Pain specialists say many chronic conditions previously considered "hopeless cases" can now be treated. Photo: MICROGEN IMAGES/SCIENCE PHOTO LI
- Chronic pain conditions previously considered "incurable" can now be treated
- Little understanding of chronic pain, even among general medical medical workforce
- Patients struggle to get help, feel lost and dismissed
- Health NZ says plan to better co-ordinate services "still in the early stages"
Hopeless case. "It's all in your head." It's a "suicide disease".
These are some of the things chronic pain sufferers have been told over the years - and are still being told.
Pain specialists say many chronic conditions previously considered "hopeless cases" can now be treated.
However, a huge lack of understanding - even within the medical profession - means patients are missing out on potentially life-changing treatment.
Christchurch-based pain physician Dr Christopher Rumball said chronic pain affected every part of someone's life: their relationships, education, career, earning potential and general enjoyment.
"There's a term, which has been used in the past, which is 'pain is the cancer of the soul'.
"It's a really difficult thing for individuals and then there's the cost to the system - often they may present to emergency departments, GPs, outpatients, attending other specialists, often getting interventions or more investigations."
Suffering in silence - the hidden burden of pain in NZ
Dr Rumball, who chairs the New Zealand committee of the Faculty of Pain Medicine, said chronic pain was best treated by a multi-disciplinary team of physiotherapists, occupational therapists and psychologists, as well as doctors and nurses.
Yet both the public and private systems were largely focused on acute interventions - pills and surgery.
A survey by the Pain Society earlier this year found a 75 percent shortfall in practising pain specialists, with the equivalent of just 13.8 full-time specialists working in either the public or private sectors.
Invercargill nursing student Ella Dixon - who has had a long recovery from Complex Regional Pain Syndrome (CRPS) following a rugby accident as a young teenager - travels to Christchurch to see Dr Rumball.
"Sometimes with pain you actually need that in-patient whole multidisciplinary team to come together - your physio, your OT, your doctors - which you don't get if you're at home," she said.
Recovery possible, say specialists
Paediatric pain specialist Paul Vroegop said children who were treated for CRPS had "a 99 percent recovery rate".
"People do actually recover, whereas it used to be seen as a dead-end, nobody will ever recover, hideous 'suicide disease' kind of thing."
Unfortunately many doctors did not know how to recognise or manage chronic pain, he said.
"Chronic pain does not fit at all into the biomedical belief system.... so a lot of the people we see in specialist pain services get the kind of message that 'Oh, your pain is all in your head' or 'All you need to do is relax and do cognitive behavioural therapy and your pain will go away', which is just bullshit."
Psychological therapy did have a major role to play in treating chronic pain, but that whole team approach - everyone working to a plan - was the key to recovery, he said.
Treatment involves understanding what is causing the pain, how the brain is responding to those signals, how that affects someone's function and what could be changed to lessen symptoms or restore function.
Doctors not "up to date"
The Pain Society's incoming president, Dr Karen Joseph, said the big advances in the understanding of pain have only happened in the last decade.
Many doctors' view of pain stuck in 17th century
"When I went through medical school we really knew so little about pain and what we were taught had really not moved much further forward than the 17th century.
"So I don't think it's that people who aren't specialised in this area don't want to help their patients, but I think they're just not really aware and up to date with the modern science of pain, which actually looks at things really differently."
Taranaki-based pain physician Yvonne Murray said they were "usually the last" specialists to see a patient.
"They've seen the neurologist, the surgeon, they might have had several operations, and several investigations, and finally someone says 'Oh well, let's send them to the pain specialist'.
"And by then it's really entrenched patterns and changes in their nervous system that are really difficult to make improvements on."
If doctors knew how to identify early on those people at risk, there was so much that could be done to stop pain becoming chronic.
Health New Zealand said patients in areas without dedicated pain specialists could be referred to those services in other regions, supported by multidisciplinary teams.
A plan to better co-ordinate services was still in the early stages of development, it said.
Where to get help:
Need to Talk? Free call or text 1737 any time to speak to a trained counsellor, for any reason.
Lifeline: 0800 543 354 or text HELP to 4357
Suicide Crisis Helpline: 0508 828 865 / 0508 TAUTOKO (24/7). This is a service for people who may be thinking about suicide, or those who are concerned about family or friends.
Depression Helpline: 0800 111 757 (24/7) or text 4202
Samaritans: 0800 726 666 (24/7)
Youthline: 0800 376 633 (24/7) or free text 234 or email talk@youthline.co.nz
What's Up: free counselling for 5 to 19 years old, online chat 11am-10.30pm 7days/week or free phone 0800 WHATSUP / 0800 9428 787 11am-11pm Asian Family Services: 0800 862 342 Monday to Friday 9am to 8pm or text 832 Monday to Friday 9am - 5pm. Languages spoken: Mandarin, Cantonese, Korean, Vietnamese, Thai, Japanese, Hindi, Gujarati, Marathi and English.
Rural Support Trust Helpline: 0800 787 254
Healthline: 0800 611 116
Rainbow Youth: (09) 376 4155
OUTLine: 0800 688 5463 (6pm-9pm)