Delegates to Irish Pain Society’s Annual Meeting Hear Lectures on Chronic, Postsurgical, Pediatric, and Breast Cancer Pain

Oct 16, 2017

The Irish Pain Society held its 17th Annual Scientific Meeting in August at the National University of Ireland, Galway. Outgoing President David Finn welcomed speakers and delegates to the beautiful NUI Galway Campus and thanked Science Foundation Ireland for grant support and meeting exhibitors for their generous sponsorship.

Dr. John McDonnell, consultant anesthetist at Galway University Hospital, demonstrated thoracic and
Dr. John McDonnell, consultant anesthetist at Galway University Hospital, demonstrated thoracic and abdominal wall blocks at the annual scientific meeting of the Irish Pain Society in August.

Finn then summarized activities of the society in terms of collaboration in research projects, presentations at international conferences, peer-reviewed publications, board memberships, and participation of Irish health-care professionals in field-testing of the new ICD-11 codes for diagnoses of categories of chronic pain. Finn also outlined the clinical and nonclinical medals, prizes, and bursaries now offered through the Irish Pain Society and thanked the sponsors.

Following were the key speakers at the conference:

Esther Pogatzki-Zahn of University Hospital in Muenster, Germany, discussed a study by Gerbershagen et al (2013) associated with the Quality Improvement in Postoperative Pain Management (QUIPS) registry that compared patient pain outcomes. The study found that although patients who had undergone major surgical procedures rated their worst pain as low, probably due to sufficient epidural analgesia and adherence to treatment pathways, many patients who had undergone minor to medium-level surgical procedures (particularly tonsillectomy, appendectomy, cholecystectomy, and haemorrhoidectomy) reported high worst-pain scores, as did patients following limb surgery. Pogatzki-Zahn said health-care professionals’ assumption that minor surgical procedures are less painful than major surgical procedures needs to be challenged.

Alison Twycross of London South Bank University outlined the status of pain management in children and aims for improvements. Many nurse fail to use long-available pediatric pain measurement tools, and their decision making may be guided less by pain assessment than by the child’s behavior. Studies show that if a child’s behavior matches their self-report of pain they are more likely to receive the correct, prescribed dose of analgesia. A vision for the future includes improved communication with the child and parent, listening to and validating the child’s postoperative pain experience, and encouraging the child to tell their parent or the nurse when they are in pain. Twycross said it should be made clear that pain is not an inevitable consequence of hospitalization.  

Patricia Lavand’homme of Catholic University of Louvain in Belgium stated that the PROMS (Patient Reported Outcome Measures), designed to assess the subjective impact of treatment interventions on patients’ quality of life, should help improve patient postoperative pain outcomes. Chronic postsurgical pain is experienced by at least 10% and sometimes up to 50% of the population. While chronic postsurgical pain may occur after any surgical procedure, some procedures carry a higher risk than others, and it is necessary to identify patients most at risk. Many patients are unaware that the procedure they will undergo carries a risk of chronic pain. Therefore, in order to prevent chronic postsurgical pain syndrome it is necessary to individualize patient treatments and care. It is particularly necessary to identify neuropathic pain early after surgery, to be aware of types of surgical procedures most frequently associated with postoperative neuropathic pain, and to have strategies and procedures that address patient risk factors.

Niamh Moloney of Thrive Physiotherapy in Guernsey discussed the complexity of pain profiles in women following treatment for breast cancer. Survival rates for Stage 1 breast cancer are now 90% at five years. However, side effects of breast cancer treatment can be severe and painful, reducing quality of life. Studies have attributed cause of pain variously to younger age, invasive surgical interventions, radiation therapy, high acute postoperative pain as well as psychosocial factors. For patients with persistent pain following breast cancer treatment, it is important to assess and exclude neuropathic pain and to address management of nociceptive pain with patient-centered stress-reduction interventions, such as graded exercises and relaxation techniques.

Rachael Powell of the University of Manchester, UK, showed that how a person thinks and feels before surgery affects their postsurgical pain experience. A fear-avoidant model of chronic pain explains how inactivity due to fear of experiencing pain on movement leads to loss of  muscle tone  and muscle strength and, along with anxiety and pain experience, reduces the threshold for further pain. Studies show that that it is necessary to reduce the number of psychological variables influencing negative emotions and cognitions, particularly anxiety. Powell referred to studies in which preoperative techniques, particularly relaxation and emotion focused techniques, help reduce patients’ pain and negative emotion. 

Irish Pain Society committee member Shelagh Wright, a retired lecturer, is author of Pain Management in Nursing Practice.

Photograph by Aengus McMahon Photography, Galway