How to deal with chronic aches and pain

by Nicky Pellegrino / 14 July, 2017

Photo/Getty Images

When chronic aches can’t be dulled with drugs, the pain clinic may offer relief.

Controlling pain isn’t always as simple as popping a pill. About a fifth of people suffer from chronic pain that is far more challenging to treat.

Any pain that lasts longer than three months is considered chronic. When it persists for a long time, it inevitably affects a person’s ability to lead a normal life.

“It’s not uncommon for people with chronic pain to lose their jobs and end up in financial difficulty,” says Auckland pain-medicine specialist Tipu Aamir. “People have limited or no social life, and it can break up relationships.”

Not surprisingly, up to 80% of those with chronic pain develop depression or anxiety, and a significant number become dependent on alcohol or prescription medication.

Neuropathic (nerve) pain is particularly difficult to treat, because there are no effective drugs. The condition is usually caused by an underlying disease or injury – one of the more common causes is diabetes, but anything from a fracture to a stroke can result in nerve damage, leading to ongoing pain.

“Pain is like a security system,” says Aamir. “The body is full of millions of sensors whose job it is to keep scanning for damage and trigger an electrical signal that travels through the nerves up the spinal cord to the brain, which interprets the information.”

When the nerves are damaged, they can start sending signals without the sensors telling them to. Over a period of time, this lays down memories of pain, creating cellular changes inside the spinal column and the brain.

“These changes are complex and varied, and our drugs are not sophisticated enough to undo them. It’s like trying to repair a computer with a hammer.”

Commonly used medicines such as gabapentin and amitriptyline can cause drowsiness, which in older people leads to an increased risk of falling and resultant fractures. And they don’t actually do much for the pain – Aamir says only a third of patients will get a 30% reduction.

Although medical cannabis has been touted as a potential treatment, he warns that it may not work any better than the drugs already in use, and it also has potential side effects. “Cannabis needs to prove it’s going to be helpful. It needs proper research, just like any other drug.”

Relying on medication isn’t necessarily the best response to pain, in his view. In the US, overdose deaths involving prescription opioids have quadrupled since 1999. “We don’t want to repeat the same mistake here.”

The modern way to deal with pain is a tailored treatment plan that uses several different approaches. The Auckland Regional Pain Service (Tarps) has a team that includes anaesthetists, occupational therapists, psychiatrists and physiotherapists. Patients start with a half-day holistic assessment, and then the various practitioners meet to discuss the best way to manage their case.

“We start to look at pain as a pie with lots of different segments,” says Aamir. “We work with these people in areas where we can make a difference. It’s very individual and might be a combination of medication, physical therapy and some psychological input.”

In some cases, patients are invited to complete a three-week intensive pain-management programme, and their progress is then monitored for a year. “At the end of the year, about two-thirds are doing better than patients who haven’t done the programme,” says Aamir. “They have reduced their medication, are less depressed and have returned to some form of work.”

Such treatment is expensive – the intensive course can cost up to $6000 – but it’s still cheaper than surgery. ACC and benefit payments can bring down the price to the patient.

But pain treatment is under-resourced. There aren’t enough specialists in the country, says Aamir, who has been lobbying for more funding. He estimates that we need almost double the number we have.

Pain is a problem for the elderly in particular, but a programme for the over-seventies had to be cut by Tarps when a staff member left and there wasn’t the funding to continue with it. And although there are pain clinics of varying sizes throughout the country, only two big centres, Auckland and Christchurch, are able to offer the three-week intensive course.

As the population ages, the numbers suffering chronic pain are likely to rise. Aamir plans to keep on lobbying for more help for them.

“Once pain has set in for years, it doesn’t matter what started it – the end effect is that it has an impact on life.”

This article was first published in the July 1, 2017 issue of the New Zealand Listener.


MostReadArticlesCollectionWidget - Most Read - Used in articles
AdvertModule - Advert - M-Rec / Halfpage

Latest

Cartoonist Tom Scott on the art of a good skewering
84198 2018-01-24 00:00:00Z Profiles

Cartoonist Tom Scott on the art of a good skewerin…

by Joanna Wane

Cartoonist and writer Tom Scott’s memoir is soaked in all the pathos and black humour of his Irish roots.

Read more
The Shape of Water – movie review
86244 2018-01-24 00:00:00Z Movies

The Shape of Water – movie review

by James Robins

It’s brilliantly directed and acted, but there’s something fishy about the romance.

Read more
When New Zealand shipped its criminals to Australia
86182 2018-01-24 00:00:00Z Books

When New Zealand shipped its criminals to Australi…

by Nicholas Reid

For 10 years, New Zealand “cleansed” the colony by transporting criminals to an Australian island.

Read more
Should mental health experts speak out about Donald Trump?
86030 2018-01-24 00:00:00Z Psychology

Should mental health experts speak out about Donal…

by Marc Wilson

Psychology professor Marc Wilson assesses whether mental-health experts have an ethical obligation to speak out about the Don.

Read more
The Midnight Line by Lee Child – book review
86240 2018-01-23 15:20:32Z Books

The Midnight Line by Lee Child – book review

by Peter Calder

Jack Reacher joins the war on drugs in a sloppy and sludgy new thriller by Lee Child.

Read more
Doing the sums for retirement brings on the uh-oh moment
85840 2018-01-23 00:00:00Z Social issues

Doing the sums for retirement brings on the uh-oh …

by Bill Ralston

I had always assumed my retirement would be something like I was doing then, lying in the sun, drinking beer and reading books, writes Bill Ralston.

Read more
What Jacinda's baby announcement has done for Kiwi working mums
86153 2018-01-23 00:00:00Z Social issues

What Jacinda's baby announcement has done for Kiwi…

by Genevieve O’Halloran

If the Prime Minister can’t make this full-time working motherhood gig work, frankly, what hope is there for the rest of us?

Read more
How Titanic Live became a near-religious experience for singer Clara Sanabras
86138 2018-01-23 00:00:00Z Music

How Titanic Live became a near-religious experienc…

by James Belfield

The titanic, Oscar-winning hit song gets another lease of life in a stage presentation.

Read more