Module 2 - SURG0134  - has introduced us to Acute Pain. Personally, and I think this will be a recurring theme throughout this degree, it was a fairly steep learning curve. The module began with the physiology and pharmacology relating to acute pain. Some of the content I last read many years ago, so although challenging, I have really enjoyed re-visiting the neuro-physiology and this time I feel I have gained a deeper understanding of it!

I have no prescribing experience, and at this stage of the osteopathic profession, we cannot learn independent prescribing. I therefore only had some knowledge of commonly prescribed pain medications when I began this module. I also don’t work in a hospital environment, so some of the medications mentioned I only know about from being on the receiving end as a patient. 
The analgesic ladder is a great tool, it clarifies how one makes the most appropriate patient-centred decision when choosing a drug for the patient peri and post-operatively or relief of chronic symptoms. It can also be applied in reverse when helping patients wean off from the stronger opioids. Given the risks versus benefits, potential interactions, side effects and the patient’s history, it’s vital to tailor the treatment appropriately. It isn’t a ‘one size fits all tool, some pain presentations are very complex, and strict adherence to the ladder may not completely apply, but I feel that it is a great starting point.
If I ever do get the opportunity to learn to prescribe, I feel that I’m now slightly ahead of the curve, at least with opiates, non-opiates and anti-inflammatories.
I feel in my practice I’m better able to explain to my patients what their drugs are for and how they work. For patients who are about to have surgery, I’ve been better equipped to answer their questions as to what’s likely to happen to them, for example, what to expect when they are about to undergo joint replacement surgery.

The underpinning of the mechanisms behind it all, the spinothalamic tract and the Dorsal Column Medial Lemniscus (DCML) in particular – how amazing are they? So simple, and yet so, so complicated! That said, I just find it utterly amazing how we’ve evolved to be fully equipped (to a point) to have our own built-in pharmacy. I can’t say I’ve fully committed to memory (yet) all the specialised receptors in our nerve endings for our endogenous opiates, but certainly, the µ (mu) receptor seems to be significant concerning analgesia, as it is the primary receptor for our beta-endorphins and enkephalins - the naturally occurring chemicals which are partly responsible for our body’s response to pain, as well as exogenous opioids - the ones we introduce through pharmacology with drugs such as Fentanyl, Codeine and Morphine. Once bound to the receptor, the action potential is reduced or halted, so the transmission of the pain signal is subdued or prevented.

The treatment of acute pain to prevent chronic pain is a common theme throughout my studies so far. At the time of writing, I am slightly behind where I wanted to be in the module, but I can say that I am looking forward to learning more about patient management where the normally established protocols do not work or are less effective.
In my clinic, I will be seeing a patient shortly who I know is a double lower limb amputee – it will be interesting to discuss things such as phantom limb pain from his perspective (if he wants to, of course) and apply it with the course material.

When I’m working with my patients, my hands are the tools of my trade. As I work with my patient’s anatomy, I visualise the structures beneath my hands – it’s kind of a hodgepodge of cadaver specimens, Netter’s anatomical drawings and live surgery I’ve observed in the past. I find that I’m now overlying this image with the ‘schematics’ of the pain pathways ie I’m visualising the primary and secondary neurons, ‘seeing’ where they decussate in the cord before entering the brain.
From speaking to my patients, they’ve either described their pain or I have observed signs of it in their demeanours, in how they move their body, so potential stoicism and other barriers aside, I am perhaps more perceptive to the emotional aspect of their pain as well as the physical.
Does this help my practice? I’m not sure I could say in real terms yes, but I love the fact that what’s beneath my hands feels has somehow become more ‘real’.