Neuroscience – the brain and pain
Neuroscience – the brain and pain
Dr Diana North, Goodfellow GP Advisor talks with Dr Gwyn Lewis, Neuroscientist about the neuroscience behind pain to enable GPs, nurses and pharmacists to understand and educate patients about pain, including:
- Pain mechanisms that:
- turn up the intensity of pain in the periphery and dorsal horn to protect tissue from damage.
- turn down the intensity of pain in the periphery and dorsal horn to help us survive and to stay mobile
- modulate pain in the central cortical systems.
- How acute pain becomes chronic pain.
- Where in the pain pathway things can go wrong and result in chronic pain.
- The management of chronic pain.
- Issues of overprescribing of opioids for chronic pain.
Resources
- Pharmacological management of acute pain Goodfellow Webinar archive (2017)
- The management of chronic pain Goodfellow Webinar archive (2017)
- Guidelines for prescribing opioids for chronic non-malignant pain Goodfellow Gem (2018)
- When to consider strong opioids for patients with acute pain BPAC (2018)
Peer group discussion points |
1. Approximately 1 in 5 New Zealand adults experience chronic pain. The reasons why acute pain may become chronic pain are complex. One risk factor for the development of chronic pain is the intensity of the acute pain and how well it is managed.
2. The use of the WHO analgesic ladder in those with cancer pain has been challenged. A newer idea is that analgesics are matched to the intensity of the pain (rather than ‘stepping up’ the pain relief intensity as required). For example, it might be appropriate for a patient with severe acute cancer pain to receive a strong opioid +/- non-opioid. The need for the use of weak opioids has also been questioned, with non-opioids or low dose strong opioids being proposed as treatment options for mild cancer pain.
3. There is limited evidence for the efficacy of treatment of non-cancer chronic pain with opioids and non-opioids are likely to be as effective. There are significant risks and adverse effects associated with the use of opioids to manage chronic non-cancer pain. The treatment of chronic non-cancer pain requires a biopsychosocial multidisciplinary team approach with regards to assessment and management.
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This MedTalk was supported by: