Pain ‘stealing people’s lives’ in NZ

Problems increasing and system barely coping, say experts

One in five New Zealanders live with persistent pain and the health system struggles to deal with the problem effectively, researchers say. Writing in the New Zealand Medical

Journal, University of Otago psychology expert Dr Nicola Swain and colleagues say: “Pain is extremely common and increasing in prevalence in New Zealand . . . and current biomedical treatment is often ineffective.”

“Pain is stealing people’s lives. As we live longer and are more healthy, pain is an increasing issue,” said Swain.

She said there was little research done on pain in New Zealand and patients had difficulty in getting treatment. Back problems, arthritis and migraines are major causes of persistent pain. The Ministry of Health says musculoskeletal disorders cause around 13 per cent of the “health loss” in New Zealand, to which the largest contributor is low-back and neck pain.

In their journal editorial, the authors say the prevalence of persistent pain is higher in women than men, and higher in Asian, Pacific and Maori people than Europeans. Our ageing population is driving an increase in prevalence because pain is more common in old people.

People suffering persistent pain commonly also have other problems, such as depression, anxiety, poor sleep, impaired movement, impaired concentration, social limitations and difficulties with relationships.

Chairman of the New Zealand National Committee of the Faculty of Pain Medicine, Professor Ted Shipton, said there is a real issue in New Zealand which will only get worse.

“In New Zealand, the four of the six causes of disability were chronic pain conditions. Low back pain, knee pain, neck pain, and other musculoskeletal pains,” he told the Herald.

Poverty is also a risk factor for persistent pain and the poorer a person is, the more likely it is they will have a bad outcome from treatment. The authors emphasise that “pain is always real”, although the causes can be “elusive or illusory”. Doctors often don’t understand it.

“Patients continue to be characterised as ‘malingering’ or ‘attention seeking’, and pejorative pronouncements are made about drug seeking or illness behaviours.

“To query whether a particular patient’s pain is real is a nonsense. There are no objective tests for pain; it is a subjective experience, and its complexity can make assessment challenging, even when using accepted measures.”

Good care for those with persistent pain includes “building autonomy and optimising physical activity, sleep, nutrition, stress and social participation”. Pain education in the main health-worker training programmes is poor, they say, although a good post-graduate programme is available.

“Research shows that clinicians generally demonstrate inadequate knowledge and inappropriate beliefs about pain. Insufficient pain-related competencies may limit how well healthcare professionals provide effective treatments.”