Treating chronic pain as a disease in its own right

A conference being held in Dublin this week will focus on chronic pain as ‘a disease in its own right’

Most people and even most doctors have trouble understanding pain as being anything other than a symptom of an illness. It was always understood that pain was a manifestation of an underlying condition and not a condition in itself.

That notion is slowly changing as doctors come to realise that chronic pain, mostly located in the lower back, is a medical condition itself. Other forms of chronic pain can be headaches lapsing into migraine, pains in the bones and pains in the stomach. It is a function of a poorly designed nervous system.

The classification of chronic pain as a disease in its own right is the theme of a conference taking place Thursday-Saturday in the Convention Centre Dublin. Entitled Chronic Pain – A disease in its own right and a major healthcare problem, it amounts to an attempt by specialists to raise awareness among the public about the status of chronic pain as a condition.

Traditional approaches to medicine do not categorise persistent pain as a disease. It was believed that chronic pain was an unavoidable consequence of trauma and various illnesses.

An organisation called the International Association for the Study of Pain has defined pain as an “unpleasant sensory and emotional experience associated with actual or potential tissue damage or described of in terms of such damage”. Even then there are 500 types of chronic pain and no two patients suffer in a similar fashion.

Calls to action

Pain is not currently recognised as a disease in Ireland, changing this will be one of the main calls to action.

Among the speakers at the conference is world-renowned Australian pain specialist Prof Michael Cousins. He will give the keynote Francis Rynd lecture on Thursday named after the Irish doctor who invented the intravenous needle.

He played the key role in the recognition by the Australian government of pain medicine as an independent medical specialty in 2005. Australia is regarded as a world leader in pain management. He has pioneered the use of an electronic stimulator close to the spine which disrupts damaged nerves sending signals to the brain. In a recent interview, Cousins said chronic pain was “a disease in its own right and the basis of it is the sensitisation of the nervous system by fairly complex mechanisms”.

When he started out in the late 1960s, he maintained that only 10 per cent of people with chronic pain could be treated effectively; that ratio is now up to 80 per cent, but the 20 per cent are still relatively helpless.

Part of the problem in dealing with the issue of chronic pain is the different ways people experience pain. He says there is an “enormous variation in pain appearance for the same noxious stimulus”. He succinctly says that acute pain “is a symptom, but chronic pain is an illness”.

“When it becomes chronic, things change. Then it becomes a disease because the nervous system changes and becomes sensitive in the spinal chord and brain,” he says.

A recent international study estimated that almost one in five Europeans has some form of chronic pain and the bill is in the order of €300 billion a year. A compendium of Irish international studies found that 13 per cent of the adult population have some form of unresolved chronic pain, yet there is an average two-year wait for diagnosis.

The Department of Social and Family Affairs estimates that lower back pain accounts for €350 million in annual disability payments.

Early treatment

Doctors maintain that a lot of the long-term consequences of pain could be avoided if patients were treated early. They say that a national clinical pain programme would facilitate an integrated approach which would allow pain to be treated in the most efficient fashion from the beginning.

In 2010 a European Parliament report argued that by treating pain with the same significance as other major conditions and making systems for delivering pain management more efficient, patients and member states can be assured of better outcomes and cost savings.

Organiser Dr Camillus Power, a consultant anaesthetist and director of the Ulysses Programme at Tallaght hospital, said the theme was chosen because of Ireland’s European Union presidency.

“Given the economic difficulties of the country we also felt that a chronic disease that affects 13 per cent of the population and costs the taxpayer over €4 billion per year demands a fresh look, especially since it has been left out of the national clinical care programmes and currently has no one in charge of policy nor service at a national level.” he says. “We feel that the reason for this omission is that the condition does not exist as a disease in its own right despite being a major healthcare problem.”