Pain is a complex medical condition requiring a teamwork approach, specialists across the country have said.
Southern District Health Board anaesthetist and pain physician Dr Paul Templer said pain was “ubiquitous” in medicine.
He said about 50 percent of GP visits were due to pain of some sort.
“Persistent pain is also extremely common with about one in six people suffering significant pain on a daily basis. It is expensive — with direct medical costs, loss of productive work, and reduced quality of life, — distressing, and is a major challenge for our health system.”
He said every health practitioner needed to play a part in helping patients manage pain.
“Because persistent pain is so common health professionals are going to meet these patients all the time and basically the more they know, the more they can help.”
Counties Manukau District Health Board pain specialist Dr Paul Vroegop agreed.
“All health practitioners and clinicians should be responsible for managing pain, obviously in collaboration with people suffering pain and their whānau.”
He said it “definitely should not be left to specialists,”’ regardless of whether it was acute or chronic pain, or if the person was in the community or a hospital.
College of Nurses Aotearoa executive director Professor Jenny Carryer said nurses played a vital role in pain management.
“The biggest things for patients with chronic pain is that they need to be believed, enabled and supported. That’s a critical role nurses can provide as they are often the ones that the patient sees the most.”
She said access to services impacted on patients.
“Our focus is on building the number of nurses within the community that have prescribing rights.”
Vroegop said it was important healthcare professionals understood the different types of pain and their treatments, so as to help their patients understand their condition.
He said of 580,000 people in South Auckland, it was estimated 115,000 people suffered chronic pain, and there were 45,000 people whose quality of life was significantly impacted by chronic pain.
“The specialist chronic pain team can only see 800 people a year, so most people with chronic pain are managed by themselves, privately or in primary care.”
Integrative Pain Care pain specialist Dr Nick Penney said pain was complex, and if it was not easily resolved or explained then further investigation was warranted.
“Short term pain is protective, but when it persists beyond the natural history of the originating injury or disease it ceases to be protective and can be deleterious to the person’s physical and mental health.”
Penney said there were a number of clinical practice guidelines for the management of acute pain in primary care.
If the pain was responding to usual care in the first six to eight weeks there was usually no
need to refer.
“If the patient has reached the ‘sub-acute’ stage at around eight weeks post onset, then
the psychosocial factors, for example, anxiety, stress or distress, or depression, may be starting to have an effect on recovery and referral may need to be considered.”.
Templer said a specialist referral should be sought when the original healthcare provider needed help.
“Some GPs are fantastic at dealing with pain and many of our specialists, physios, and psychologists are awesome too. But everyone gets stuck and needs a hand sometimes.”
While there were lots of guidelines about referrals, the only real criteria was “I’ve tried my usual plan A, B, and C and the person is still distressed by the pain or not able to function,” he said.
It was important that people understood specialists were not “magicians,” Templer said.
“Nor do we have access to special medicines that cure everyone’s pain. We work as a team with physios, psychologists, occupational therapists, and nurses, and we help as much as we can. We don’t fix people – we help people fix themselves.”
Carryer said society as a whole had “funny attitudes” about pain.
“We aren’t really that tolerant of pain as a society.
She often recalled pain researcher Margo McCaffery’s quote – ‘pain is whatever the experiencing person says it is, existing whenever he says it does.’
“As health professionals we need constant reminders about that. It is not for us to judge, we need to listen and support.”