Pain, human rights and the law
Jonathan Herring
pp 1-3
Is there a human right to pain relief? We live in a world where the political and legal rhetoric generally demands that arguments be put in terms of rights. It is, therefore, inevitable that those seeking better provision of pain relief will claim a human right to it. However, if we are to move beyond the rhetoric, we need to be clear precisely what is meant by a human right, and in what sense such a right can become legally enforceable. The conclusion of this article, that ‘there is a sort-of legal right to pain relief sometimes’, is not a slogan that will get people marching in the streets, but it is one that reflects a more realistic claim than a general right to pain relief.
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Comment: Putting the patient first
Dominic Aldington
pp 3-3
These days I find myself spending rather longer than I would like commuting in my car. I tend to have the car radio tuned to Radio 4, and I doubt that many days go by without hearing someone on the radio suggesting that it is their human right to be treated in a certain way. In this issue of Managing pain in practice, we start with a paper by Jonathan Herring, who clearly explains what ‘rights’ are and, more importantly, what they are not. He goes on to air many of the issues around the idea of pain relief as a human right. What the article clearly states is that, currently, ‘under English law, you have a right to pain relief if your doctor thinks it is the best treatment for you’. As many clinicians and, certainly, patients know, relying on a doctor to decide if pain relief is appropriate for a patient can often be a problem, because it seems that many of our colleagues are confident that they can determine how much pain a patient suffers. The trouble is that the views of healthcare professionals and patients seldom agree, with professionals, typically, underestimating pain, and overestimating treatment effectiveness.
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Managing pain in fibromyalgia
Stefan Bergman
pp 4-5
Fibromyalgia is a condition characterised by long-standing widespread pain and an increased pain sensitivity. Patients also report fatigue, unrefreshing sleep, cognitive disturbances and different somatic symptoms. There is no one clear aetiology, and the causes are believed to vary between patients. The complex of symptoms in fibromyalgia is best understood from a biopsychosocial perspective, where peripheral musculoskeletal symptoms and the nociceptive system interact with cognitive, emotional and behavioural factors in a social context. A dysfunction in the inhibitory control of pain in the spinal cord may be one key factor behind the increased pain sensitivity. Fibromyalgia is common together with other painful musculoskeletal conditions, such as rheumatoid arthritis and osteoarthritis, but a strict focus on the musculoskeletal symptoms could be misleading. This article will present a mechanism-based model for management of fibromyalgia.
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A sideways look at fibromyalgia
Andrew Moore
pp 5-6
When it comes to fibromyalgia, one might be excused for feeling like a frail piece of elastic, pulled on by two strongly opposing forces. On the one hand, there are those professionals who would have it be said that there is no such disease as fibromyalgia, and that it is all in the mind. In Europe, the Committee for Medicinal Products for Human Use (CHMP) has refused licences for fibromyalgia to pregabalin, duloxetine and milnacipran, mainly based on insufficient efficacy, lending weight to the idea that fibromyalgia is a non-existant problem. There is no licensed treatment for fibromyalgia in Europe.
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Gastroprotection with NSAIDs: guidance versus reality
Andrew Moore
pp 7-9
Some guidelines are followed widely. For example, there is strong evidence that the National Institute for Health and Clinical Excellence (NICE) guideline that recommends cessation of antibiotic prophylaxis for prevention of infective endocarditis is extensively followed by professionals. General adherence to guidance on the treatment of cardiovascular risk factors, like blood pressure or cholesterol reduction treatment, has contributed to significant reductions in both heart disease incidence and mortality.
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How to recognise and treat common causes of foot pain: part 2
Heidi J Siddle and Philip S Helliwell
pp 10-11
Part one of this article, in the previous issue of Managing pain in practice, covered the different types of foot pain – inflammatory foot pain, degenerative foot pain, stress factures, plantar fasciitis, Morton’s neuroma and painful peripheral neuropathy – how to recognise them, and the difficulties that arise in assessing them. This final part discusses imaging modalities and treatment options available for the above conditions.
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