This issue collates three diverse topics that all directly relate to our pain clinical practice. Estelle Barker and Lance McCracken explored the staff experiences of changing from a traditional cognitive behavioural therapy (CBT) model to an acceptance and commitment model. The survey used both quantitative and qualitative questioning and identified that staff were positive about their level of engagement in the change of model, experienced some discomfort and uncertainty coupled with discord and group cohesion. The quantitative aspects of the survey revealed a lack of clarity that one model was superior to the other, but that progress was positive and that staff experienced benefits.
This article demonstrates how exploring staff experience of a change in working practices can make them reflect on past and current processes and enable them to be more aware of the positive role that they had in contributing to these processes.
Commonly, I overhear prescribers suggesting to patients that if they have neuropathic pain why not try some low-dose amitriptyline as it can enhance sleep. Miqdad Bohra and colleagues explore the relationship between pharmacological agents used in the management of chronic non-malignant pain and the effect these medicines have upon sleep. This relationship has never been described fully, and this article uses an accessible approach so that readers can understand the architecture and physiology of sleep. Much has been described about the ‘hygiene of sleep’, but there is a dearth of communiqués about the impact of analgesic and other medicines on patients’ sleep patterns and their effect on the individual patient’s pain experience. This review has reminded me of the sometimes negative impact that tricyclic antidepressants (TCAs) can have on sleep, but I have learnt that non-steroidal anti-inflammatory drugs (NSAIDs) can be considered to be sleep neutral.
For those of us who have contributed to the soon to be published systematic review of pain assessment in older people undertaken jointly by the British Geriatric Society and the British Pain Society, the finding of Rachael Docking’s cross sectional study of over 1100, 75+ year olds in Cambridge might come as a surprise. This well-designed study reports no correlation between the level of cognitive impairment and the reporting of back pain (BP). The authors suggest that as cognitive impairment increases, there is not an adequate explanation for age-related decline in self-reported non-disabling BP.
In other words, as your cognition declines, non-disabling BP reduces. What we have learnt from undertaking the review of assessment is that pain should be assessed in all older populations and that a lack of patient self-report or the presence of cognitive impairment should not impact upon the actual performance of a structured pain assessment. Nor the frequency with which this is undertaken.
Felicia Cox
Editor