Year-long tracking survey demonstrates that 19% feel that their pain has become worse

European Federation of Chapters of the International Association for the Study of Pain (EFIC) Congress — 95% of patients are suffering from moderate to severe chronic pain after one year of treatment(1) and only 12% are being prescribed strong opioids, according to a year-long survey presented today at the EFIC congress. The research reveals that more than half of patients’ pain levels fail to improve over the course of a year’s treatment and for 19%, their pain has become worse. Despite the high proportion of patients continuing to suffer pain, 64% of patients believe they are taking the most appropriate level of medication and 58% believe that everything is being done to help them.

The new survey, entitled PainSTORY (Pain Study Tracking Ongoing Responses for a Year), is the first of its kind to track the impact of chronic pain on patients’ lives over the course of a year and involved 294 patients in 13 European countries.

Regarding pain management, the survey demonstrates that out of all patients who took part in the survey, 83% are prescribed medication but 30% also resort to over the counter (OTC) medication to try to manage their pain either alone or in combination with other therapies. Despite the fact that 95% of patients receiving treatment are suffering from moderate-to-severe pain, only 12% of them are being prescribed a strong opioid treatment, 25% a weak opioid and 43% are prescribed a non-opioid treatment. The research also reveals that only 23% had their prescription changed to a stronger type of pain medication over the course of the year.

The survey illustrates almost half of all patients report side effects as a result of their medication, the most common of which is constipation(2), experienced by almost half of patients, 49% of whom are receiving treatment with opioids. Although highly effective in controlling pain, opioids can be associated with opioid-induced constipation (OIC). The research indicates that 26% of patients taking opioid medication turn to laxatives to help relieve their constipation, which may alleviate symptoms but will not address the cause of the problem.

Commenting on the findings, Dr Tony O’Brien, Consultant Physician in Palliative Medicine at Cork University Hospital said: ‘This research reveals an alarmingly high prevalence of uncontrolled chronic pain in our communities. This serious public health problem must be addressed as a matter of urgency. Patients suffering pain require comprehensive evaluation and assessment by skilled healthcare professionals. Selected patients will benefit from a supervised trial of opioid medication in order to achieve an optimal level of analgesia, whilst preventing unwanted opioid adverse effects, including opioid induced constipation. The objective is to ensure that patients can experience the best possible quality of life.’

The research provides some valuable insights into patients’ experience of the healthcare professional team. Despite the high proportion of patients continuing to suffer pain, the number of patients visiting a doctor declined over the course of the year from 83% at the beginning of the survey to 70% at the end. By the end of the survey, 58% had been given a physical examination, 22% were rated on a pain scale, 19% were sent for further tests and only 2% had seen a pain specialist consistently throughout the year.

Across the year, 44% of patients report feeling alone in tackling their pain and two thirds of patients feel anxious or depressed as a result of their pain. For 28% of patients, their pain is so bad they report they sometimes want to die. Patients report feeling trapped by a pain which may vary in intensity, but continuously affects every aspect of their life.

Commenting on the findings of the survey, Hans Kress, President Elect, European Federation of Chapters of the International Association for the Study of Pain said: “This research presents a unique insight into patients’ journey in pain across Europe. It is shocking to observe that one year on, patients are still trapped in an ongoing cycle of pain and a large proportion seem to be losing hope. I urge patients to speak to their doctor if they are experiencing chronic pain or are concerned about side effects and not suffer in silence.”

PainSTORY (Pain Study Tracking Ongoing Responses for a Year) is the first study of its kind to track patients with chronic pain over one year, providing in depth insight into how pain impacts the daily lives of patients and the management of pain in 13 European countries.

The PainSTORY survey was conducted by an independent research company, Ipsos MORI, in collaboration with the following independent third parties:

– European Federation of IASP Chapters
– World Institute of Pain
– OPEN Minds

The survey was sponsored by a restricted educational grant from, and prepared in association with, Mundipharma International Limited.

Methodology

294 patients suffering from non-malignant (osteoarthritis, back pain / lower back pain, osteoporosis, neuropathic pain, mixed pain, other long term pain), chronic pain (i.e. lasting for more than three months) rating greater than or equal to 5-10 on a pain scale at screening stage (where 0 = no pain and 10 = the worst pain imaginable) completed the survey. At the evaluation stage of the survey, patients’ pain levels were ranked as mild (1-3), moderate (4-7) or severe (8-10). Respondents were studied for 12 months and research was carried out in 13 countries across Europe: United Kingdom, France, Germany, Switzerland, Italy, Spain, Ireland, Belgium, Sweden, Denmark, Finland, Netherlands and Norway by an independent research company, Ipsos MORI.

