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Tuesday, 28 April 2015

Uncertainty at the British Pain Society conference in Glasgow, April 2015

Another Premier Inn for Athula and Carolyn, but right opposite the conference centre, and blue skies heralded the start of the conference. 

The Pat Wall Lecture, given by Prof Andrew Rice was excellent (reminding me of my days in Physiology, and the ‘gate theory of Melzack and Wall’). Our parallel session ‘Dealing with Diagnostic Uncertainty’ attracted good numbers, and a mixed audience of clinicians (pain specialists, psychologists, rheumatologists, physiotherapists) and academics (including Andrew Moore who is now at Bristol working with Rachel Gooberman-Hill).
Tamar Pincus did a wonderful job of chairing the session, and engaging with the audience who politely listened to our presentations, but did not hold back in their questioning (at times quite challenging). 

Danijela Serbic (one of Tamar’s former PhD students from Royal Holloway) presented results of her PhD studies, emphasizing the guilt people with chronic low back pain may feel as they struggle to obtain a satisfactory diagnostic label.

Carolyn spoke from the ‘swamp’ of general practice, offering a taxonomy of approaches which GPs may use to deal with complex patients, where there is uncertainty in their presentation. Athula reported on his work in Sri Lanka, using metaphors to convey the principles of CBT.

We hope we gave a good account of ourselves, and the RI, certainly the discussion lasted well in lunch (which, incidentally was very good!). We are already planning a workshop for next year’s conference in Harrogate.

By Carolyn Chew-Graham and Athula Sumathipala

Wednesday, 1 April 2015

Alternatives to paracetamol for managing osteoarthritis

Professors Christian Mallen and Elaine Hay have an editorial published in the BMJ today (Mallen & Hay 2015) discussing the importance of non pharmacological treatments in light of the publication on the potential adverse effects of paracetamol for low back pain and osteoarthritis (OA) (Machado et al 2015). Professor Mallen also added on BBC Health that treatment choices other than drugs should be the "cornerstone" of managing these health conditions.

Our research studies on exercise (Uthman et al 2013) for knee and hip OA and joint protection for hand OA (Dziedzic et al 2015; RACGP guidance) support the benefit of such approaches in osteoarthritis. Christine Walker, a former trial participant and now member of our Research Users Group added, "My daily life with hand osteoarthritis has improved dramatically after being shown, on the SMOOTH study trial, some new ways to perform everyday tasks. I was told about some inexpensive gadgets that helped me around the house. For me taking regular simple exercise for the osteoarthritis in other areas of my body is far more effective than taking a pill.” 

Another publication (Roberts et al 2014) had previously described the safety considerations for paracetamol from observational studies.

Managing OA is a combination of pharmacological and non pharmacological approaches. Core treatments (written information, exercise & weight loss if overweight) should be offered to all irrespective of age, comorbidity and severity. Exercise and Topical NSAIDs can provide pain relief for those with OA. Such approaches may reduce the need for paracetamol.