Friday, September 03, 2010

Efforts to battle chronic pain found lacking - The Globe and Mail

Chronic pain is a disease in itself and proper treatment a human right, doctor says

Some 80 per cent of people around the world who suffer from chronic pain can't get the treatment they need and governments must step up their efforts to tackle the issue, says Michael Cousins, an Australian anesthetist and the driving force behind the first International Pain Summit.

Fixing the problem would entail changing the curriculum in medical schools, co-ordinating between physicians to better treat chronic conditions and getting the word out to pain sufferers that there are alternatives to drugs, Dr. Cousins said.

Earlier this year, he had a hand in drafting a national pain management strategy for Australia - the first in the world - and the summit, which takes place in Montreal on Friday, will draw up guidelines to help other countries follow suit. As health professionals, academics and researchers gathered for the summit, Dr. Cousins told The Globe and Mail that chronic pain must be considered a disease in itself, that there is an enormous economic cost to not dealing with the problem, and that proper treatment is a human right.

Q: You say the vast majority of people who suffer from chronic pain can't get the treatment they need. Can you give us a sense of what's causing the problem?

A: If you wanted to characterize this era of health care, it's the fiscal era. It's one where the most important considerations are financial. There aren't any resources - it's as simple as that. A lot of my research over the last five years has been to measure the scale of the problem [of pain]. In my country, one in five people suffer from chronic pain. It costs $34-billion per annum. That's in health-care costs, lost work days and the entire economic burden of the disease.

Q: Often people think of pain simply as a symptom of illness, but you characterize chronic pain as a disease in its own right. Can you explain?

A: There are changes in the spine, pathophysiological changes [associated with pain]. There are extreme neuroplasticity changes in the brain for people with chronic pain. Catherine Bushnell at McGill has done extensive neuroimaging work showing a loss of brain tissue associated with chronic pain. It's my contention that sufferers are being discriminated against because they're being denied access to treatment for their chronic disease.

Q: What do governments around the world need to do to address the problem?

A: First, you need epidemiological research: You want to know what the magnitude of the problem is in your country. The second is pain education. It's got to start at the undergraduate level. All primary care doctors need to have more training in pain medicine. All countries also need to have physicians who specialize in pain. We're also recommending that the population be educated. The general public needs to know that they have access to all forms of treatment.

Q: Is a lack of access to medication also part of the problem?

A: With the new knowledge of the mechanisms of pain, there are now drugs being developed that target the causes of the problem. Most patients have the idea that taking a pill is the only option and that's completely untrue. [There are] things like cognitive behavioural therapy, physiotherapy.

Q: How do you make sure the recommendations on pain management that come out of the summit are adopted?

A: There are two approaches available. One is to go to governments and get them to work on that. In Montreal, there will be a high official from the U.K., a senior Canadian health official, the deputy health minister of Malaysia and a high-ranking official from Portugal will all be there. The second is to try to empower the general community, tell them that they have the right to effective pain medicine. I've spoken with human-rights organizations and human-rights lawyers, too.

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