{"id":29546,"date":"2021-02-14T20:40:25","date_gmt":"2021-02-14T20:40:25","guid":{"rendered":"https:\/\/wames.org.uk\/cms-english\/?p=29546"},"modified":"2021-02-14T20:40:25","modified_gmt":"2021-02-14T20:40:25","slug":"the-challenges-of-chronic-pain-fatigue-for-clinicians","status":"publish","type":"post","link":"https:\/\/wames.org.uk\/cms-english\/the-challenges-of-chronic-pain-fatigue-for-clinicians\/","title":{"rendered":"The challenges of chronic pain & fatigue [for clinicians]"},"content":{"rendered":"

The challenges of chronic pain and fatigue<\/a>, by Jessica A Eccles and Kevin A Davies in<\/span> Clin Med<\/em> January 2021 [doi.org\/10.7861\/clinmed.2020-1009]<\/h3>\n

 <\/p>\n

Review abstract:<\/strong><\/h3>\n

In this review, we explore the challenges of chronic pain and fatigue in clinical practice. Both pain and fatigue are common, troubling and frequently overlapping symptoms, and we describe both the clinical burden and the \u2018clinical problem\u2019. We explore commonly associated symptoms and possible pathological associations, including variant connective tissue (joint hypermobility), small fibre neuropathy, mast cell activation, dysregulated inflammatory and interoceptive processes, which may inform treatment targets. We suggest a multidisciplinary management approach.<\/p>\n

[The paper explores ME\/CFS, Fibromyalgia, POTs, Long COVID, Mast Cell Activation, Small fibre neuropathy, Joint hypermobility, IBS]<\/p>\n

Excerpt: <\/strong><\/h3>\n

\"\"Outpatient assessment of a patient with fatigue and chronic pain can be challenging. This is particularly the case when the patient is polysymptomatic and they have had many interactions with healthcare professionals before. It is all too easy to \u2018admit defeat\u2019 as in Dr A’s case, or initiate a test or another referral in \u2018response\u2019 to every symptom described by the patient during the course of their illness (Dr B). How can this be avoided?<\/p>\n

One approach is to adopt the \u2018snapshot\u2019 approach<\/strong> and ask the patient to identify a maximum of three \u2018live\u2019 clinical problems (eg in the previous 2 weeks), highlighting which is the most significant one. If the primary problem is fatigue or pain (as in our exemplar Patient A), it can be highly informative to identify the single most important additional symptom: the \u2018plus one\u2019 approach. This should raise a specific subset of diagnostic possibilities, often limited in number, which will prompt further, more focused \u2018direct\u2019 questioning, and may inform an initial investigation strategy, if considered appropriate.<\/p>\n

All physicians are trained to identify \u2018red flag\u2019 symptoms<\/strong>, such as unexplained weight loss, which, in older patients particularly, may point to a diagnosis of malignancy, malabsorption, endocrine disease or depression. However, there is a number of conditions that are frequently missed, and easily identified. Some of these are summarised in Table\u00a01. We focus on the \u2018plus one\u2019. The average time it takes to diagnose Beh\u00e7et’s, for example, may be up to 7 years and there is frequently a delay in the diagnosis of Sjogren’s syndrome; few doctors ask about\u00a0sicca.64<\/span>\u00a0Inflammatory bowel disease or endometriosis can also easily be missed, as can HIV, especially in older patients.65,66.<\/span><\/p>\n

What is rarely helpful or informative in a busy clinic setting is to rehearse in detail with a patient the detailed chronology of what may be several years of ill-health. This can all too often result in a \u2018memory test\u2019 for the patient, with the physician seeking to corroborate dates and details in the notes or electronic patient record. This wastes time, and can be frustrating for all concerned. However, it may be useful before, or more often after, the consultation to look back at previous letters, imaging or pathology results to help substantiate or refute a presumptive diagnosis.<\/p>\n

In patients with a \u2018long history\u2019 and multiple medical interactions, it is, however, important to avoid \u2018medical transference\u2019 and give undue credence to diagnoses made by other doctors, often years before. Firstly, the patient’s recollection of the outcome of a previous consultation may be far from accurate, and secondly, the professor may well have been wrong. It\u00a0does\u00a0happen.<\/p>\n","protected":false},"excerpt":{"rendered":"

The challenges of chronic pain and fatigue, by Jessica A Eccles and Kevin A Davies in Clin Med January 2021 [doi.org\/10.7861\/clinmed.2020-1009]   Review abstract: In this review, we explore the challenges of chronic pain and fatigue in clinical practice. Both … Continue reading →<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[1],"tags":[93,251,252,610,6487,6477,6196,2743,2744,331,6526],"class_list":["post-29546","post","type-post","status-publish","format-standard","hentry","category-news","tag-diagnosis","tag-fibromyalgia","tag-fm","tag-irritable-bowel-syndrome","tag-jessica-a-eccles","tag-kevin-a-davies","tag-long-covid","tag-mast-cell-activation-syndrome","tag-mcas","tag-pots","tag-small-fibre-neuropathy"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p5qkYK-7Gy","_links":{"self":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts\/29546","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/comments?post=29546"}],"version-history":[{"count":2,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts\/29546\/revisions"}],"predecessor-version":[{"id":29750,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts\/29546\/revisions\/29750"}],"wp:attachment":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/media?parent=29546"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/categories?post=29546"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/tags?post=29546"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}