• - Chronic pain sufferers report being dismissed by doctors, missing out on effective, multi-disciplinary treatments.
• - A survey found a 75% shortfall in practising pain specialists, with only the equivalent of 13.8 specialists working fulltime.
• - Experts say recent advances in understanding pain highlight the need for better training for doctors.

By Ruth Hill of RNZ

Hopeless case. “It’s all in your head.” It’s a “suicide disease”.

These are some of the things chronic pain sufferers have been told over the years - and are still being told.

Pain specialists say many chronic conditions previously considered “hopeless cases” can now be treated.

However, a huge lack of understanding - even within the medical profession - means patients are missing out on potentially life-changing treatment.

Christchurch-based pain physician Dr Christopher Rumball said chronic pain affects every part of the life of those afflicted: their relationships, education, career, earning potential and general enjoyment.

“There’s a [phrase], which has been used in the past, which is ‘pain is the cancer of the soul’.

“It’s a really difficult thing for individuals, and then there’s the cost to the system - often they may present to emergency departments, GPs, outpatients, attending other specialists, often getting interventions or more investigations.”

Rumball, who chairs the New Zealand committee of the Faculty of Pain Medicine, said chronic pain was best treated by a multi-disciplinary team of physiotherapists, occupational therapists and psychologists, as well as doctors and nurses.

Yet both the public and private systems were largely focused on acute interventions - pills and surgery.

A survey by the Pain Society earlier this year found a 75% shortfall in practising pain specialists, with the equivalent of just 13.8 fulltime specialists working in either the public or private sectors.

Invercargill nursing student Ella Dixon - who has had a long recovery from Complex Regional Pain Syndrome (CRPS) following a rugby accident as a young teenager - travels to Christchurch to see Rumball.

“Sometimes with pain, you actually need that in-patient whole multidisciplinary team to come together - your physio, your OT, your doctors - which you don’t get if you’re at home,” she said.

Recovery possible, say specialists

Paediatric pain specialist Paul Vroegop said children who were treated for CRPS had “a 99% recovery rate”.

“People do actually recover, whereas it used to be seen as a dead-end, nobody will ever recover, hideous ‘suicide disease’ kind of thing.”

Unfortunately, many doctors did not know how to recognise or manage chronic pain, he said.

“Chronic pain does not fit at all into the biomedical belief system ... so a lot of the people we see in specialist pain services get the kind of message that, ‘Oh, your pain is all in your head’, or, ‘All you need to do is relax and do cognitive behavioural therapy and your pain will go away’, which is just bullsh**.”

Psychological therapy did have a major role to play in treating chronic pain, but that whole-team approach - everyone working to a plan - was the key to recovery, he said.

Treatment involves understanding what is causing the pain, how the brain is responding to those signals, how that affects someone’s function and what could be changed to lessen symptoms or restore function.

Doctors not ‘up to date’

The Pain Society’s incoming president, Dr Karen Joseph, said big advances in the understanding of pain have only happened in the last decade.

“When I went through medical school, we really knew so little about pain, and what we were taught had really not moved much further forward than the 17th century.

“So I don’t think it’s that people who aren’t specialised in this area don’t want to help their patients, but I think they’re just not really aware and up to date with the modern science of pain, which actually looks at things really differently.”

Taranaki-based pain physician Yvonne Murray said they were “usually the last” specialists to see a patient.

“They’ve seen the neurologist, the surgeon, they might have had several operations and several investigations, and finally someone says, ‘Oh well, let’s send them to the pain specialist’.

“And by then it’s really entrenched patterns and changes in their nervous system that are really difficult to make improvements on.”

If doctors knew how to identify early on those people at risk, there was so much that could be done to stop pain becoming chronic.

Health New Zealand - Te Whatu Ora said patients in areas without dedicated pain specialists could be referred to those services in other regions, supported by multi-disciplinary teams.

A plan to better co-ordinate services was still in the early stages of development, it said.

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