When the pain is always there

Pain can be dull or sharp, intermittent or constant, general or localized. The International Association for the Study of Pain defines pain as an “unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. It is the organism’s way of warning us that something is not functioning well. If a serious disorder is not accompanied by pain, it may become life-threatening without us realizing. Pain is a reality that we all know: everyone has felt pain at some point in their life. However, thousands of people also have to learn to live with chronic pain. Pain is the main reason for medical consultations worldwide. It is a serious health problem and its relief is a recognized right.

The pain clinics

Advances in diagnostic and therapeutic techniques have led to the emergence of a new speciality called pain medicine, and new units have been formed that focus specifically on treating pain. These are known as pain clinics. Carme Busquets is in charge of the pain clinic at the Hospital Clínic de Barcelona, where she started work after setting up a similar centre in the Hospital de Girona in 1985. “At that time, around half the patients had cancer. That has changed. Now the majority ─ around ninety per cent ─ are patients with musculoskeletal disorders. That is, we treat pain in muscles and the spine, basically back pain”.

Pain can have an impact on people’s lives to the extent that it incapacitates them

The goal of pain clinics is to treat painful disorders that are difficult to resolve. The staff try to improve patients’ quality of life through the recovery of their physical, social and emotional well-being, because the consequences of pain, and particularly constant pain, are not just feelings of discomfort. Pain can have an impact on people’s lives to the extent that it incapacitates them.

“Acute pain is an intense pain, a pain related to a specific event. We know that it will last for a certain time and will eventually disappear. It does not have much of a psychological impact. However, chronic pain, which is pain suffered for months and years every day… this can lead to what is frankly a low quality of life. At the pain clinic, we give our patients a questionnaire on how pain affects them. We ask, for example, how they would describe their state of health, if they have had to cut their working hours, if there are things they want to do but can’t, and what their relationships with family and friends are like. We ask them if the pain has affected them emotionally, if they have suffered from pain in recent weeks, if it makes their daily activities difficult, or if they feel well and full of vitality or anxious. These are the additional effects of pain”.

The pain threshold varies depending on the person. It also depends on the context

One of the factors that make it difficult to treat pain is that it is subjective: the pain threshold varies depending on the person. It also depends on the context. “The definition given by the International Association for the Study of Pain mentions experience. And the word experience means that it is individual. Pain is specific to each person; it has nothing to do with what others think. It is an independent, personal and unique experience. In addition, it is changed by circumstances. For example, in emergency situations such as war, hormones released by fighting can lead to a person being seriously injured without feeling it. But if the same injury occurs at home when a person is calm, the perception of pain will be different”. A phenomenon that varies depending on the nature of the individual and the situation must be treated in a highly personalized way. Consequently, professionals must evaluate both the event itself, and how the person is experiencing it.

A comprehensive treatment of pain

This is the task of professionals from different specialities who carry out a range of therapeutic procedures, as the treatment of pain must be comprehensive. “We share patients with doctors in rehabilitation, palliative care, psychology, psychiatry and, particularly, all areas that are related in some way to the spine, including neurosurgery and orthopedic surgery. Patients are referred to us from primary care or from other specialists in the hospital”. The most common pain is backache: 80% of the population has suffered from it recurrently or sporadically. The main disorders that are treated are chronic lower back pain, orofacial pain syndromes, myofascial pain, fibromyalgia, chronic post-surgery pain, postherpetic neuralgia (which follows an outbreak of shingles), complex regional pain syndrome (CRPS), chronic post-amputation pain and degenerative joint pain. The most commonly used treatments are pharmacology and infiltrations.

“One of our first tasks is to stress to patients that they must actively participate in their treatment, or at least we try to transmit this idea, because some people are not open to it. Patients can’t do much with some disorders, but in musculoskeletal pain, which is the most common case, we have to convince patients that they are the ones that are ill and they have to do their part”. Dr Busquets mentions all the factors that can be changed to improve the recovery process. “Anatomy is what it is and we cannot change it. But some things can be altered. For example, if a person has backache and is obese, they should lose weight, eat well, exercise, strengthen their muscles, improve their posture, go out, have a social life. All of these things help. If they stay and home and enter into a cycle of inactivity and apathy, their health will end up suffering.”

“As a society we have little tolerance of pain; pleasure has become our primary objective”

So patients need to be aware that there is an opportunity to act on pain that depends on them alone, and that the chances of totally eliminating pain are limited. “We cannot perform miracles. Zero pain doesn’t exist. Generally, patients come to us with very high expectations: they sit down and ask us to stop the pain. It is very hard to make it disappear. But we can make it more tolerable. Sometimes we can help a lot; other times not so much. We do what we can”. If they cannot eliminate the pain, the aim of the staff at the pain clinic is to at least make it bearable. Another aspect that Dr Busquets believes should be accepted is age: “People want to die healthy, but that is not possible: you die when you have a serious disorder. But people are practically demanding to be helped to die without suffering. As a society we have little tolerance of pain; pleasure has become our primary objective.”

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