health & science

The persistent pain affecting one in five Kiwis

There’s an invisible condition destroying the quality of life of one in five New Zealanders, with no national strategy in place for its management, and limited treatment facilities.

Persistent, or chronic pain, defined as pain which lasts for six months or more, is poorly understood by medical professionals according to researchers and people seeking help are treated differently based on their sex.

The editorial published in the New Zealand Medical Journal points out women who seek treatment for pain are more likely to seen to be "exaggerating their pain" and offered psychological support. Men on the other hand, are more likely to get pain killers.

Part of the problem stems from proving persistent pain exists.

Lead author and University of Otago associate professor Nicola Swain said: “Pain’s always real. You can’t test for it and you can’t see someone else’s pain.”

She said at various times people have tried to come up with an objective way to find out about pain, but they’ve never been successful.

There’s often a difference between the level of pain a patient says they are experiencing and how much pain a doctor thinks they should be experiencing. This is where problems can occur where patients are considered to be “malingering” and attention or drug seeking.

“Pain’s always real. You can’t test for it and you can’t see someone else’s pain.”

Women tend to suffer from persistent pain more than men due to conditions such as fibromyalgia, endometriosis and migraines.

“I think doctors sometimes don’t take people seriously and you will see women complain more about pain in more places, more often and say it’s more intense. They often don’t get taken as seriously.”

Swain said while most practitioners claim they don't treat people differently based on sex, research shows they do. 

For those living with chronic pain the effect can be brutal. It’s described as invading every part of a person’s life, from sleep to employment to socialising.

The solution isn’t always an operation. In fact, in many cases surgical intervention doesn’t offer any benefit other than in cases such as hip replacements.

Doctors too are asked to prescribe fewer opioids for pain management.

“The trouble is for doctors it’s hard for them to access any other treatment,” said Swain.

The best solution is working with patients to manage pain. This includes individualised plans around physical activity, sleep, nutrition, stress and social activity.

There are only two pain centres in New Zealand which offer this type of help, one in Auckland and one in Christchurch. Other services are available through ACC funding, but the funding only applies if you’ve experienced an injury.

“If you’ve got lower back pain, you’ve been quite disabled and off work and it wasn’t caused by an accident, it would be very difficult to get treatment.”

Swain said it is technically possible for people living outside Auckland and Christchurch to get treatment at the pain centres but it’s not easy to do.

“It’s hard for people to know how to navigate the system. DHB-to-DHB is the only way to refer. Your GP can’t refer you and you can’t self-refer.”

"It’s easy for people living with pain to find they are being pushed from person to person in the hopes somebody has got the answer to what it is and how we can get rid of it."

With an ageing population the number of people living with persistent pain is growing. Swain also pointed out ironically improved health is also contributing to persistent pain.

“Where people in the past might have died, now instead they live on with painful conditions. Even if you survive cancer, you might then live the rest of your life with some painful legacy of the cancer.”

These people are not covered by ACC funding.

University of Otago clinical senior lecturer and co-author of the editorial Dr Bronwyn Lennox Thompson said more people in New Zealand suffer from persistent pain than asthma.

“We don’t have a National Pain Management Strategy and I’m not sure why.”

Pain strategies are in place in Australia and in other countries but in New Zealand she described the service provision as “patchy”.

She believes it’s important to improve training so medical professionals learn how to identify and manage persistent pain.

“The endless frustration of trying to get a clear label of diagnosis is really tough for people.

“The training health professionals have in pain is pretty skinny. It’s easy for people living with pain to find they are being pushed from person to person in the hopes somebody has got the answer to what it is and how we can get rid of it. I think it’s disheartening and demoralising.”

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