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

Comments

  1. I have been living with pain for 22 years and I have no doubt that pain is a disease. Pain impacts all areas of my life and certainly affects all the major systems in my body. My endocrine system is affected along with my digestive system. When I broke my ankle a few years ago, it became very clear that my nervous system has become extremely altered and I had pain that was on a higher pain scale than the 0 to 10 one commonly used. I have had several surgeries before I developed chronic pain and the pain was normal and analgesic worked normally too. With my fractured ankle massive doses of morphine IV was as effective as water and I spent a week in ICU for pain management.
    For me, it is very clear that chronic pain is the disease and not a symptom.

  2. (I apologize if submitted twice. I hit submit but did not see comment submitted.)
    It is wonderful that chronic pain is starting to be recognized as a major public health issue.
    As for “Why has there been little progress in treatment of chronic pain?” I have felt the answer is somewhat simple.
    Each pain disorder is its own world, People trying to get the word out about CRPS, or fibromyalgia, for example, only get people to learn about that disorder. I have trigeminal neuralgia. There is no public campaign about that.
    The treatment of chronic pain as a disease in its own right will come about when there is a concensus, if that is possible, on the commonality inherent in pain syndromes. Neuropathology for instance, is a somewhat common thread, regardless of the underlying illness or disorder. An answer for this problem would go a long way towards helping those of us in constant intractable pain.
    Thank you.
    Carol Jay Levy
    author A PAINED LIFE, a chronic pain journey
    WOMEN IN PAIN AWARENESS
    http://www.facebook.com/?ref=home#!/groups/111961795481256/
    apainedlife.blogspot.com/

  3. Sabina Walker says

    ‘Is chronic pain a disease in its own right?’ –
    I think that Associate Professor Philip Siddall and Professor Michael Cousins have said it all already!! Anything that I might add would only ‘pale in significance’, compared to their writings! Suffice to say that I 100% support their view that chronic pain (and its underlying mechanisms) is a disease in its own right.
    Sabina Walker (a person with more than a casual interest in neuropathic pain research)

  4. Dear people who have commented on this post. We have taken the decision to remove all comments that weren’t primarily discussing Prof. Cousin’s article so that we can get back to the main focus. See also the previous post for some excellent contributions.
    We are all for discussion and we want to stay right on topic with this especially as Prof. Cousins has given his time to write a guest article for BiM.