Understanding pain and what healthcare professionals can do
As healthcare professionals, we are all too familiar with the debilitating effects of pain on our patients' quality of life. Whether acute or chronic, pain can be a challenge to manage effectively. Fortunately, advancements in pain management have led to a better understanding of pain and its mechanisms, and have improved the overall effectiveness of treatments.
One expert who has dedicated her career to this field is Dr. Andrea Furlan, an Associate Professor in the Department of Medicine at the University of Toronto and a Staff Physician and Senior Scientist at the Toronto Rehabilitation Institute. Dr. Furlan was the team leader for the development of the Canadian Opioid Guideline, and she is now involved with Guideline's National Faculty in the dissemination and implementation of the guideline across Canada.
I interviewed Dr. Furlan recently for Friendly Pharmacy 5 and we were able to discuss some of the major misunderstandings and challenges that we still face when treating patients who struggle with chronic pain. For example, we know that pain can be categorized as acute or chronic, and the treatment strategies for each differ. In the interview, Dr. Furlan explains that pain can be further categorized as nociceptive, neuropathic, or nociplastic. Nociceptive pain is the pain we are all familiar with, being caused by tissue damage or inflammation, whereas neuropathic pain is caused by damage or malfunction of the nerves. Nociplastic pain, however, is pain that persists without any clear evidence of tissue damage, and is due to a malfunction of the pain system. This type of pain is commonly present in patients with fibromyalgia, complex regional pain syndrome type 1, and irritable bowel. Dr. Furlan went on to explain the importance of a proper diagnosis of nociplastic pain as this type of pain typically responds poorly to medications but does respond very well to mind-body therapies and deprescribing.
When it comes to medication, Dr. Furlan stressed the importance of appropriate use and how under-treating acute pain can sometimes cause increased sensitization of the pain system, and that this approach can also have long term consequences . She also illustrated what a successful opioid taper should look like and how patients need to be on side for a successful taper to occur.
What you may not know is that Dr. Furlan now has her own YouTube channel where she teaches patients how to live better with chronic pain (an incredible resource to point your patients to) and her book “8 Steps to Conquer Chronic Pain” is now available for pre-order and is scheduled to be released in mid-April.
I really learned a lot from this interview and it is my hope that this easy-to-understand interview with Dr. Furlan will be a great resource for both healthcare professionals and patients who suffer from chronic pain.
