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