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Feature

Quick Look: Pain

Posted on: 31 Mar 09

Summary

For some patients, namely those suffering from terminal illness, pain relief is an issue that talks to them about the right to end their lives in relative comfort and dignity. In such situations, new kinds of research that attack the complications and side effects of high level pain killers – such as opium based pain relievers – are particularly pertinent.

For some patients, namely those suffering from terminal illness, pain relief is an issue that talks to them about the right to end their lives in relative comfort and dignity. In such situations, new kinds of research that attack the complications and side effects of high level pain killers – such as opium based pain relievers – are particularly pertinent. This article by the Medical Center at The University of Chicago describes important research back from 2000, where Professor Chun-Su Yua and his team made important strikes towards tackling the problems caused by opium-based painkillers for terminal cancer patients. In testing a new drug designed to tackle such side effects, a 'double-blind, placebo controlled study' confirmed methylnaltrexone's ability to counter opium-induced constipation and critically, to do so without producing any further side effects itself. 'In more than 90 percent of patients, relief came within one minute of the first infusion'. Such research could, as the study's author explains '...enhance the quality of the last months of life for terminal cancer patients'. To those patients suffering from terminal illnesses, these kinds of studies provide not only the most obvious benefits of further pain relief, but in addition, the right to die with self-respect and solemnity.

In other cases, and particularly for those individuals suffering from bouts of 'chronic pain' in their day-to-day lives, progressive pain relief is something that can provide the difference between unbearable pain on a daily basis, often provoking other complaints such as poor concentration, disturbed sleeping patterns and even depression, and the right to move and operate with relative normality and effectiveness. Whilst this is something that troubles people the world over, a recent report released by Professor Sir Liam Donaldson, the UK's top medical officer, argues that patients in Britain are particularly suffering, especially emphasising the lack of specialist clinics to tackle prolonged suffering. Yet, far from making the argument purely on the basis of compassion, Professor Donaldson also stressed the wider benefits to society that such progress would bring. Not only would fitter, healthier Brits have less reason to claim expansive incapacity benefits, but they would also be more productive in the workplace and generally, happier, more effective members of society. Commenting on the range of new treatments and techniques available, Donaldson commented that: “Modern pain services are much more broadly based. They focus not just on pain-killing injections but what techniques, including psychological techniques, can help people cope with pain” Adding that “They also look at the functional limitations of pain – people's inability to work, sleeplessness, anxiety, depression and lots of other things that are stopping people functioning as human beings”.

For those individuals suffering from problems with chronic pain on a daily basis, such reports offer both a sense of progression from inside the medical community and a realisation that pain relief is not only something that should be afforded to terminally ill patients, but also to those individuals that suffer from ceaseless pain over years of their everyday lives. This interesting review of an autobiographical take on chronic pain is well worth a look - courtesy of the pages of the Wall Street Journal.

Also of relevance are several new studies that have sought to assess the value of 'pain teams' and a more comprehensive approach to chronic pain relief. The structural makeup of such collaborative-care groups would include not only primary physicians, but also full-time psychologists and other experts employed to tackle not only the root source of the pain, but also the list of common side effects including complaints like depression and post-traumatic stress disorder. In one such study for the Journal of the American Medical Association, Dr. Steven K. Dobscha, of Portland VA Medical Center in Oregon particularly praised the potential benefits of such an approach. By looking at 401 people with an average age of 61 or 62 who were in pain for at least three months, Dr. Dobscha was able to show that not only did those patients under the supervision of 'pain teams' have an average of around 10 or 11 meetings with members of their medical teams across the year (far more than those without such a plan), but they also experienced 'modest but measurable declines in their pain-related disability, and were less depressed too'. Indeed, whilst part of the aim of such teams is to draw up a comprehensive and individually suited treatment plan for the patient in question, the secondary goal is simply to provide the necessary encouragement and impetus to get the patient back on their feet. To help them return to their everyday lives and to offer reassurance as to the cause of the pain they are experiencing; reducing anxiety and stress levels for those most vulnerable. For many people, this kind of support can be just as valuable – particularly to those patients for whom potentially risky surgery isn't an option and for reasons of cost and doubtful effectiveness, technologies for pain isolation, such as high-tech imaging, are equally unrealistic.

As the very same CNN article notes: 'Up to 15 percent of the U.S. population have chronic pain, and as many as five percent have pain so persistent that they need heavy-hitting painkillers, known as opioids, just to get through the day'. And yet, whether you are a patient suffering from chronic pain on a daily basis, or one of the infinitely more unfortunate individuals suffering from a terminal illness, pain relief can become one of the most taxing, most mentally consuming aspects of your life. Fortunately, it seems that there is also a growing awareness of this reality from within the medical community and reports such as Professor Donaldson's further emphasise the point. Long may the trend continue.
 

Max Golby

Last updated on: 27/08/2010 11:40:18

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