Pain Matters - Dr Kevin Markham

Suffering from chronic or persistent pain can be one of life’s more unpleasant experiences and is often associated with profound social, psychological and debilitating consequences.

It is estimated that 14 million people in England alone have a chronic pain complaint and that of these individuals one in four said that their pain had kept them from their usual activities, 41% of people are unable to work because of their pain and a further 13% have had to reduce their hours. Controlling pain therefore should be not only a humanitarian priority, but a socio-economic one also.

Any discussion on pain needs to begin with one or two definitions. Perhaps the most appropriate place to start therefore is to define pain itself. It is important to realise that pain is a human expression of an unpleasant experience and in this sense it can be physical, psychological or even spiritual.

Sometimes it is a combination of these factors. The way we perceive and report pain has a number of important influences, some are poorly understood such as genetic determinants of pain and others such as cultural influences are a little more obvious (some countries in Europe report twice as much pain per individual as others!).

Pain is usually divided into two types depending on its duration.

Acute pain is defined as any report of pain up to three months. As such, simple injuries which resolve within that time period are described as acute and for most soft tissue injuries resolution occurs within three months. In an evolutionary sense acute pain developed is nature’s way of warning us of impending injury. A good example of this would be the way in which we withdraw from a noxious stimulus such as heat, which would cause burns and tissue damage if we placed our hands within it.

Chronic pain is a rather different phenomenon. It is defined as any form of pain that lasts greater than three months and is usually considered to be a “dysfunction” of the sensory nervous system in tandem with some form of peripheral injury.

A very good example of this is lower back pain which can occur on a chronic basis secondary to a pathological process in the spine such as an acute disc prolapse. Not infrequently this acute injury becomes chronic largely due to sensitisation of the nervous system which instead of blocking pain out, tends to promote its transmission to the higher centres in the brain.

The history of managing pain in a modern sense is a relatively short one in comparison to most other specialities in medicine. Having said this, opiate drugs such as morphine were used in Egyptian times and electrical techniques of pain relief which have become so prevalent in modern pain management were first described as early as 79AD when an electric shock from a stingray was used in an attempt to cure the pain from a neuropathic ulcer.

Modern day pain clinics only really developed post-World War II in America and most English pain clinics came into being in the early to late 1990s. There have been enormous strides more recently in the pain relief world in terms of our understandings of the mechanisms of pain, our means of investigation and treatments.

At Spire Clare Park Hospital we have a dedicated team of professionals with a common approach to assisting people suffering from chronic pain. Given the fact that chronic pain is complex, we work in a multidisciplinary fashion addressing all of the dimensions of chronic pain. This means that we are able to treat physical elements of pain, psychological sequelae and help with social issues as well as providing an excellent and specialised rehabilitation service delivered by a physiotherapy team.

We utilise standard investigation techniques on site such as MRI and CT scan and have access to cutting-edge technology including nuclear medicine. As such, more often than not we are able to determine the cause for a pain and treat accordingly.

Treatment too is focused on a multimodal approach. Pain relief techniques can include physical treatments such as nerve blocks, acupuncture and instruction in the use of devices such as TENS machine. Every patient has rationalisation of their drug regime to maximise beneficial effects and reduce the incidence of adverse effects. Intervening to treat chronic pain can be very effective.

In a recent national pain audit, published in 2012, 76% of patients who attended a pain clinic achieved improvements in their pain-related quality of life. At Spire Clare Park Hospital we recognise that curing pain is perhaps an unachievable objective but major improvements in pain levels and quality of life are possible with our treatment programme.

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