The World Health Organization (WHO) has updated the International Classification of Diseases (ICD-11). For the first time, they have included chronic pain and provided specific pain diagnoses. Under the new system, chronic pain is classified as either chronic primary pain or chronic secondary pain.

Chronic primary pain is defined as pain that persists for longer than three months and is associated with significant emotional distress or functional disability and that cannot be explained by another chronic condition. This new definition applies to chronic pain syndromes that are best conceived as health conditions in their own right.  Examples of chronic primary pain conditions include fibromyalgia, complex regional pain syndrome, chronic migraine, irritable bowel syndrome and non-specific low-back pain.

Chronic secondary pain syndromes are defined as pain that may initially be regarded as a symptom of other diseases having said disease being the underlying cause. However, a diagnosis of chronic secondary pain marks the stage when the chronic pain becomes a problem in its own right. In many cases, the chronic pain may continue beyond successful treatment of the initial cause; in such cases, the pain diagnosis will remain, even after the diagnosis of the underlying disease is no longer relevant. Examples of chronic secondary pain are chronic pain related to cancer, surgery, injury, internal disease, disease in the muscles, bones or joints, headaches or nerve damage.

More detail can be found in the online edition of Pain: The Journal of the International Association for the Study of Pain:

journals.lww.com/pain/Fulltext/2019/01000/Chronic_pain_as_a_symptom_or_a_disease__the_IASP.3.aspx.

NICE guidance on cannabis-based medicines out for consultation

The National Institute for Health and Care Excellence (NICE) has issued draft guidance for the use of cannabis-based medicines considering the evidence for their use in intractable nausea and vomiting; chronic pain; spasticity and epilepsy. It covers other related topics, such as prescribing, and the economic aspects. NICE guidelines apply only to England unless adopted by devolved governments. Doctors are expected to take the guidelines into account in their clinical practice. However, it is not mandatory for doctors to follow them where they believe they are not in the best interests of a particular patient. The evidence review for chronic pain runs to nearly 262 pages and reviews data from 20 trials. There are no headline grabbing conclusions.

The committee noted that most of the trials were limited in scope and of poor quality. There is some evidence that some cannabis-based products reduce chronic pain in some patients. However, the benefit is small compared with the cost of the treatment. NICE noted that cannabis-based medicines would have to be 10 times more effective or 10 times cheaper to have an acceptable cost/benefit. However, the committee acknowledged the many patient reports of benefit and has recommended further research be done, particularly in fibromyalgia and persistent treatment-resistant neuropathic pain in adults, and chronic pain in children and young people. Notes will keep an eye on developments.

Read the draft guidance here

What is Cannabidiol?

Cannabidiol (CBD) is a natural compound extracted from the cannabis plant. It is freely available in the UK as a food supplement and the market for it is growing. The products for sale do not claim any medical benefit and some products do not contain a sufficiently high dose to be likely to have any benefit. They are not cheap. Cannabidiol does not get you ‘high’, but some formulations available on the internet (from US sites for example) contain tetrahydrocannabinol (THC) which is the chemical that does make you high. Possession of formulations with THC is likely to be illegal in the UK. Synthetic cannabinoids such as Nabiximols are available for some conditions under medical prescription having been tested and shown to be both effective and safe. For more information, we recommend the NHS website: nhs.uk/conditions/medical-cannabis/.

The World Health Assembly (WHA) – a subsection of the World Health Organization (WHO) – has declared September Pain Awareness Month. This month is dedicated to raising public awareness and understanding of pain. Many organisations around the world contribute, including the U.S. Pain Foundation, the International Pain Foundation and the American Massage Therapy Association (AMTA).

During September, the U.S. Pain Foundation will be sharing 30 stories of people living with pain over 30 days, while the AMTA has posted resources to inform people of the role of massage therapy in pain management strategies. Here at Pain Concern, we will be posting regularly on social media.

Everyone can play a part during this month by using the hashtag #PainAwarenessMonth.

You can also get involved by ‘liking’/‘following’ Pain Concern on Facebook and Twitter to stay up to date and share the cause.

Links:

• World Health Organization (WHO)
• International Association for the Study of Pain (IASP)
• U.S. Pain Foundation
• American Chronic Pain Association (ACPA)
• International Pain Foundation
• American Massage Therapy Association
• Thirty Stories of Pain
• The Role of Massage Therapy in Pain Management

The International Association for the Study of Pain (IASP) has made 2019 their ‘Global Year against Pain in the Most Vulnerable’. The groups included in IASP’s Global Year against Pain in the Most Vulnerable are: older persons (including pain in dementia), infants and young children, individuals with cognitive impairments (non-dementia-related) or psychiatric disorders, and pain in survivors of torture. Alongside healthcare professionals, patients and other members of the public IASP have created a campaign to highlight the needs of individuals who cannot articulate their pain in ways that health professionals can easily understand or whose pain problems are underestimated and so they are more likely to receive inadequate pain control. IASP president, Dr Lars Arendt-Nielsen, discussed how that this year was created because he feels that ‘so much needless suffering could be alleviated if only the right clinical approaches were applied, the right policies adopted, and the right partners engaged, including patient advocacy organizations’.

The Airing Pain episodes that address these issues are listed below:

Programme 3: Children in pain

Programme 4: Diet, CBT and mindfulness

Programme 6: Pacing and arthritis

Programme 10: Young people in pain

Programme 18: Growing Old with Pain

Programme 22: Pain Support Groups and Facial Expressions

Programme 27: Arthritis – Challenging Perceptions

Programme 28: Challenging Pain

Programme 40: Children in pain

Programme 44: Pain management at both extremes of life

Programme 57: Self-management, psychology and “physio-terrorists Stiff joints and dark thoughts

Programme 66: Not a burden

Programme 71: Protect our girls

Programme 78: Putting children’s pain in the picture

Programme 82: Pain, PTSD and perfume

Programme 83: Arthritis

Programme 89: Dementia