In our pleasure-driven society, chronic pain has emerged as a challenging medical problem, the annual Merriman Summer School in Lisdoonvarna, Co Clare, has heard.
Dr Camillus Power, consultant pain physician at the Tallaght Hospital in Dublin, in a paper entitled "Pain and the Whole Person", said the immediate research challenge was to generate epidemiological chronic pain data for the Irish population.
As a society, we spend approximately £500,000 a week on back pain disability alone and Scandinavian figures indicate that if a man is out of work for 12 weeks because of pain, the probability of his returning to work that year is less than 9 per cent.
Apart from the economic costs of keeping someone out of work for years, there are the hidden costs of paying for the family and significant others who live under the stress of a loved one suffering without any end in sight. "It takes its toll and is often exacerbated by the long duration of the medicolegal process if litigation is involved," Dr Power added.
"One of the great debates in pain research is the question where is the pain located. Is the pain in the body or in the mind? Sometimes, regional anaesthesia can nicely solve this dilemma by the application of a pain block using local anaesthetics which switch off the pain in full consciousness, demonstrating to the patient that wherever the location of the pain in the system, there is a space between the observer (subject) and the pain (object). We can try and recapture this space when we teach relaxation/distraction techniques on pain-management programmes," Dr Power said.
He added that some doctors, the interventionists, believed that the pain signal could be switched off or modulated; whereas rehabilitation doctors believed in abandoning the attempt to solve the pain problem and sought instead to address quality of life issues that accompany pain, such as inactivity, and mood and sleep disturbance.
Such a dualistic approach was no longer useful, and integrated models to explain a range of chronic diseases that could not be neatly categorised as purely physical phenomena were needed, Dr Power said.
Traditional medicine, he added, could provide innovative concepts about disease processes which were worthy of further investigation. One example was the Ayurveda, the traditional medicine of India, which held the real problem was neither the chronic pain nor the associated depression. Of particular interest in this approach was the belief that in chronic disease, the abnormal cognitive and behavioural derangement ought to be corrected before specific intervention.
This was in contrast to the modern approach which put rehabilitation at the end of the intervention process. Dr Power added that at the Tallaght Hospital, a new behavioural pain-management programme, called the Ulysses project, was aimed at "capturing the spirit of adventure that launches us into a journey to unearth holistic treatment that respects the achievement of modern science and yet demands that the altered biology is seen in the context of correcting the lifestyle that sustains the pathological process".
Prof Cecily Kelleher, Professor of Health Promotion at UCC, said Ireland had a relatively poor health status when compared to other European Union states, and Irish migrants had more adverse health outcomes in the countries to which they migrated.
Given the changing socioeconomic profile of the State and the increasing resemblance to area-based patterns of deprivation in urbanised areas seen more typically in Britain, there was an onus to address the issues. In the main, while indicators such as education, employment status, tenure and social class all revealed differences in health status, the single best predicator of ill health was possession of a medical card.
International evidence suggested preventive services are either not availed of or not available to those most in need.
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