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Forward by the President of the Irish Pain Society Dr Ray Victory
Chronic pain, pain that persists longer than three months, is a very prevalent problem and it has very predictable effects on patient’s lives. Recent studies have demonstrated that 13% of the population of the Irish population suffer from persistent pain and many of these patients follow a pattern of disability and depression. It is estimated that the annual cost due to chronic pain is about 2 billion in Ireland. Despite the huge cost to our country training in Pain Medicine is very limited at undergraduate level. Many medical and surgical treatments can lead to chronic pain and yet there is very little done to prevent it or warn patients about it. Practitioners working in the area of Pain Medicine are trying to lobby the appropriate authorities to have this illness of Chronic Pain recognised as a disease in its own right. Because Ireland holds the Presidency of the European Union this year it would be an appropriate time to move forwards and establish recognition of chronic pain as a disease in its own right and develop a plan to improve prevention and treatment of this illness. It would also be imperative that the Medical Council recognise Pain Medicine as a Specialty and that undergraduate medical training in this area is improved.
The Irish Pain Society is the Irish Chapter of the International Association for the Study of Pain (IASP) and is a multidisciplinary group of practitioners, which promotes education, training and research in pain. The Irish Pain Society believes that every individual suffering from a chronic pain condition has the right to access appropriate information for the better understanding of pain. The Society has promoted research in Ireland which has helped identify the effect pain has had from a socio-economic point of view.
Apart from the ethical and humanistic aspect of this problem pain produces a huge socio-economic impact on society. Chronic pain has detrimental effects on physical and mental health, daily activities, family relationships, employment, and economic well being of the sufferers and family caregivers. A significant number of these patients do not work because of the pain. The link between pain and disability is now well established in very large studies and also prevention and effective treatment of pain are important in order to reduce the incidence of early retirement due to disability. It is estimated that there is an increased cost of about 2 billion per year in Ireland because of chronic pain. From these studies it is clear we would save money by developing a national strategy to treat pain at an early stage before it has become complex and difficult to treat.
I believe the pain services in Ireland are quite piece-meal and are being exacerbated by reduced hospital budgets. There are pain clinics in many hospitals around the country but access to these has become more limited. There is very limited access to multidisciplinary Pain Management Programs, which take a holistic approach to pain and provide input from many services including Physiotherapy, Psychology, and Occupational therapy etc. Access has been limited further in the last year as hospital services in major centres are limiting access to patients from their catchment area. This might be reasonable if Pain Programs were available in many geographical locations but they are not.
Medicine has always focused more on medical conditions that can be seen, where a clear diagnosis can be made and an effective treatment delivered. There has traditionally been less interest in poorly understood conditions such as persistent pain where effect on patients is difficult to measure and treatments are frequently complex. Many of the patients with persistent pain have been cured of some disease but left with on-going pain and disability. Until the 1970’s very little was known about the pain mechanisms in the body. In recent years there has been an explosion of knowledge in this area. There have been great advances in medications for various types of pain and the technology behind neurostimulator implants has improved greatly.
The Irish Pain Society and other medical groups have proposed that chronic pain is a disease in its own right. Pain produces physical and emotional changes in the patient leading to disability and frequently depression just like many other chronic diseases. It is therefore important that official bodies such as the Department of Health and the Medical Council recognise chronic pain as a disease and those treating it as members of a separate specialty. We need to recognise chronic pain for what it is, a specific medical condition and to promote and recognise the training and research in this challenging area. Organisations such as the Faculty of Pain Medicine at the College of Anaesthetists in Ireland, An Bord Altranais, the Irish Pain Society and patient support groups such as Chronic Pain Ireland and Arthritis Ireland need to work together with the Minister of Health on this issue. In this way we can help to set up more Pain Centres that would provide quick access to chronic pain treatments which would actually save the country money in the long run.
Doctors working in General Practice have many sources of guidelines on the management of chronic pain problems. A good place to start is the American Pain Society website (www.ampainsoc.org ) which provides a comprehensive guide on treatments of common pain problems and what sort of problems need to be referred on to Pain Centres. There are some guidelines on medications for various types of pain and what sort of patients need to be referred for interventional pain procedures or a pain management program.
The Irish Pain Society is running a meeting in the Radisson Hotel in Dublin on 2nd November 2013 for all practitioners who deal with pain problems ( details on www.irishpaincociety.com). The focus of this meeting will be on “Visceral pain” and will involve many international experts, from neuroscientists to clinicians, who specialise in this area.
