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Notes on Prof. Michael Cousin
interview on 3 June '10 with Michael Peschardt
Definition of Pain by the Int'l Assoc and Study of Pain
IASP Pain Terminology
"An unpleasant sensory and emotional experience associated
with actual or potential tissue damage, or described in terms of such damage."
Note: The inability to communicate verbally does not negate the
possibility that an individual is experiencing pain and is in need of
appropriate pain-relieving treatment. Pain is always subjective. Each individual
learns the application of the word through experiences related to injury in
early life. Biologists recognize that those stimuli which cause pain are liable
to damage tissue. Accordingly, pain is that experience we associate with actual
or potential tissue damage. It is unquestionably a sensation in a part or parts
of the body, but it is also always unpleasant and therefore also an emotional
experience. Experiences which resemble pain but are not unpleasant, e.g.,
pricking, should not be called pain. Unpleasant abnormal experiences
(dysesthesias) may also be pain but are not necessarily so because,
subjectively, they may not have the usual sensory qualities of pain.
Many people report pain in the absence of tissue damage or any likely
pathophysiological cause; usually this happens for psychological reasons. There
is usually no way to distinguish their experience from that due to tissue damage
if we take the subjective report. If they regard their experience as pain and if
they report it in the same ways as pain caused by tissue damage, it should be
accepted as pain. This definition avoids tying pain to the stimulus. Activity
induced in the nociceptor and nociceptive pathways by a noxious stimulus is not
pain, which is always a psychological state, even though we may well appreciate
that pain most often has a proximate physical cause.
Variation in the pain experience caused by a wide array of
physical, psychological and environmental factors.
Part genetically determined
Always deploy a Team Approach.
Team Members to assess 1. Physical, 2. Psychological, 3.
Environmental factors of each suffers chronic pain.
Now assist 80% of suffers of chronic pain.
Chronic Pain is a disease in its own right.
Sensitisation of the nervous system.
Central nervous system sensitisation
Suffers of MS often have nerve damage pain.
Treating Chronic Pain is a moral imperative.
The Gate Control Theory that pain can be moderated -
signal can be tuned down or tuned up - brain and spinal cord can play an
important role in moderating pain.
Psychological factors can influence on level of pain.
When pain become chronic, it becomes a disease.
Acute pain is a symptom. Chronic pain becomes a
disease.
It is not only the trauma injury, but the meaning of pain.
The gate is composed of >40 transmitters.
The gate can open or close.
High state of anxiety or depression
A 30% overlap between depression/anxiety and chronic pain.
Fear avoidance behaviour - develop a fear of re-injury -
influence the behaviour of patients with low back pain by inducing
avoidance behaviour due to fear of increased pain.
stop bending your back - get into a vicious cycle
whereupon the pain becomes greater and greater
How can Environmental factors - relationship with superior
at work. become anxious. depressed become hyper vigilant - sensitisation of the
nervous system.
In one as-yet-unpublished study, Herta Flor and colleagues at the
University of Heidelberg in Germany examined whether a social factor
could alter basic brain function in some way that might make pain
sensations worse.
Twenty sufferers of chronic back pain were brought into a
laboratory and hooked up to arrays of sensors set up to monitor
levels of brain activity not subject to conscious control. Ten of
the test subjects had spouses who tended to focus a lot of attention
on the pain problem, while the other 10 spouses tended to ignore it
or actively sought to get the sufferer to focus on something else.
This kind of difference in social support has long been known to
make a difference in how pain is expressed. The new study appears to
be the first time it's been shown to have a deeper impact in the
brain.
Test subjects with the solicitous spouses showed a threefold
higher overall level of brain activity, compared with the other 10
test subjects, when the spouse was present and a painful stimulus
was applied in the area of the chronic back pain, Flor said.
Need a Team Approach comprising various clinical and
therapeutic skills.
Lifelong expense
ACCESS Economics $34b pa.
cost of chronic pain.
medical, burden of disease, lost opportunities in
workspace
life long expense
Burden of disease. lost opportunities in workplace
developed a National Pain Strategy
If all done reduce from $34b to <$1b.
government initiative to move ahead to reduce from $34b to
<$1b.
It won't happen unless the general community gets strongly
behind it
hasn't been recognised that chronic pain is a disease
Michael Cousins Philip Siddall Chronic pain is a
disease
It is also an economic priority human rights issue - a
moral imperative.
Strong family and/or friends support network
Euthanasia - Oregon USA - state provide with the means to
end one's life
I like to frighten myself a bit of adrenalin - surf ski
Professor & Director Pain Management Research Institute,
University of Sydney at Royal North Shore Hospital, St. Leonards NSW Australia
Adopting a 'Team Approach' where individual team members
with medical, rheumatology, physiology and psychology skills each assess each
suffer's chronic pain.
http://chronicpainaustralia.org/
I have listened to your chat on 3 June with Michael
Peschardt a couple of times. Aspects which particularly interested me
were:
A 30% overlap between depression/anxiety and
Chronic Pain.
'Fear Avoidance Behaviour' and 'Environmental Factors' can
impact a patient going from acute pain to
Chronic Pain.
Psychological and 'Environmental Factors' such as a strong family
and/or friends 'support network' can play a significant role in successfully
treating chronic pain, just as a poor relationship with say your boss can
increase anxiety and trigger
Chronic Pain.
Access
Economics' "The high price of
pain: the economic impact of persistent pain in Australia -
Nov 2007"
reported that
Chronic Pain cost Australia
$34.3 billion in 2007.
On a personal note, you identify the value of "frighten
yourself on big waves on your surf ski with regular doses of adrenalin.
You sighted the opportunity to reduce the annual $34b
all-up cost of
Chronic Pain by
a robust government support.
Following a career administering the financing of very
large infrastructure projects, including social infrastructure such as hospitals
and a prison, upon retiring three years ago I began |