Abstract
A fascinating smörgåsbord of papers in this issue: two on good practice, two on models and mechanisms, one on efficacy and one on healthcare professionals’ behaviour.
Good practice
Torkamani and colleagues developed an audit checklist from the FPM (Faculty of Pain Medicine of the Royal College of Anaesthetists, UK) core standards for pain management services, 279 of them overall, most assessable by checklist but some requiring observation. Scrutiny of our services is important, and this will facilitate it, but will there be recognition from managers and commissioners for services that perform well, and support to improve those that are not? Sheehan and colleagues examined hospital records for pain care for fractures or dislocations in the emergency departments of 12 UK hospitals against the Royal College of Emergency Medicine guidelines. 58% of those in pain got analgesia, most with some delay, and 5% of those in severe pain got none. Pain documentation was poor before treatment and vanishingly rare after it. Authors suggest mandating pain scoring and – wisely – finding out from patients what matters most about Emergency Department pain care.
Models and mechanisms
Morgan and Aldington review the literature on comorbid post-traumatic stress disorder (PTSD) and chronic pain in United Kingdom veterans, summarising it perfectly as ‘a lot of theory but not enough evidence’. The four models described are all rather abstract and data-free, and remote from pain science. Pragmatic treatment data came mostly from the United States, but cast no light on mechanisms. Wodehouse and colleagues describe apparent changes in central sensitisation from percutaneous occipital nerve stimulation for 13 patients with intractable headache. Conditioned pain modulation changed towards normal with stimulation, but mechanical pain threshold remained low; curiously, they do not report clinical outcomes.
Online pain management
Pimm and colleagues report on a Web-based pain management programme (Pathway through Pain) used by various National Health Service (NHS) Trusts. Results, for those who completed, were good, with cost savings in healthcare over the following year, and some clinically significant changes, but 41% of the originally eligible population never engaged, and of those who started, 59% never completed the 24 units. This is substantial loss, not unusual for unsupported online programmes, but likely with adverse consequences for the dropouts.
Reading pain literature
An original investigation by Arumugam and colleagues identified different Canadian healthcare professionals’ access to pain paper abstracts following alerts from a free local service. Doctors, nurses and physiotherapists accessed most abstracts; psychologists least. Although just over half papers accessed were of primary treatment, by proportion, systematic reviews and meta-analyses were most popular. Someone is reading the evidence!
Footnotes
Conflict of interest
The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Contributorship
A.C.de C.W. contributed to this article.
Funding
The author(s) received no financial support for the research, authorship and/or publication of this article.
Guarantor
A.C.de C.W. is the guarantor for this article.