Pain suf­fer­ers seek an­swers

Fewer than 10 per cent of peo­ple ex­pe­ri­enc­ing se­vere dis­com­fort re­ceive ef­fec­tive treat­ment. Lyn­nette Hoff­man re­ports

The Weekend Australian - Travel - - Health -

THE pain in Yas­mene Sal­hia’s hands and feet was once so de­bil­i­tat­ing that she couldn’t open a tube of tooth­paste or squeeze a bot­tle of sham­poo in the morn­ing. Di­ag­nosed with rheumatoid arthri­tis at the age of 25, Sal­hia would lie in bed for more than an hour af­ter wak­ing up, so sore, stiff and swollen that she would lose her bal­ance and fall when she tried to walk.

Af­ter an hour or two, the pain would sub­side to tol­er­a­ble lev­els, only to re­turn again each evening.

‘‘ I was los­ing three or four hours each day,’’ she says.

‘‘ I was un­com­fort­able all the time. I didn’t sleep well, and I didn’t feel well. I was too tired and stiff to en­joy any­thing.’’

The pain sent Sal­hia on a wild goose chase from spe­cial­ist to spe­cial­ist.

At one point, her em­ployer even paid for her to see a world renowned ex­pert.

But the med­i­ca­tion she was pre­scribed didn’t help and she found her­self fre­quently nau­seous and dizzy. Other treat­ments she re­ceived were use­ful only as a tem­po­rary ‘‘ quick fix’’.

Sahlia’s story is far from unique. A se­ries of stud­ies and re­search by the Pain Man­age­ment Re­search In­sti­tute in Syd­ney has found that it’s not just older Aus­tralians who ex­pe­ri­ence on­go­ing pain.

One in five work­ing age Aus­tralians are suf­fer­ing from ‘‘ per­sis­tent’’ or chronic pain, de­fined as pain that lasts for more than three months, af­ter the heal­ing phase is over.

That fig­ure rises to one in two Aus­tralians over the age of 65.

Pro­fes­sor Michael Cousins, di­rec­tor of re­search at the PMRI, says pre­lim­i­nary re­search es­ti­mates per­sis­tent pain is to blame for some 36 mil­lion lost work days ev­ery year and costs the econ­omy $5.2 bil­lion in terms of the lost work alone, and some­where in the realm of $10 bil­lion a year when health care and so­cial wel­fare sup­port costs are con­sid­ered.

In Au­gust, MBF Foun­da­tion an­nounced it would pro­vide $115,000 for a much more com­pre­hen­sive and de­tailed study into the eco­nomic costs of per­sis­tent pain, which will be car­ried out by Cousins and his col­leagues at the PMRI.

They say the prob­lem of per­sis­tent pain is both ‘‘ un­der-recog­nised and un­der­re­ported,’’ and con­se­quently pa­tients aren’t get­ting the best treat­ment avail­able.

In Sahlia’s case, af­ter three years of frus­tra­tion she made sev­eral lifestyle changes that helped her man­age the pain.

The pain is still there, but she can cope. But many pa­tients aren’t so lucky.

In the­ory per­sis­tent pain can be ef­fec­tively man­aged in more than 70 per cent of cases, but the re­al­ity is that less than 10 per cent of pa­tients get ad­e­quate pain re­lief, Cousins

in says. The rea­sons for that are com­plex. Even among health pro­fes­sion­als, per­sis­tent pain isn’t taken as se­ri­ously as it should be, ex­perts say. Of­ten it’s viewed as if it’s the same as acute pain that oc­curs in the short term, as if it’s just a symp­tom.

‘‘ But when pain goes on af­ter three months, af­ter proper in­ves­ti­ga­tions are car­ried out and ap­pro­pri­ate treat­ments are given, it be­comes a dis­ease in its own right,’’ Cousins says.

‘‘ There are phys­i­cal changes in the nerves, the spinal cord and brain and those changes are semi-per­ma­nent.

‘‘ They are very long-last­ing and dif­fi­cult to re­verse. There are also psy­cho­log­i­cal and be­hav­ioral changes that oc­cur and there are changes in the pa­tient’s en­vi­ron­ment, for ex­am­ple in terms of their re­la­tion­ships and their work.’’

Peo­ple with per­sis­tent pain of­ten de­velop other health prob­lems as a re­sult of their con­di­tion, putting them at risk of pre­ma­ture death. Up to 50 per cent may have some de­gree of de­pres­sion, for ex­am­ple, and may be at risk of sui­cide.

Per­sis­tent pain



pre­vent some

Pic­ture: Alan Pryke

Pain: Michael Cousins, left, says pre­lim­i­nary re­search es­ti­mates per­sis­tent pain is to blame for some 36 mil­lion lost work days ev­ery year and costs the econ­omy bil­lions

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