The Chronic Pain in England Report (Versus Arthritis 2021) makes for sobering reading. Pain and pain experiences have been present since the dawn of time. Humans feel pain as do animals. If you are a living conscious organism you are likely to feel pain or abnormal and atypical sensations. This is because acute pain has a purpose which is, protection and survival.
When it loses its purpose of protection, it is largely being viewed as chronic or persistent pain. The consensus is the chronic pain is pain which has been present or recurrent for more than 3 months. Many reasons are likely to contribute to why a person may develop and manage chronic pain. These include, upbringing, socialisation, faith, beliefs, early childhood trauma, parental love and sympathy, stress, anxiety, worklessness and poverty.
The statistics from the report are stark. One third of adults are affected with pain in England. 12% are affected by high-impact pain. I could repeat the same figures quantitatively in millions but statistics mean very little to the people and families who are affected by pain. What does matter is how we, as clinicians, are going to help them with their pain.
The impact of having chronic pain is profound and life-changing. It impacts on relationships, daily activities, work, sex, mood, finances and much more. However, I feel one of the most important factors we neglect to help people with is how the chronic pain impacts on their sense of self.
I feel we need to take a new heuristic approach to how we help people live and manage their chronic pain. The key has to be a more nuanced epistemological approach to chronic pain. The branch of medicine which researches biological pain is Neuroscience. Neuroscience research with chronic pain has come on leaps and bounds over the last 15 years since I have been working in realm of pain. Ashamedly, a new approach to how we educate clinicians and people with pain has only really come about after the failure of conventional biomedical approaches to manage pain. Pharmaceutical preparations for chronic pain are not efficacious. In fact, they are more likely to worsen the false misconception that external focuses of control will alleviate the suffering of people with chronic pain.
We need to re-evaluate how we conceptualise pain. This needs to start straight away. From our childhoods, teens and early adulthood to those in their senior years. Pain is ubiquitous, suffering is not. As a high income society and nation we need chronic pain higher up the political agenda. Appropriate strategies which are likely to benefit people in pain include, alleviating deprivation, educating employers and businesses, flexible working arrangements as the norm and raising awareness of the impact of pain on people and families. There needs to be a societal shift towards a more trauma focussed and compassion based communities. Structural racism needs to be recognised and legislation put in place to reduce the devastating impact of discrimination on communities.
Managing Pain effectively is my passion. It is becoming more and more difficult to manage persistent pain in the general population. Guidelines are limiting options for clinicians and patients year on year. Effective evidence based resources are scarce. Add into the mix health inequity and we have a perfect storm. The problem of pain is only likely to increase if we don't put effective countermeasures in place.
My biggest challenge over the next 1 -2 years is likely to be how I empower people to take back control of their pain. How do we move from people and clinicians taking a passive approach to a more proactive / reactive one? How do we engage with communities to improve peer to peer learning and provide support to each other? Ultimately, how do I explain that pain has been around since our ancestors became bipedal and rather than treating it as, ‘the enemy within’ we take a more compassionate, mindful and pragmatic approach so as to reduce the suffering.