The study consisted of four waves of qualitative interviews between April 2008 and May 2009. Interim engagement activities such as diaries and ‘life books’ were sent to patients between the four waves to provide additional insight. Comparisons between baseline data and subsequent wave results showed how the impact of pain and pain management changes over the course of a year.

References
1. Treatment includes prescription medication, over the counter medication and alternative medication
2. The term ‘constipation’ incorporated bloating, stomach ache and stomach cramps

Source: www.painstory.org


Children at risk for undetected vision problems

  • Author: Health Informer
  • Filed under: Health News
  • Date: Sep 10,2009

New Report Highlights Best and Worst State Laws Protecting Kids’ Vision

A new report by The Vision Council, Making the Grade? finds state laws regarding vision assessments for children entering school are inconsistent, impeding children’s ability to succeed in school. Since 80 percent of what children learn is through visual processing of information, undetected vision problems can severely impact a child’s cognitive development. Early detection and treatment of vision problems are key to preventing permanent vision loss in children.

The Vision Council’s report examines the importance of early detection of vision problems for children and provides detailed information on states laws. Since the report was first issued in 2005, 14 states have enacted or enhanced laws regarding vision assessment for school-age children. “Many states are recognizing the critical connection between vision and learning,” said Ed Greene, CEO of The Vision Council.

Key findings include:
– Nine states do not require children to receive a vision assessment before starting school;
– Thirty-nine states (including D.C.) require a vision screening for children entering school; however 32 of these states do not mandate any follow-up care for children who fail the screening; and
– Three states require all children to receive a comprehensive eye exam by an eye care professional before entering elementary school.

While the report finds that many states are enhancing their requirements for vision assessments, most do not include provisions for adequate follow-up care.

Undetected vision problems can affect a child’s cognitive, emotional, neurologic and physical development by potentially limiting the kinds of information the child is exposed to and impacting performance in extracurricular activities like music and sports.

The warning signs of potential vision problems include:

– Squinting, closing or covering one eye
– Holding materials close to the face
– Tilting the head to one side
– Rubbing eyes repeatedly
– One or both eye turn in or out
– Redness or tearing in eyes.

To view the report and an interactive map of the country, showing current vision assessment requirements, visit http://www.thevisioncouncil.org/.

Source: The Vision Council


Choosing a More Appropriate Route of Administration for Fast Acting Pain Relief Could be the key to Improvement

The first results of the first European survey of cancer patients’ experience of breakthrough pain[1] were presented today at the 6th congress of the European Federation of Chapters of the International Association for the Study of Pain (EFIC).

Previous surveys have looked at the overall management of pain in cancer patients but this is the first international study to look in detail at Breakthrough Cancer Pain (BTCP) from a patient perspective.

These results for the first 200 patients from the UK, Sweden and Denmark offer valuable insight into cancer patients’ experiences with breakthrough pain management and the impact of the condition on their daily lives.

- On average each patient had 3 episodes of BTCP per day
- Each episode had an average duration of 60 minutes
- 96% of the pain episodes were described as moderate to severe
- For 87% of patients their BTCP interfered with their daily living including their ability to sleep, walk and get on with other people

“The study documents that breakthrough pain has a significant impact on cancer patients’ daily lives,” explained Dr. Andrew Davies, Department of Palliative Medicine, Royal Marsden Hospital, UK and the principal investigator of this survey. “Breakthrough pain is very different to background pain. Background pain is a continuous, chronic pain requiring around-the-clock medication. Breakthrough pain is a fast onset, short duration, intense pain that breaks through the chronic pain even when this is being controlled with medication. It is incapacitating and very distressing to the patient.”

For this kind of pain episode the ideal treatment would be fast acting with short duration of action to most closely match the nature of BTCP episodes.

Moreover, it must be easy to use to improve patient compliance. However, the results of the survey show that:

- 98% of patients were using orally administered drugs
- The time to first noticing a reduction in pain was on average 20 minutes
- The time to knowing that the pain medication was really making a difference was on average 30 minutes or half way through the typical  BTCP episode observed in this survey

“Oral opioids are still commonly used to manage BTCP despite the fact that the way these drugs work does not match the characteristics of a BTCP episode. Opioids given by other routes, for example intranasal, have significant advantages over oral opioids and the interim results from this survey suggest that these routes would be suitable for and welcomed by the majority of cancer patients with breakthrough pain,” said Dr. Andrew Davies.

The European Survey of Breakthrough Cancer Pain is continuing to recruit patients in Germany and Ireland and will expand into Austria, Belgium, Czech Republic, Finland, France, Greece, the Netherlands, Norway, Portugal, Spain and Switzerland to provide health care professionals across Europe with patient insights on the management of breakthrough cancer pain.

