Pain relief neglected, researchers say

Press, 10 December 1984, Page 15

Pain relief neglected, researchers say

Pain is the most common reason for people seeking help from doctors but, in spite of modern medicine’s advances in treating disease, there is considerable neglect in successfully relieving pain according to researchers.

Britain’s Pain Relief Foundation is the only institute in the world devoted to research on the nature and treatment of chronic pain, - which it believes can be a disease in itself rather than the symptom of one. As Europe’s only multidisciplinary research team, the researchers work alongside the Pain Relief Clinic at Liverpool’s Walton Hospital and treat about 3500 people a year who suffer from chronic pains like arthritis, rheumatism, backaches and headaches, as well as terminal illnesses.

Their methods vary from conventional pain-killing drug treatment and portable electrical stimulation treatment or surgery, to more naturopathic or osteopathic techniques, like exercise, relaxation and diet, as well as acupuncture. Severe back pain is responsible for the loss of 19 million working days in Britain. The team is adamant that the practical application of as much as is known today for correct treatment of chronic pain must be its priority. One of its directors, Dr

David Bowsher said, “It is like the patient who says,“They are looking for a cure, and have been for years, but I don’t give a damn when I am doubled up in pain all the time.” Apart from assessing the effectiveness of existing techniques and developing new ones, the foundation also provides intensive training and courses for doctors throughout the world in the hope that the medical profession’s failure to get to grips with successful treatment of pain can be minimised.

Its honorary Medical Director, Dr Sampson Lipton, who as former director of the hospital’s pain relief clinic helped the Pain Relief Centre at the University of Otago several years ago, still gives lectures throughout the world.

His latest work, “Conquering Pain,” was published this year as a positive health guide for individuals.

He says that the effect of pain on people has a great impact on society, resulting in enormous expenditure on painkilling drugs, but only recently has any scientific attention been paid to the control of pain. Nearly a third of the British population suffer from headaches each year which leads to the loss of another 20 million working days, Dr Lipton said.

“About £2O million are spent annually on cancer research and a similar amount on rheumatism yet this foundation receives only £lOO,OOO a year from the Medical Research Council,” he said. In the United States more than SUS 26 billion were spent annually on painkilling drugs, though less than a SUSI million a year went on research to alleviate pain, Dr Lipton said.“ Usually pain is thought to be a warning signal of actual or impending damage to tissue. Many types of pain undoubtedly do this,” Dr Lipton said. “But most pains, and all those that have devastating consequences, can not be explained on this basis. The foundation’s main aim is to treat these chronic pains, best thought of as diseases themselves rather than symptoms of diseases.” Dr Lipton and his colleagues believe few doctors can manage to administer the drugs scene effectively. Dr Bowsher said one example was shingles, which affected almost half the patients over 60 visiting the pain relief clinic. “They often arrive incredibly doped up with normal pain-killing drugs which do not help at all. The main treatment is stimulation therapy.” he said. Another example was of patients with thalamic syndrome - (a pain which often follows strokes) - which may not killed by drugs but by stimulation and acupuncture, he said.

Other typical cases involved patients with cancer. Dr Jack Morley, also working at the foundation said, “There is.no reason for a person dying of cancer to be in pain if properly treated. “Often doctors are afraid

of causing addiction to morphine, which is usually used in these cases.

“But this can be supplied directly into the spinal cord in much smaller amounts to have a better effect than large injections which are dispersed through the bloodstream.” One of the main achievements of Dr Lipton, who received the prestigious Merseyside Gold Medal in 1982 for outstanding work during his 25 years as director of the Pain Relief clinic, was to improve the technique used to bum out part of the spinal cord to relieve pain in patients with terminal cancer.

He said a major concern was to improve the quality of life in these patients for the time they have. But as well as concentrating on ways of long-term control or prevention of pain the foundation’s neurochemists and neuropharmacologists are making considerable inroads towards understanding chronic pain. Dr Lipton said, “The foundation is trying to find non-invasive methods of preventing pain by correcting body reactions. “An injury to a peripheral nerve in the wrist, for example, eventually regenerates and heals, but chemical changes occur to leave marks from this in the farremoved spinal area.

“This can lead to imbalances which may cause other pathways of pain to form.”

The discovery of why such chemical changes occur in the nerve pathways of the body could revolutionise methods of treating pain, Dr Lipton said. The foundation has about 12 full-time researchers. “There is still widespread ignorance on the part of both doctor and patient as to causes, meaning, conse-

quences and treatment (of pain),” Dr Lipton said, and education remains an integral part of the foundation’s work.