Sickle Cell Disease Dr Jeremy Anderson Clinical Haematology What is pain IASP definition of pain An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage ID: 1010711
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1. Dealing With Persistent Pain inSickle Cell DiseaseDr. Jeremy AndersonClinical Haematology
2. What is pain?
3. IASP definition of pain:“An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”
4. Key Points:It’s a sensation, and it has a valence to it—comes with distressNot just about damage—can be no damage—more about ‘danger’Pain is inherently a matter of one’s subjective experience (pain is something your brain does)
5. BrainSpinal cordInhibitorydescendingpathwayAscending pathwaysAβfibresInjuryTouchPain signalPain gateInhibitory spinal neuronTouchFast Aβ fibresSlowC fibres
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9. ALL PAINIS PSYCHOLOGICAL
10. Acute vs. Chronic/Persistent Pain
11. Sources of Pain in Sickle Cell
12. ToleranceStimulusResponseReinforcementLearning
13. Tolerance
14. ToleranceDependence
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17. The US Opioid EpidemicIn 2016:130+ died every day from opioid overdose47,600 total dead, 28,466 dead from Rx886,000 used street heroin, 81,000 for first time2.1m had opioid use disorder2m misused Rx for first time
18. Starts with Rx oxycontinWhen access cut back, people turn to street heroinHeroin cut with fentanyl, overdosesFentanyl deaths up 29% in UKUK opioid Rx doubled last 10 yearsUK opioid Rx common for chronic painQuarter of patients Rx higher than guidelines warrant (Ashaye, et al., 2018, BMJ)
19. Carroll et al., 2016
20. We need a framework to identify a maladaptive coping pattern and intervene early
21. Situation:
22. What should this look like?
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24. How to decide if there is a problem?
25. Decision Rules: High or Low?
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27. High rating on one or more of these factors is a sign of maladaptive coping
28. A strategy is maladaptive when it seems to help initially, but leads to greater harm later
29. 2 x 2 x 2 = 8 Profiles (7 really):
30. 2013
31. 2014
32. 2 x 2 x 2 = 8 Profiles (7 really):
33. 2014
34. 2015
35. Building tolerance
36. 2 x 2 x 2 = 8 Profiles (7 really):
37. 2015
38. 2016
39. 2017
40. Assess and identify profile:Intervene earlyCan get a sense of how far along the path patient isFlagged patients can be referred to specialised pain service, specialist providersIn most cases, patient has developed chronic or persistent pain, needs a more comprehensive approach to pain mgmt
41. Comprehensive Pain Management ProgrammeStarting Now
42. Programme in Development:Physiotherapist for outpatient and inpatient support.
43. Input from consultants with expertise in complex pain management and reducing reliance on pain medication.
44. Core of service.~8 sessions, beginning April 24, refer nowOne-off sessions open to patients, friends, family, staffSafe activities led by the Physiotherapist, to prevent or eliminate pain coming from inactivityHighly specialised medical advice in conjunction with your core medical teamPractical help to reduce burden and worry that contribute to your pain experience
45. Explore broader life goals
46. Examine activity cycles and pain, practice pacing, exercise, and stretching
47. Reducing Reliance on OpioidsFrom short-acting to long-actingVery gradualHelp with withdrawal
48. Look at thoughts & emotions
49. Discuss communication & relationships
50. Plan for dealing with pain flare-ups
51. BrainSpinal cordInhibitorydescendingpathwayAscending pathwaysAβfibresInjuryTouchPain signalPain gateInhibitory spinal neuronTouchFast Aβ fibresSlowC fibresLearn about different pain mechanisms
52. Stress Management
53. Improving Sleep
54. Goal is improve patients’ overall quality of life
55. Change won’t happen if patients,or providers,do the same old thing
56. Must refuse to enable continued harmful behaviour, while giving patients new, helpful options
57. Thank you for listeningDr. Jeremy Anderson0203 313 8119jeremy.anderson1@nhs.net