Everyone knows what pain is. It is part of everyday life, and though always unpleasant, usually serves to protect us – for example by making us rest an injured limb, or forcing us to withdraw our hand from the flame. But sometimes this “normal” pain keeps going, after the danger is gone, the injury healed, or when there is an underlying disease that keeps producing pain. This is when it becomes chronic pain.
A major European study found that 1 in 5 people currently has chronic pain. Our own research in Scotland found that, in people aged over 75, this figure was as high as 60%, and the pain was more often severe, disabling and debilitating. It can affect physical, psychological and social health, and leave people feeling isolated and depressed. Some of us assume that “aches and pains” are a normal part of growing older, and that we should tolerate this in silence. However, there is no need to do this, and we desperately need our healthcare services and treatments to address this problem effectively.
Fortunately, chronic pain has recently begun to receive the political and scientific attention it deserves. In 2008, after many years of lobbying and commissioned reports, the Scottish Government recognized chronic pain as “a long-term condition in its own right”, probably the first government to do this, and stimulated progress in policy, research and development.
The Government and NHS Scotland collaborated to establish a national pain service improvement programme, and appointed the first Lead Clinician for Chronic Pain (“Pain Tsar”). They agreed a chronic pain service model, with an identifiable, standard “patient pathway”, from management in the community, rightthrough to highly specialist clinics, meeting the needs of people of all ages. Implementing this model is a priority for all NHS Boards, under the Government’s NHS Scotland 2020 Local Delivery Plan Guidance, supported by pain Service Improvement Groups in each Board. Approval has just been given for the first residential chronic pain service in Scotland, providing intensive treatment for those most severely affected.
What about new treatments for chronic pain? Although some established drugs have been “re-purposed” or developed to be delivered in new ways, there have been no new drug classes since the non-steroidal anti-inflammatory drugs (such as ibuprofen), in the 1960s. The search for new drugs is constant, but only one part of the story. We continue to develop non-pharmacological treatments, including psychological approaches and physiotherapy. Self-management (including education, increasing physical activity, and personal goal-setting) should always form part of the overall management. This is the subject of our research programme, funded by the cross-Council Lifelong Health and Wellbeing initiative and focusing on older adults.
In Universities and the NHS all across Scotland, researchers are actively pursuing improvements in the understanding and treatment of pain. In March the University of Dundee hosted the 4th Annual Scientific Meeting of the Scottish Pain Research Community (SPaRC). SPaRC’s aims are that (1) treatment of pain in Scotland is informed by the best evidence; and (2) pain research in Scotland addresses the most important clinical questions. SPaRC presents an active and internationally-competitive approach to addressing chronic pain, ranging from molecular mechanisms of pain and drug response, to population-based trials of service innovations.
The internationally-renowned Scottish Intercollegiate Guideline Network (SIGN) published the first evidence-based guideline covering the management of chronic pain, in December 2013. This impressive project identifies and collects, for the first time, the best available evidence for all forms of non-specialist treatment, and includes versions for patients and professionals internationally.
We have recognized and begun to address the problem, but much more work is needed. More information about SPaRC and chronic pain is available for patients and professionals at www.chronicpainscotland.org.
Blair H. Smith is Professor of Population Health Science, University of Dundee; and Consultant in Pain Medicine, NHS Tayside