Chronic Pain sufferers – walking therapies

Chronic pain sufferers should take exercise, not analgesics, says Nice

Medicines watchdog recommends physical and psychological therapies when treating pain with no known cause.

People suffering from chronic pain that has no known cause should not be prescribed painkillers, the medicines watchdog has announced, recommending such patients be offered exercise, talking therapies and acupuncture instead.

In a major change of pain treatment policy, the National Institute for health and Care Excellence (Nice) say that in future, doctors should advise sufferers to use physical and psychological therapies rather than analgesics to manage their pain. Medical teams can also consider prescribing antidepressants, the government health advisers suggest.

Nice’s new guidance potentially affects the way many hundreds of thousands of people in England and Wales tackle their condition because between 1% and 6% of the population of England is estimated to have chronic primary pain.

There is “little or no evidence” that treating the condition with painkillers makes any difference to the person’s quality of life, or the pain they suffer or their psychological distress, according to its new guidelines on the assessment and management of chronic pain.

Pain caused by a known underlying health condition such as osteoarthritis, rheumatoid arthritis, ulcerative colitis or endometriosis is known as chronic secondary pain. However, pain with no identified cause that has persisted for at least three months is known as chronic primary pain.

Nice recommends that doctors draw up a care and support plan with patients about how to manage their pain based on how badly it is affecting their day-to-day life, what activities they feel they can undertake and honesty “about the uncertainty of the prognosis”.

The plan should include “interventions that have been shown to be effective in managing chronic primary pain. These include exercise programmes and the psychological treatments cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT).

“Acupuncture is also recommended as an option, provided it is delivered within certain clearly defined parameters,” Nice says.

The antidepressants amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine or sertraline can also be used, it adds.

Sufferers should not be started on commonly used medications such as paracetamol, non-steroidal anti-inflammatory drugs, benzodiazepines or opioids, which poses risks including addiction, the watchdog says. Dr Paul Chrisp, director of Nice’s centre for guidelines, said: “Based on the evidence, for most people it’s unlikely that any drug treatments for chronic primary pain, other than antidepressants, provide an adequate balance between any benefits they might provide and the risks associated with them.”

The Royal College of GPs backed the shift away from painkillers but cautioned that patients’ access to the new forms of treatment being recommended was variable.

Prof Martin Marshall, the college’s chair, said: “Pain can cause untold misery for patients and their families. Chronic primary pain… can be challenging to manage in general practice, and the college has been calling for guidelines to address this for some time.

“We understand the move away from a pharmacological option to treating chronic primary pain to a focus on physical and psychological therapies that we know can benefit people in pain.

“However, access to these therapies can be patchy at a community level across the country, so this needs to be addressed urgently, if these new guidelines are to make a genuine difference to the lives of our patients with primary chronic pain.”

Lucy Ryan, a patient representative who helped Nice draw up the new guidelines, welcomed its acknowledgement of the risks that a regime of tablets for chronic primary pain can involve because patients are sometimes not told about those.

“Everyone with chronic pain experiences pain differently, so I feel the more options available to help people effectively manage their pain, the better,” she added.

Reduce risk of blood clots

Patients recovering from a stroke can dramatically reduce their risk of blood clots by wearing a device that is half the size of a wristwatch around their leg, a new trial has found.

A study at Royal Stoke University Hospital in the UK found that the electro-stimulation band, known as a geko, could reduce the risk of clots compared with standard treatment, was comfortable to wear and could save hospitals money.

The battery-powered geko, which is approved for use on Britain’s NHS for other conditions, is designed to increase blood flow in the deep veins of the legs by stimulating the common peroneal nerve, activating the calf and foot muscles. As a result, patients benefit from about 60pc of the effect of walking without having to move.

Dr Indira Natarajan, a consultant and clinical director of neurosciences, conducted an in-hospital study. It found that of 219 patients fitted with the geko there was no evidence of blood clots within three months of discharge, compared with 11 cases of clots in 463 people prescribed intermittent pneumatic compression (IPC), the standard treatment for preventing them.

Dr Natarajan said: “Around 30pc of patients cannot go on an IPC pump, which puts pressure on calf muscles.

“They can’t use this standard treatment for a variety of reasons, such as having leg ulcers, broken skin or fluid in the leg.

“A lot of people also find that a sleeve pumping pressure down their leg means they can’t sleep.

“The geko gets round these problems. It’s like a half wristwatch which fits round the outside of the knee.”

(Henry Bodkin © Daily Telegraph, London)

Cost – expect to pay up to GB£200/US$280

Beware of Shovelling Snow

Every winter, about 100 people in the US die while shovelling snow. Why?

A study looking at data from 1990 to 2006 by researchers at the US Nationwide Children’s Hospital recorded 1,647 fatalities from cardiac-related injuries associated with shovelling snow. In Canada, these deaths make the news every winter.

Cardiologist Barry Franklin, an expert in the hazardous effects of snow removal, believes the number of deaths could be double that. “I believe we lose hundreds of people each year because of this activity,” says Franklin, director of preventative cardiology and cardiac rehabilitation at William Beaumont Hospital, Michigan.

His team found that when healthy young men shovelled snow, their heart rate and blood pressure increased more than when they exercised on a treadmill. “Combine this with cold air, which causes arteries to constrict and decrease blood supply, you have a perfect storm for a heart attack,” he says.

Snow shovelling is particularly strenuous because it uses arm work, which is more taxing than leg work. Straining to move wet and heavy snow is particularly likely to cause a surge in heart rate and blood pressure, Franklin says.

Many people hold their breath during the hard work, which also puts a strain on the body. In addition, the prime time for snow clearance is between 6am and 10am which is when circadian fluctuations make us more vulnerable to heart attacks.

Franklin considers snow shovelling to be so dangerous that he advises anyone over the age of 55 not to do it.

Sue Radka helps shovel out a friends driveway on in Lancaster, N.Y.

“People at greatest risk are those who are habitually sedentary with known or suspected coronary disease, who go out once a year to clear snow,” he says, adding that smoking and being overweight drastically increase the risk. If you must do it, push rather than lift the snow, dress in layers, take regular breaks indoors and don’t eat or smoke before shovelling, he advises.

Be aware of the risks. Better to ask neighbours to lend a hand, to be on the safe side.

original article 09/02/17

Create a free website or blog at

Up ↑

%d bloggers like this: