Treat pain more aggressively, experts insist

Allison Gandey

October 28, 2005

Oct 28, 2005

Catherine Seton

Ottawa, ON - "If you take nothing else away from this, take this one idea: Pain is like a noxious weed," Toronto-based patient advocate Catherine Seton told doctors and officials at the Bone and Joint Decade World Network Conference here in Ottawa [ 1 ]. "I challenge you in your strategy work today and in your offices thereafter to treat pain early and aggressively?before it takes root." Experts presenting at this session including Dr James Henry, research director for the DeGroote Centre for Research and Care in Central and Thalamic pain at McMaster University in Hamilton, ON, said that chronic pain should be thought of as a disease in itself rather than as a symptom secondary to a condition. He and others warned that as professionals continue to inadequately treat this complex sensory and emotional experience, long-term neurosensory damage is taking root.

Dr James Henry

"One of the main messages is that chronic pain is a very complex medical and health issue and to see it in simplistic terms does a disservice to people who live with this disease," Henry told rheumawire . "It was mentioned in one of the sessions this morning that many healthcare professionals prefer to turn their backs on chronic pain because the issues are so insurmountable, compensation isn't there, and there's a certain frustration level where professionals would prefer to care for people they feel they can do something for." Henry says there is no question it takes longer to see someone with chronic pain and this can be a real disincentive.

"Pain is a soup," Dr Angela Mailis-Gagnon, director of pain services at a University of Toronto-affiliated hospital said during an animated presentation. "It is a complex soup involving biology, psychology, and the socio-environment." She explained that treating pain is a multifaceted process that should encompass a variety of therapies.

Pain is complex, its treatment can be wide-ranging, and may include:
  • Pharmacologic options

  • Psychotherapy

  • Physiotherapy

  • Invasive procedures

Source: Pfizer

Henry noted that chronic pain is a disorder of the nervous system. He emphasized that prolonged synaptic input changes the phenotype of sensory fibers and central neurones?alterations that are brought about by glutamate and substance P.

After living with persistent pain for 12 years, Seton says she is an example of a life shattered by the physical, emotional, and social costs of this problem. Following a car accident, Seton describes nine years of "wandering the silos of medicine" with little relief. She speaks of drugs that didn't work, healthcare professionals that didn't "get it," a process of demoralizing ping ponging between physicians and psychiatrists, and patronizing labels that contributed to the downward spiral of her once-productive life. In addition to her personal health and wellbeing, Seton points out that her career and her family were affected by chronic pain. She says that she has begun to find relief in a multidisciplinary pain clinic where a variety of specialists oversee her care. "My body is regarded as an interconnected whole and for the first time, I have partners in a process I control."

Henry says it's not uncommon for patients to feel this way. "A lot of people who suffer from chronic pain look pretty normal. If you have a disfigured hand, it's obvious that you require medical care. With pain, it can sometimes be hard to convince others you are living with a chronic disability." He added that this tends to be further complicated by the fact that many pain patients have a variety of comorbidies including other pain conditions.

Types of pain
  • Nociceptive?pain from injured bones, muscles, ligaments, skin, and so forth

  • Nociceptive visceral?pain from the heart, kidneys, bladder and so on

  • Neuropathic?pain from injury of the nerves, spinal cord, or brain.

Henry told rheumawire that healthcare professionals need to spend more time with chronic pain patients and they should consider approaching them with a varied team of specialists all working together to help move patients forward. But he acknowledges that funding has been a problem. "There are pain clinics in Canada with waiting lists of three years. To live with chronic pain for three years is an inordinate task and it's an unfair burden to place on these people," Henry said. "Money is being cut and the compensation just isn't there. This is one of the reasons that pain services are less today than they were three and five and ten years ago."

Mailis-Gagnon adds that inadequate pain management education is also an important factor and medical schools are going to have to improve their curriculum to address this largely unmet need. "My patients taught me what my medical schools never said."


  1. Risk factors and strategies for prevention and care of chronic pain. Bone and Joint Decade Annual World Network Conference; October 26-28, 2005 Ottawa, ON.


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