Clinical management
Are you asking about childhood trauma in patients with fibromyalgia and chronic pain?
Childhood trauma and traumatic events during adulthood have been linked to fibromyalgia and chronic pain. If childhood adversity is identified, patients can benefit from focused therapies.
WiseGP Action:
1. Sensitively discuss the links between traumatic events and pain with patients who present with chronic pain or fibromyalgia. Signpost those affected to focused therapy, highlighting the potential benefits this would have on their pain.
Read more about the research informing these recommendations here:
https://bjgp.org/content/72/720/332
Optimism and support with self-management strategies to help people with pain-related distress
Low mood and distress are common in people with persistent musculoskeletal pain. Exploration of how a patient feels about the future, acceptance, supported by optimism and creation of a new identity and support with self-management strategies can all help.
WiseGP actions:
1. Reflect on whether you differentiate between low mood and distress in people with chronic pain. In people with suspected distress, explore their feelings about the future, encourage optimism and support them to develop management strategies.
Read more about the research informing these recommendations here: https://bjgp.org/content/early/2022/08/08/BJGP.2022.0120
Cannabis-based medicines reduce pain but are linked to multiple adverse effects
A review of meta-analyses of randomised controlled trials (RCTs) and observational studies looked at the risks and benefits of cannabis use.
In people with chronic pain, cannabis-based medicines or cannabinoids reduced pain by 30% but increased psychological distress.
Meta-analysis of RCTs in mixed conditions, supported by high to moderate certainty, showed cannabis-based medicines increased adverse events related to vision and the central nervous system, psychological adverse effects and somnolence. Whilst some had improved nausea and vomiting, others experienced gastrointestinal side-effects. Benefits for pain and spasticity were noted.
WiseGP Actions:
Do you know how to advise patients who inform you they are taking cannabis-based medicines/ cannabinoids for their chronic pain? Consider sharing this research evidence with your practice team at a clinical meeting so they can inform patients of the potential harms to balance against benefits of these drugs- particularly consider the risks in people with comorbid mental health problems.
Have a look at our other GEM sharing wider information on cannabis risks to inform your future practice.
Read more about the research informing this GEM here: https://www.bmj.com/content/382/bmj-2022-072348
