In response to ‘Is chronic pain a disease in its own right?’

Professor Michael Cousins took some time to read and comment on ‘Is chronic pain a disease in its own right‘.  It was so good that we didn’t want it to get lost at the end of the comments section so we have made it a post in its own right. Here he is:

Recognition of  chronic pain as a chronic disease is not only a key element of the National Pain Strategy (painaustralia.org.au) –  it is also a key principle of the prestigious Institute of Medicine(IOM) report to U.S. Congress – Relieving Pain in America, a Blueprint for Transforming Prevention, Care, Education and Research.

Both reports result from the concerted efforts of a wide range of scientists, clinicians, consumers and community. Driving forces behind these efforts are the documented deficiencies in the management of all pain, but particularly for those suffering chronic pain. Extensive changes to education, training, attitudes and practice are needed (see ref 1 below), and this will accompany the recognition of chronic pain as a chronic disease.

In my experience post National Pain Summit, patients, carers, community and government do understand the concept of chronic pain as a chronic disease, if appropriately explained. This is exemplified in the cover story of Time magazine (Understanding Pain, Time 2011, March, page 30-34).

With respect to other bloggers, it is important to realise the critical nature of what is at stake here : the allocation by Governments of resources for improved clinical care, education and research. Therefore I strongly urge people to read the recommendations of the National Pain Strategy.

These recommendations are already being implemented in Queensland with funding of $39 million, and are currently under consideration in NSW,  following a Ministerial Task Force report.

I also urge you to read in detail the case assembled in the paper by Phil Siddall and I in 2004 (see ref 2 below). Briefly, we propose that the disease of chronic pain consists of physical, psychological and environmental changes, all of which represent maladaptations. Often the changes (and the pain) become rapidly worse.  Whist in recent studies brain imaging reveals brain changes that correlate with pain severity, there is long standing evidence of psychological and environmental changes that also make a strong case for a ‘disease.’ Importantly effective treatments are associated with reduction in the bio-psycho-social changes associated with this disease.

In the Siddall – Cousins paper, we discuss implications for assessment and treatment.  Step 1 is to identify any underlying treatable condition, ‘red flags’, for low back pain. Thus the adoption of chronic pain as a disease (and  associated measures) will result in improved assessment and treatment of chronic pain (ref 2).

Why has there been little progress in treatment of chronic pain?  Lack of a clear, understandable message about the science and treatment of chronic pain. In Australia and America we now have an opportunity to make major progress. Similar initiatives are underway in Canada and Europe.

Prof. Michael CousinsProf. Michael Cousins

Chair, National Pain Summit/ National Pain Strategy.
Chair, IASP International Pain Summit.

References
ResearchBlogging.org

1. Cousins, M.J. and Lynch, M.E (2011). The Declaration Montreal: Access to pain management is a fundamental human right. Pain, 152 (12), 2673-4 PMID: 21995880

2. Siddall PJ, & Cousins MJ (2004). Persistent pain as a disease entity: implications for clinical management. Anesthesia and analgesia, 99 (2) PMID: 15271732