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Interview with Dr. Pedro Branquinho on the National Day Against Pain

20 de October, 2023

On October 20th, the National Day Against Pain is celebrated. Pedro Branquinho, an anesthesiologist and head of the pain clinic at CNS – Neurological Campus, explained how pain can be present in neurological diseases and the importance of being followed by a specialist for the quality of life of patients.

Can you highlight the relationship between chronic pain and neurological diseases?

Pedro Branquinho (PB) – Chronic pain (persistent pain lasting more than 3 months) affects between 20 and 40% of patients with primary neurological disorders and can seriously contribute to decreasing their quality of life. The diagnosis and approach to the neurological disease should be accompanied by the treatment of pain symptoms to avoid chronicity.

What are the most common types of pain associated with neurological diseases?

PB – Pain can be classified as neuropathic, when originating from the nervous system (central or peripheral), or nociceptive, when associated with damage to other organs.

Depending on the type of neurological disease, one or the other, or sometimes both types of pain can be found. For example, in diseases like Multiple Sclerosis or after a Stroke (CVA), central neuropathic pain can exist, while in movement disorders like Parkinson’s Disease, the pain present is more associated with muscle and joint inflammation or muscle spasms.

When should one consider scheduling a pain consultation?

PB – When faced with complaints of long-lasting pain that compromise daily life activities and do not improve despite the use of usual pain medication.

What is the role of a pain specialist and how can they help manage painful conditions?

PB – All doctors are familiar with conventional pain medication. However, when faced with intense pain despite the instituted medication, the action of the pain specialist allows for a comprehensive assessment of the pain syndrome to establish a treatment plan tailored to the patient. From this moment on, pain management is done by the pain specialist through a multidisciplinary approach, assessing the need for therapeutic escalation and performing analgesic techniques if indicated.

What non-pharmacological treatment options are available to deal with pain in patients with neurological diseases? Are there pain prevention strategies that patients can adopt?

PB – We can treat chronic pain through drugs or minimally invasive techniques, but it’s important to complement with other types of approaches, such as psychological support, physiotherapy, or lifestyle changes (for example, opting for a healthier and balanced diet and regular physical activity). Only in this way can chronic pain be addressed in all its facets and expect more consistent improvement of complaints.

What are the most common challenges faced by patients with neurological diseases regarding pain? How can pain treatment in neurological diseases improve the patient’s quality of life?

PB – Pain treatment in patients with neurological diseases becomes challenging due to the complexity of its diagnosis and the difficulty in finding effective treatment. The patient’s comorbidities, associated with the need for multiple drugs, can complicate or limit the doctor’s approach to pain treatment. With early pain assessment and intervention, it is possible to alleviate complaints and potentially improve the patient’s quality of life.

What resources are available to support patients in managing pain related to neurological diseases?

PB – At CNS, we have a multidisciplinary team with various medical specialties, nurses, and therapists, working to ensure the best support for patients in distress. In specific situations, performing percutaneous techniques with the help of ultrasound complements the doctor’s action and can enhance relief of complaints.

What message would you like to leave on this National Day Against Pain?

PB – Chronic pain is present in more than a third of the Portuguese population and is widespread in medical practice. It should be valued and diagnosed in order to start the best treatment as early as possible, minimizing its impact, and improving the patient’s quality of life.