Breaking the pain barrierby Margo White
A holistic approach to pain management is bringing some real relief.
A new pain treatment programme introduced this year at the University of Auckland’s School of Medicine will, for the first time, teach medical undergraduates about pain treatment from a multidisciplinary perspective. Rather than being only made up of doctors, the teaching team will include nurses, psychologists, occupational therapists and physiotherapists.
The programme reflects the growing understanding that pain is a complex experience involving the physiological, neurological and emotional systems, which any treatment needs to take into account. “Now we understand the nervous system better and the different pain pathways involved, we need different types of management,” says Dr Linda Huggins, the pain specialist who has led the programme. “There are lot of different things that can cause pain, or make it worse. We need to treat people from different points of view, not just by giving them drugs.”
There are also many different types of pain. Acute pain is generally constructive – it tells us to remove our hand from a hot element before we burn ourselves, for instance. Chronic pain – the kind that goes on and on – is more complicated and more destructive.
Data from the 2006/07 New Zealand Health Survey shows that one in six New Zealanders suffer from chronic pain. According to Professor Ted Shipton, clinical director of the Pain Management Centre for the Canterbury District Health Board, too many New Zealanders are suffering unnecessarily. “I think it’s a silent epidemic. It’s undiscovered and certainly under-treated.”
Chronic pain can be put down to a number of causes, such as a disease or disorder, but some people suffer chronic pain without any obvious injury or damage. Shipton points to those who trace back their chronic pain to surgery. The acute pain after surgery generally goes away, but in 2-10% of cases it can persist and become chronic. This can be catastrophic.
“It starts to impact on the nervous system, on the individual’s mental health, and then it starts to impact on the people around the sufferers, like family.” Moreover, anxiety, stress, depression, fatigue – often caused by chronic pain – can decrease the body’s production of natural painkillers and make matters worse.
It’s not clear why acute post-operative pain sometimes becomes chronic, but Shipton says certain groups are most at risk; young females, people who have chronic pain before an operation (which is unrelated to the surgery), people inclined to depression and anxiety and poorly educated people from lower socio-economic groups. Risk is also related to the surgery itself, how invasive or traumatic it is and whether any nerve damage is caused.
In the not-so-distant but less-enlightened past, chronic pain that couldn’t be pinned down to an obvious injury would have been dismissed as being in a patient’s head. This is no longer the case, but as Shipton points out, “no brain no pain”.
“Pain is a perceived response, and you perceive it in your brain. But what happens is that the nervous system in the periphery gets worked up, and that excites the nervous system in the spinal cord, which eventually excites the brain. So we get all these changes. We can now map these changes [on brain scans] … and follow things as we treat them and see how they resolve.”
Thousands of New Zealanders could be saved an awful lot of pain if those at risk of post-operative chronic pain were identified and treated earlier, to interrupt those processes that allow acute pain to persist. “The problem is we’re not seeing these people until it’s too late,” says Shipton.
Pain management and treatment is a rapidly developing medical discipline, he says, but it is also short of funding, resources and specialists working in the area. “This is a problem throughout the world; access to pain management is quite limited. This needs to be addressed in the next few years. The population is getting older, people are living longer, joints are getting more degenerate. It makes no sense.”
Greater access to pain management would save the public health service, and the economy, millions of dollars. It would also save people a lot of unnecessary distress. “It’s the suffering you want to prevent, and the chaos that goes with it.”
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Scientists at the University of Technology Sydney, in collaboration with New Zealand company Comvita, have compared the antibacterial effects of manuka, kanuka and clover honeys on four types of bacteria commonly found in chronic wounds and found that manuka honey was the best. The researchers said the key to manuka honey was its chemical complexity, so those honeys synthetically altered to include methylglyoxal (MGO), which is present in high concentrations in manuka honey, were not as good as the real thing.
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