Managing chronic pain transcript

I’m James Elander, Professor of Health Psychology at the University of Derby. I’ve been involved in several research projects over the last 10 to 15 years that all focus on helping people with painful chronic illnesses to manage their pain better and achieve a better quality of life.

In many medical conditions, pain can be overlooked in treatment as it’s regarded as a lower priority by the healthcare providers. Some of my work has concentrated on educating health professionals about best practice in pain management and about the acute suffering experienced by patients with either haemophilia or sickle cell disease (SCD).

Since 2006, I’ve led interdisciplinary studies investigating how haemophilia patients cope with the agony of severe chronic joint pain. From this we’ve drawn the first evidence about pain acceptance among people with haemophilia, and we’ve shaped pain management programmes in the UK and US and we produced and evaluated a DVD guide to self-managing chronic joint pain for people with haemophilia that has featured in top-ranked journals and is sought-after all over Europe.

This work has had direct impact on the best practices promoted by US bodies like the National Hemophilia Foundation and the Medical and it’s Scientific Advisory Councils Pain Initiative.

With sickle cell disease we wanted to address a trend where patients were being stigmatised as ‘drug-seeking’, and denied strong pain relief because of the health care providers concerns about addition to pain medication, especially around the time of the opioid epidemic. We carried out a major psychometric exercise to find a new method for measuring patient satisfaction with hospital treatment for pain and we conducted research that informed guidance for prescribing methadone. In many hospital services, our research led to a fundamental rethink in clinical practice, also in staff training and pain management evaluation.

Our findings now underpin best practice at leading institutions from Barts Health NHS Trust in London to John Hopkins University School of Medicine in Baltimore. We’ve helped to refine both the NHS standards for management of adults with Sickle Cell Disease, and the US government guidelines on treating Sickle Cell Disease patients in Medicare.

Looking at prescription drug use, we spent time understanding how people with chronic pain can become addicted to their pain medication, and this research provided the basis for guidance issued by the Department of Health and Human Services in the US on how care providers can identify the difference between addiction and pseudo-addiction, and how to manage chronic pain in the context of substance use disorders.

All of our projects start by talking with people affected by these problems and then by working with groups from doctors to patient organisations. This also includes healthcare students, and students have played a big role in several areas of our research.

We’re now pursuing further research in partnership with NHS Multidisciplinary Pain Services to explore what affects the success of treatment for chronic back pain. Our work on pain medication addiction also continues in collaboration with the Royal Derby Hospital, and another project with the same hospital is focused on developing better support for people receiving renal haemodialysis.