Treat pain more aggressively, experts insist

[Guest guest]



Treat pain more aggressively, experts insist



Oct 28, 2005



Gandey



Ottawa, ON - " If you take nothing else away from this, take this one

idea: Pain is like a noxious weed, " Toronto-based patient advocate

Seton told doctors and officials at the Bone and Joint

Decade World Network Conference here in Ottawa [1]. " I challenge you

in your strategy work today and in your offices thereafter to treat

pain early and aggressively—before it takes root. " Experts

presenting at this session including Dr Henry, research

director for the DeGroote Centre for Research and Care in Central and

Thalamic pain at McMaster University in Hamilton, ON, said that

chronic pain should be thought of as a disease in itself rather than

as a symptom secondary to a condition. He and others warned that as

professionals continue to inadequately treat this complex sensory and

emotional experience, long-term neurosensory damage is taking root.

" One of the main messages is that chronic pain is a very complex

medical and health issue and to see it in simplistic terms does a

disservice to people who live with this disease, " Henry told

rheumawire. " It was mentioned in one of the sessions this morning

that many healthcare professionals prefer to turn their backs on

chronic pain because the issues are so insurmountable, compensation

isn't there, and there's a certain frustration level where

professionals would prefer to care for people they feel they can do

something for. " Henry says there is no question it takes longer to

see someone with chronic pain and this can be a real disincentive.

" Pain is a soup, " Dr Mailis-Gagnon, director of pain services

at a University of Toronto-affiliated hospital said during an

animated presentation. " It is a complex soup involving biology,

psychology, and the socio-environment. " She explained that treating

pain is a multifaceted process that should encompass a variety of

therapies.

Pain is complex, its treatment can be wide-ranging, and may include:

Pharmacologic options

Psychotherapy

Physiotherapy

Invasive procedures



Henry noted that chronic pain is a disorder of the nervous system. He

emphasized that prolonged synaptic input changes the phenotype of

sensory fibers and central neurones—alterations that are brought

about by glutamate and substance P.

After living with persistent pain for 12 years, Seton says she is an

example of a life shattered by the physical, emotional, and social

costs of this problem. Following a car accident, Seton describes nine

years of " wandering the silos of medicine " with little relief. She

speaks of drugs that didn't work, healthcare professionals that

didn't " get it, " a process of demoralizing ping ponging between

physicians and psychiatrists, and patronizing labels that contributed

to the downward spiral of her once-productive life. In addition to

her personal health and wellbeing, Seton points out that her career

and her family were affected by chronic pain. She says that she has

begun to find relief in a multidisciplinary pain clinic where a

variety of specialists oversee her care. " My body is regarded as an

interconnected whole and for the first time, I have partners in a

process I control. "

Henry says it's not uncommon for patients to feel this way. " A lot of

people who suffer from chronic pain look pretty normal. If you have a

disfigured hand, it's obvious that you require medical care. With

pain, it can sometimes be hard to convince others you are living with

a chronic disability. " He added that this tends to be further

complicated by the fact that many pain patients have a variety of

comorbidies including other pain conditions.

Types of pain

Nociceptive—pain from injured bones, muscles, ligaments, skin, and

so forth

Nociceptive visceral—pain from the heart, kidneys, bladder and so on

Neuropathic—pain from injury of the nerves, spinal cord, or brain.



Henry told rheumawire that healthcare professionals need to spend

more time with chronic pain patients and they should consider

approaching them with a varied team of specialists all working

together to help move patients forward. But he acknowledges that

funding has been a problem. " There are pain clinics in Canada with

waiting lists of three years. To live with chronic pain for three

years is an inordinate task and it's an unfair burden to place on

these people, " Henry said. " Money is being cut and the compensation

just isn't there. This is one of the reasons that pain services are

less today than they were three and five and ten years ago. "

Mailis-Gagnon adds that inadequate pain management education is also

an important factor and medical schools are going to have to improve

their curriculum to address this largely unmet need. " My patients

taught me what my medical schools never said. "