CLINICAL SCIENCE
Pain: its management and the underlying science
Robb Russell reports on a sample of the many informative presentations from last year’s EuroSciCon programme devoted to various aspect of pain and its treatment.
Pain is recognised as part of the human experience and is progressively attracting greater attention from researchers, but it is far from being fully understood. The EuroSciCon meeting entitled The Science of Pain and its Management, held in London last December, attracted an international array of presenters and attendees. The programme covered the topic of pain from multiple angles including basic science, pharmaceutical, psychosocial and clinical perspectives.
Veterinary perspective Dr Clare Rusbridge (School of Veterinary Medicine, Faculty of Health and Medical Sciences, Guildford, Surrey, UK) began the meeting with a thought-provoking presentation entitled ‘Neuropathic Pain –
What Can Man’s Best Friend Teach Us?’ Focusing on naturally occurring conditions in dogs and cats, particularly the inherited Chiari malformation and syringomyelia conditions, Dr Rusbridge explained how both pathologies can present as neuropathic pain syndromes. In consideration of the difficulties that
people in pain and healthcare professionals experience communicating about pain, the presenter asked the audience to consider how pain affects cognition and behaviour in cats and dogs and how this can be identified and interpreted. She stated that pain demands a response which can manifest as behaviours such as aggression and self-harm. Relative to human patients, recognition of cognitive and behavioural
changes due to pain can improve communication and have far-reaching consequences for medical care and quality of life.
Phantom limb pain Professor Jack Tsao (Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda MD, USA) reviewed theories of why phantom limb pain (PLP) arises following amputation, whether due to trauma or post-surgically due to pathology. Professor Tsao stated that both central and peripheral factors contribute to the development of PLP, which occurs in 95% of all amputations. Peripherally, temporary relief occurs when analgesics are applied at the site of the amputation. Central mechanisms are implicated because symptoms develop immediately post- amputation, regardless of the cause. He speculated that if pain were solely due to nociceptive input from scar tissue, it would be unlikely to occur without delay following amputation. Although PLP self-resolves in most
people over time, others require treatment. Some cases, however, are refractory to care. Professor Tsao discussed the use of mirror therapy to treat PLP, stating that it is of benefit to most sufferers. Patients with higher starting pain levels need a relatively greater number of treatments to appreciate a positive response or, conversely, to conclude that the treatment will not be successful. Mirror therapy need not begin immediately post-amputation in order to be successful. In bilateral amputees, for whom mirror therapy is not feasible, Professor Tsao’s research found that if the amputee observes the limb movements of an intact person, PLP improves similarly to that
Amputation as a result of diabetic complications, sarcoma or trauma is followed by phantom limb pain, which is triggered by both central and peripheral factors.
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‘Recognition of cognitive and behavioural changes due to pain can improve communication and have far- reaching consequences for medical care and quality of life’
MAY 2016 THE BIOMEDICAL SCIENTIST
©Barabas Attila/Fotolia
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