager and Exercise Lead of Arthritis Action.
This article also appears in the October issue of Pharmacy Business.