New techniques for treating chronic pain, including headaches and neck pain arising from whiplash injuries, could bring relief to the estimated 10 per cent of Irish people who suffer from it.
It is defined as pain which persists longer than three months and does not respond to conventional treatment. It can result from a road traffic or industrial accident; post operative surgery, systemic diseases, and sports or stress-related injures - sometimes, it appears for no logical reason.
Addressing an international conference on pain management in Ennis, Co Clare, yesterday, Prof Patrick D. Wall of St Thomas's Hospital in London said the classical interpretation that pain came from peripheral tissue and sent a signal to the brain, much in the way a bell is rung, had proved to be "just too simple". His research, and that of other pain specialists, was concentrating on how that message moves from the tissue through the nervous system to the brain. "A lot of things affect it, and the brain itself is controlling the message."
This opened up many possibilities and helped explain why people manifest pain differently. These factors, including the circumstances in which people are injured and dealt with afterwards, had implications for complex therapy needed to treat the patient experiencing chronic pain.
For many patients, traditional therapy had not worked and they were naturally depressed and anxious about their condition - all of which must be taken into account in the special care needed for them, he said. Electrically stimulating nerves to control pain is being shown to be effective, Prof Wall said. Similarly, narcotics applied "locally" where pain occurs as with an epidural injection, for example, were successful and almost becoming standard practice.
Dr Susan Lord of Newcastle University, Australia, outlined how precise diagnosis of where neck pain is coming from is leading to improved therapy, particularly in the case of whiplash injuries. Pain most frequently occurs in a small joint at the side of the neck, known as the facet or "Z joint", and this is the single most common cause of neck pain and headache after whiplash.
With a series of three precise "pain block" injections administered with local anaesthetic under X-ray control, it is possible to confirm and source the pain. Treatment involves blocking the pain message carried in a nerve, by in effect "cooking" a small nerve linking the joint. This can give complete relief for up to nine months, while her latest research would show that repeat treatment was possible and effective.
Whiplash fraud was known to occur in a small number of cases, Dr Lord said, but her research team's improvement on the diagnostic technique ruled these out. "Unfortunately, due to fraud, many people who suffer terribly from neck pain get a bad name."
