SECOND OPINION:Ignoring the issue is costing the State billions
THE LACK of awareness and understanding of chronic pain (CP) in Ireland is creating a huge burden in humanitarian, economic and healthcare terms. Tens of thousands of people live with persistent pain. These people face the added burden of widespread ignorance of CP, both in the healthcare system and in the community at large.
CP involves changes in the neuroplasticity of the central nervous system. It is not the same as acute pain (AP), which is a symptom of disease or injury, a warning signal that something is wrong and needs medical attention. This signal normally shuts off when the tissue damage has healed usually within three months.
Pain that lasts beyond three months, which is no longer a symptom of disease or injury, is CP. Untreated acute pain may become CP, though 42 per cent of sufferers cited in the recently published Prime study could not explain the origins of their pain.
Because we all experience acute pain, it is not surprising many people are perplexed when the feeling persists for a long time. The same confusion undoubtedly applies to family, friends, colleagues, employers and healthcare professionals often giving rise to accusations that the person is malingering, imagining their symptoms or faking it.
In the Pain Proposalreport launched recently 42 per cent of people with CP felt their pain was doubted. Not being believed makes sufferers feel isolated, lonely and helpless. This also has a profound effect on them. It is estimated 13 per cent of the population has CP and 25 per cent of those have pain at a moderate to severe level causing them disability.
I have lived with CP for 14 years, the first seven of which were a nightmare. Most of the time, the pain was unbearable. I felt I was going out of my mind and didn’t know where to get help. Finally I was referred to a pain specialist. It took four years, many X-rays, MRI scans, CAT scans, blood tests, pills, tablets, complementary therapies, self-doubt, expense and disbelief that a modern healthcare system couldn’t care for me.
I didn’t fit in anywhere and my career was over. This was compounded by my own inability to come to terms with the ongoing pain and my perceived inability to “snap out of it” and “get on with it”. I resisted accepting that there was no cure. Accepting the true state of affairs required a lot of support and a moderation in the pain intensity. This avoidance behaviour blocked my pain management. How can you solve a problem if you don’t acknowledge there is one?
I know from my many years working as a volunteer with Chronic Pain Ireland, speaking to people on our phone line and at our self-management workshops that my narrative is shared by many. No one wants to be in pain, people are desperate for relief yet only one in six CP sufferers is referred to a pain specialist and there is an average wait of two years for a first consultation – three for the Galway pain clinic.
So what issues need to be addressed? First, the problem must be recognised. CP needs to be seen as a disease and a health priority. Pain Proposal estimates CP costs the State €2.5 billion annually. In an Australian report entitled The High Cost of Pain, it was estimated that applying evidence-based treatments could halve the cost of CP to the Australian economy.
Second, early diagnosis and treatment is imperative. Many GPs have received little training in the diagnosis and treatment of CP, but 89 per cent surveyed for the Pain Proposal report said they would welcome such training.
Third, pain medicine needs to be made a medical speciality with the appointment of additional pain specialists. Best practice in pain management often requires a multi-
disciplinary approach and access to such programmes needs to be improved.
Fourth, a National Pain Strategy must be developed involving all stakeholders with the aim of improving the assessment and treatment of pain here. Finally, support for research into the epidemiology and societal impact of pain is needed. How many more lives must be shattered because of inaction?
Gina Plunkett is chairwoman of Chronic Pain Ireland