Make a CHANGE: optimising communication and pain management decisions

Abstract

c i a l D i s t r i b u t i o n U n a u t h o r i z e d u s e p r o h i b i t e d . A u t h o r i s e d u s e r s c a n d o w n l o a d , d i s p l a y , v i e w a n d p r i n t a s i n g l e c o p y f o r p e r s o n a l u s eCurrent Medical Research & Opinion Vol. 27, No. 2, 2011, 481-488 Eli AlonUniversita¨tsspital Zurich, Switzerland Beverly CollettThe Pain Management Service, University Hospitals of Leicester, UK Dominic AldingtonChurchill Hospital, Oxford, UK AbstractThe major objectives of the CHANGE PAIN International Advisory Board are to enhance understanding of chronic pain and to develop strategies for improving pain management. At its second meeting, in November 2009, evidence was presented that around one person in five in Europe and the USA experiences chronic pain, and the delay before referral to a pain specialist is often several years. Moreover, physicians' pharmacological approach to chronic pain is inconsistent, as evidenced by the huge variation in treatment between different European countries. It was agreed that efficient communication between physician and patient is essential for effective pain management, and that efficacy/side-effect balance is a key factor in choosing an analgesic agent. The multifactorial nature of chronic pain produces various physical and psychological symptoms, so the management of chronic pain should be tailored to the individual. Pharmacological therapy must be matched to the causative mechanisms responsible, or it is likely to prove ineffective and risk the development of a 'vicious circle'; doses are increased because of inadequate pain relief, but this increases side-effects so doses are reduced, pain relief is then inadequate, so doses are increased, and so on. Pain management decisions should not therefore be based solely on the severity of pain. Based on the concept of individual treatment targets (ITT), the CHANGE PAIN Scale was adopted -a simple, user-friendly assessment tool to improve communication between physician and patient. The 11-point NRS enables the patient to rate the current pain intensity and to set a realistic individual target level. On the reverse are six key parameters affecting the patient's quality of life; clinicians simply need to agree with patients whether improvement is needed in each one. Regular use can establish the efficacy and tolerability of pain management, and the rate of progress towards individual treatment targets.

Managing chronic pain in elderly patients requires a CHANGE of approach

“…Unidimensional instruments such as the Numeric Rating Scale (NRS) and Visual Analogue Scale (VAS) can be used for many elderly patients, while more information can be obtained from multidimensional instruments. Examples of these include the McGill Pain Questionnaire (MPQ), which provides a quantitative measure of subjective pain experience from an intensity scale and three categories of word descriptors 36 , and the CHANGE PAIN Scale, which records not only the current and target pain intensity, but also the improvement required in six key parameters that affect QoL 37 . Patients differ enormously both in their symptoms and what they consider to be an acceptable level of pain; these instruments can help in establishing individual treatment targets and measuring progress towards them 37 .…”

The chronic pain conundrum: should we CHANGE from relying on past history to assessing prognostic factors?

“…They usually meet about twice a year to discuss various aspects of pain management and to develop guidance which can be disseminated to healthcare professionals. To date, the Board has made recommendations on topics including effective physician/patient communication, the multifactorial nature of chronic pain, the Vicious Circle 1 in pharmacological therapy, and the need for treatment decisions to be guided by an understanding of pain mechanisms 1,2 .…”

Lasting Prolonged-Release Tapentadol for Moderate/Severe Non-Cancer Musculoskeletal Chronic Pain

“…The lack of individually tailored management may lead to inappropriate treatments, useless analgesic dose escalations, and the failure of multiple therapies; these may result in ineffective pain control, harmful adverse effects, low patient compliance, therapy discontinuation, and increased healthcare costs, patient frustration, and suffering [2–4]. The main goals of CP pharmacological management are pain control with a satisfactory quality of life (QoL) and functional and social recovery [4, 5] both in the short and long term.…”