Source: Nycomed


The mind games smokers play when trying to quit revealed in new survey

  • Author: Health Informer
  • Filed under: Health News
  • Date: Sep 8,2009

New NiQuitin(R) Pre-Quit(TM) Lozenges Launched To Help Smokers Address Their Internal Struggle By Easing Into Quitting

New research results, which delve into the mind of smokers, are launched today, lifting the veil of nicotine addiction to understand the thoughts, anxieties and fears of the British smoker. The study, conducted on behalf of NiQuitin, shows that even smokers who are keen to kick the habit are torn between the benefits of giving up and the allure of cigarettes. Of the 66% who said they wanted to quit but hadn’t set a date, 61% then went on to say that they enjoyed smoking and part of them didn’t want to quit, highlighting the inner conflict of smokers.

The Government are investing heavily in smoking cessation services and educating smokers about the benefits of quitting smoking. However, we need to do more to help people find the best way to quit with or without Nicotine Replacement Therapy (NRT). Of those smokers who had tried and failed to quit before, only 53% had tried to do so with the support of NRT. Many don’t realise that they are twice as likely to quit smoking with NRT compared to willpower alone; so using NRT with their own commitment could lead to a more successful quit attempt.

Some experts believe that the problem lies in people not understanding enough about the psychology behind their dependency. Gay Sutherland, Research Psychologist at the National Addiction Centre, Kings College Hospital comments, “Most smokers imagine wanting to give up smoking but many do not take action and this is because they are not in the right mind set to quit. Understanding their specific relationship with cigarettes will help the smoker find the best way to quit for them and is more likely to result in a successful quit.”

Almost two thirds (61%) of British smokers were afraid of giving up all of their cigarettes at once and over a third (36%) said they had failed to quit before because their cravings were too strong to resist. Understanding that giving up all cigarettes at once can be a daunting experience for many smokers, NiQuitin has launched new Pre-Quit Lozenges to help these quitters. NiQuitin Pre-Quit Lozenges have a unique short-term, structured reduction programme that can help smokers to cut down the number of cigarettes they smoke before stopping completely, on a pre-determined quit date.

Smokers follow the NiQuitin Pre-Quit programme for a period of between two to six weeks, first cutting out the easiest cigarettes, and then the harder in the run-up to a target quit date. Cutting down before quitting can help people build the confidence they need before their final quit date. Three quarters (74%) of those surveyed said they would be likely to try something that helped them to quit gradually, and with NiQuitin Pre-Quit they can.

Reinforcing the need for help and support, the study revealed that almost two thirds (59%) of British smokers have attempted to quit at least twice or more. Of those who had tried to quit before 44% said that nothing they had tried helped in times of stress, with women’s results much higher at 53%. When it came to the reasons behind previous failed attempts men tended to be influenced more by alcohol than women (24% to 16% respectively), whereas both sexes agreed that lack of willpower (48%) was also a strong factor.

As many smokers will realise, smoking is a habit as well as an addiction and there are always those cigarettes that are harder to give up than others. The NiQuitin survey showed that it is difficult to break from routine – a quarter of those surveyed said that the most difficult cigarettes to give up would be, either after they woke up (25%) or after meals (26%).

For the younger smokers surveyed the cigarettes smoked whilst socialising would prove most difficult to give up – whilst for the older smoker it was the one after mealtimes that would be the hardest. NiQuitin understands that even if you want to quit gradually not all smokers are the same and the Pre-Quit short-term, structured reduction programme allows people to choose which cigarettes to cut out first, followed by those that are hardest in the run up to the agreed quit date.”

To provide support for all smokers, NiQuitin have also developed a Step by Step Guide, “Quit Smoking Your Way”, to help smokers understand the psychology behind their habits and dependency better, and identify ways to help them quit smoking. The guide can be downloaded from http://www.Click2Quitguide.com, where quitters can also receive a tailored quit plan as well as ongoing support via e-mail or text message and discover the myths and truths about nicotine.

NiQuitin Pre-Quit 4 mg Lozenges are available in packs of 36: RSP GBP8.03 available from most pharmacies and supermarkets nationwide.

NiQuitin appreciates that different quitters will have different needs during key points of their quit journey and have developed a range of products and support services to help at each point.

All figures, unless otherwise stated, are from YouGov Plc. Total sample size was 1214 adults. Fieldwork was undertaken between 23rd – 27th February 2009. The survey was carried out online. The figures have been weighted and are representative of all GB adults (aged 18+).

Notes:

If you smoke, receptors in your brain can become dependent on nicotine, and it is these ‘nicotine-hungry’ receptors that can cause you to crave cigarettes when you try to quit. NiQuitin replaces the nicotine from cigarettes with therapeutic nicotine to help deal with the cravings. This allows you to concentrate on changing your habits. By using a Step-Down Programme, you reduce the amount of nicotine until you no longer need any.

Source: GlaxoSmithKline


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