Guardian - Chronic pain: prescribe mental health support as well as drugs, say experts (Feb 2020)

[Esther12]

Not particularly interesting.

https://www.theguardian.com/society...l-health-support-as-well-as-drugs-say-experts

Calls for social interventions to be used along with opioids, which often have little effect

Nicola Davis

While opioids are known to work for short-term pain, it is thought as few as one in 10 patients with chronic pain not linked to cancer may benefit from such drugs. Photograph: Mark Lennihan/AP

People with chronic pain should be prescribed social interventions such as mental health support instead of just opioid painkillers, experts have said.

About 28 million adults in the UK live with pain that has lasted three months or more, according to recent research. But tackling such pain is challenging, with few effective treatments on offer.

“For long-term pain there are no medical treatments that work really well – that is a harsh fact,” said Dr Cathy Stannard, clinical lead for guidelines on chronic pain from the National Institute for Health and Care Excellence.

“Long-term pain is distressing and disabling, it is dreadful to live with, but medical treatments do not work to treat it.”

Some very brief info on the sort of 'support' that could be provided - also I found it interesting that they talked of improving 'reported pain' rather than 'pain' - some useful clarity there imo. There's no discussion of the quality of evidence for interventions improving in mobility, sleep, etc.

Now Stannard says it is time to rethink how chronic pain is handled, noting that when asked to rate their pain on a scale of one to 10, with 10 akin to torture, many patients rate their pain at 12.

“That does not mean they are lying – what it means is they very, very much want help … The pain score is an articulation of distress,” she said.

Stannard said that not all relief comes in the form of medication. “Maybe we can’t change the pain, but we can do various things like we can improve mobility, we can improve sleep, we can improve social isolation, we can provide housing support, we can provide financial advice,” said Stannard, adding that such approaches can reduce reported pain.

This followed on from a Science Media Centre briefing:

https://www.sciencemediacentre.org/opioids-in-the-uk/

 

[shak8]

My opioid and muscle relaxant work for me (50-90% pain reduction). As for socializing (or mental health support), more problems than it's worth, except for the most empathetic and kind friends.

This is rehash. There haven't been enough studies on the opioid front to conclude that they "don't work" on chronic pain. Au contraire.

 

[wdb]

“We know now there is a very close relationship between, for example, adverse childhood experience and adult chronic pain,” she said, adding that she had also seen cases where intense pain had been linked to grief.

Do we really know that, and if they are related did we rule out the dozens other changes in ones life that adverse childhood experiences might have led to before presuming the causation is psychological ?

 

[Hoopoe]

This is maybe a bit off topic but I didn't think it deserved its own thread.

Yesterday I caught myself thinking that I was feeling pretty good. I then assessed my state a little more deliberately, and I still felt sick and in pain. There had been no objective improvement in things like daily activity levels. Nevertheless i was in a good mood. I think it's because spring is coming and I've recently had some pleasant events in my life. It's a bit better than it was several weeks ago but well within the usual boundaries in which the illness fluctuates.

I think this shows how current mood can influence how people rate their health.

It might also reveal why psychiatry is so confused and thinks emotions are driving illness. It might look like illness severity changes with current mood.

The other aspect to this is that people might rate their present and past as horrible and traumatizing if they're currently in a very bad mood. Maybe especially so if they've been told that emotional trauma is causing their illness.

 

[rvallee]

But there is plenty of evidence that it is useless and generally leads to more problems than it tries to solve, mainly by blaming patients for their suffering. It's pretty much this exact mindset that is making progress slow and ineffective, those weird beliefs that have always belittled chronic pain because the minds of those who never experienced it are unable to process pain that doesn't magically goes away.

It would be great if it worked. It doesn't. Trying anyway is foolish and counterproductive. You might as well prescribe astrology but in the end it's the same misuse of public resources.

So this basically looks to be promotion for IAPT, a false solution still in search of a problem. It's certainly true that current drugs are not adequate but promoting outright quackery is not the right approach people, get over yourselves and start listening to the damn patients for once in your sheltered privileged lives where reality is just a set of numbers and features that you twist and distort because that's still far easier than doing the hard slog of figuring out a problem that is counterintuitive.

And you do have to marvel at the hypocrisy here of mentioning that drugs only "work" on a small subset of patients meaning it should be thrown out when the exact opposite argument is made in our case, that we should hold on to the lottery of hope because a treatment that works should not be denied to those for whom it does work just because it doesn't work for everyone, with "work" doing a whole lot of... uh... work here.

 

[Snowdrop]

Yes, it is interesting that the opposite argument is used for CBT for ME. A few may benefit so everyone should be made to try it. Of course it's not a drug so no possibility that it might harm -- especially if there is no procedure for reporting harms.

 

[alktipping]

it seems to me like propaganda after all if a nice chat with a cretin who has been trained to talk absolute bs to a patient with an earnest and sympathetic demeanour can alter how you answer a heavily loaded self report form then it must actually be an effective treatment .at least for those who are suffering from a delusional illness . so much money wasted that could of been used for real research by people who actually understand the scientific process .