Thursday, August 21, 2008

'Pain treatment is a human right … We should be able to guarantee it to anyone' - News

Pain treatment is a human right … We should be able to guarantee it to anyone'

Tristan Stewart-Robertson talks to Prof Michael Bond about how to bridge the divide between the West and the developing world

YOU trip over a rock, falling to the ground and landing on your knee. You cry out in pain and look for comfort, but you are alone and there is no doctor or nurse for hundreds of miles. The superficial injury heals, but pain persists and there is no treatment for years to come.

This scenario, common in the developing world, is far removed from that experienced in more developed countries, and this divide between levels of pain treatment available around the planet is a major theme of a conference being held in Glasgow this week.

Thousands of scientists, doctors, nurses, dentists, pharmacists and patients have descended on the city for the 12th World Congress on Pain, one of the biggest conferences set for Scotland this year, with about 6,000 delegates expected to attend.

One of the major concerns for pain experts in recent years has been bridging the global divide in pain research and treatment, and getting training and support for pain relief to remote and less-developed regions.

Sir Michael Bond, emeritus professor of psychological medicine at Glasgow University, is one of the organisers of the congress and a former president of the International Association for the Study of Pain (IASP), the body that awarded the biennial event to Glasgow.

He was instrumental in turning the attention of the IASP beyond the western world, and now argues that the developing world must continue to be a prime focus.

"The IASP had always had limited programmes for people in developing countries," says Prof Bond. "But it became clear to me and others that the developing countries were falling behind the western world.

"We started a clinical programme for training people in the actual practical management of pain. We now try to ask people to set up the programmes in their own countries for a bottom-up application.

"Bringing people to the West would be costly and teach them things that are not necessarily applicable."

The so-called "brain drain" of trained practitioners from developing countries particularly to the US and Australia, is also a considerable problem.

Prof Bond admits the West takes the "best people" but the IASP scheme aims to keep the knowledge local, and health care professionals – mostly doctors – have already benefited from the programme's work in Mongolia, Laos, Thailand, Indonesia, Bangladesh and Vietnam. 

There are also programmes in Nigeria, Kenya and South Africa, but in other African countries there are huge gaps in care, says Prof Bond.

It is here where the IASP's goals differ from those of groups such as Médecins Sans Frontières and Douleurs Sans Frontières which offer immediate relief. The IASP's approach is a long-term aim to ensure more services are available in developing countries, he says.

"There are gross differences that exist in care. As an international organisation, we had a responsibility," says Prof Bond. "Pain treatment is a human right, and that comes up quite a lot in discussions. We should be able to guarantee pain treatment to anyone."

Pain in the developing world will be just one topic at this week's congress. Topics for other sessions include: stress and chronic pain; pain and suffering following torture; traumatic nerve injury and treating pain caused by cancer therapy.

Prof Bond explains that pain is now thought of on a biological-psychological social model: the physical causes of pain, the chronic affect of pain on an individual, and the way society addresses that pain.

He says there can be emotional causes of pain, and even the memory of a past pain can cause physical symptoms, which often present difficulties for doctors seeking the specific source of a patient's complaint.

Prof Bond's own work started with studies of women with advanced cancer of the cervix in the 1960s, and research continues today identifying how unique an individual's experience of pain can be, from the genetic level to the emotional and the social contexts in which they live.

For example, a rugby player's injury might not cause much stress, whereas a cancer patient could experience high levels of fear and anxiety. Both would be affected differently by the pain, and express it differently to care professionals.

Prof Bond says those fears must be dispelled, both through practical treatment and how the care is provided. And he hopes the congress will send out a message to the public that pain treatment is a serious issue being addressed on every level, from the cellular to societal attitudes as a whole.

"On a professional level this conference will bring as many people as possible together to share ideas, get new information and go back home charged up to improve their research and clinical practices.

"We want to alert the local population and beyond to the impact of good pain management. Most people think of cancer and cancer pain as the main area we know more about now than 20-30 years ago. It has improved immensely, but so has treatment of other pains. We still face difficulties and we want the public to know this is a live and active topic."

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