10. Data from 2006/07 New Zealand
Health Survey
1 in 6 (16.9%) of New Zealanders
report chronic pain
Nearly half (48%) use some form of
medical treatment
A fifth (21.4%) report severe or very
severe recent pain
Two-thirds (67%) have lived with
chronic pain for 5 or more years
11. Epidemiology
N# 85,088 in 17 countries
Between 10% and 42% report
chronic back/ neck pain in the
previous 12 months
Between 20% and 45% of persons
with back and neck pain also met the
criteria for depression
Approximately 25% meeting criteria
for anxiety
12. “Pain is a passion
of the soul”
Aristotle 300BC
Acknowledgement to:
Lorna Fox
NZPS 2007
14. Descartes
When it is not in our
power to determine
what is true, we ought
to act according to
what is most probable.
Discours de la Méthode
Acknowledgement to:
Lorna Fox, NZPS 2007
15. “ What is Pain? ……
…incapable of definition,
or even of accurate
description”
Lancet 1887
In G D Schott Communicating the Experience of Pain :
the Role of Analogy Pain 108 (2004) 209-212
16. “Pain … is known to us by
experience and described by
illustration … we have no
knowledge of pain beyond
that derived from human
experience …”
Sir Thomas Lewis 1942
In G D Schott Communicating the Experience of Pain :
the Role of Analogy Pain 108 (2004) 209-212
17. Definition of Pain
IASP 1979
Pain is an unpleasant sensory and
emotional experience associated
with actual or potential tissue
damage, or described in terms of
such damage.
18. Analogy serves a remarkable
and unique function, enabling
the inexpressible to be
communicated by reference to
something else. This is never
more important than in the
expression of pain.
In G D Schott Communicating the Experience of Pain :
the Role of Analogy Pain 108 (2004) 209-212
19. “Were it not for the
possibility of sensing body
states that are inherently
ordained to be painful or
pleasurable, there would be
no suffering or bliss, no
longing or mercy, no tragedy
or glory in the human
condition.”
Antonio Damasio
From Descartes’ Error
20. “Chronic pain turns a life into a
mere existence. The effects
are devastating and often
demeaning. It has a negative
impact on relationships inside
and outside the home. It
involves the loss of
independence, dignity and
control”
International Pain Summit IASP Montreal, Sept 2010
21. Some observations
We live in a time when science seems
to be bursting with promise
We are told to expect cures
The hype serves to delude us into
thinking that each of us is the sum of
our genes
The hype drives a reductionist
philosophy
Created industries based on diagnostic
entrepreneurs
22. Some observations cntd
Back pain in the workplace is just
one window on human predicament
Global illness narrative- the worried
well
The illness of work incapacity
If you have to prove you are ill, you
can’t get well
23. Paradigm shift
Adopt a “salutogenic model” with
relationship understanding between
health, stress and coping
“health-ease” versus “dis-ease’
continuum
The choice to be a patient is just
that, a choice
Accepting that to be “well” is not to
be free of symptoms
24. Paradigm shift cntd
We should question just what in the
workplace is compromising their
ability to cope
We should guarantee workplaces
that are comfortable when we are
well and accommodating when we
are ill
“common sense” is seldom common
and not always sense
25. Pain is
My pain as it grows, is an imperative,
an obsession, a compulsion, a
dominating, engulfing reality. Your
pain is a different matter. I observe you
and listen to you. I sympathise with you
by guessed analogy . . .
Patrick D Wall
Editor's Notes
I would like to take you on a journey. A historical journey of moving and handling, but also of pain and injury. I suggest to you that much of what we do is based on interpretation. Interpretation is therefore an evolving process and the legacy is often faddish. Let us have a look at some history, some present observations and see how we might influence the future.
THE CREATION OF ADAM by MICHELANGELO around 1511 on Sistine Chapel. Illustrates the biblical story from the Book of Genesis in which God the Father breathes life into Adam, the first man. God is depicted as an elderly white-bearded man wrapped in a swirling cloak while Adam is completely naked. Gods right arm is outstretched to impart the spark of life from his own finger into that of Adam.
CRUCIFIXION OF ST PETER by CARAVAGGIO in 1600. The painting depicts the martyrdom of St Peter by crucifixion- Peter asked that the cross be inverted so as not to imitate his mentor, Christ, hence he is depicted upside- down, his lifting requires the efforts of three men, as if the crime they perpetrate already weighs on them.
THE ENTOMBMENT OF CHRIST by CARAVAGGIO 1602-1603. A diagonal cascade of mourners and cadaver- bearers descending to the limp, dead Christ and bare stone. There is an emotional diagonal represented from a somewhat hysterical Mary, through subdued emotion to death as the final emotional silencing.
Translates to the surgery. The wounded sufferer grimaces with intense pain. This was painted 100 years before the use of ether in surgery(1846) and 150 years before the commercial use of aspirin(1899)
The straps of the corset seem to be all that is holding the artists body together and upright. An ionic column, broken in several pieces takes the place of her damaged spine. The yawning cleft in her flesh is taken up in furrows, scarring the bleak, fissured landscape behind, which therefore becomes a symbol both of her pain and her loneliness. Even more powerful symbols of her pain, however, are the nails sticking into her face and body. Polio at age6 in her right leg. At age 18 involved in a accident, tram vs bus. Right below knee amputation at 46, died at 47. Over 30 operations.
Prevalence increases with age from 8.6% to 28.1%. People with chronic pain have poorer health related quality of life and limitations in daily functioning. 12,488 New Zealand adult residents aged 25 years and older NZMJ 24 June 2011. vol124 no1337 pg63-76 Chronic pain ranks as an economic and social problem of enormous magnitude.
Mental disorders among persons with chronic back and neck pain: results from the world mental health surveys PAIN: 129 (2007) 332-342 NZ 1:6 NZers at some time in their lives will experience depression. It is most common in 16-24 year olds but it can happen at any age. NZ Guidelines Group 2009 New Zealand Mental Health Survey 2003- 2004 face to face household survey of 13,000. 40% reported they had had a disorder at some time in their lives. 21% in the past 12 months. Anxiety disorders were the most common (lifetime prevalence 25%), followed by depression and other mood disorders like bipolar and dysthymia (20%) and substance abuse disorders (12%) Pain is decisively shaped or modified by individual human minds and by specific human cultures.
A Greek philosopher, a student of Plato and teacher of Alexander the Great
A French philosopher, mathematician, scientist, and writer. The Father of Modern Philosophy. “ I think therefore I am” “thought cannot be separated from me therefore I exist”
Started in 1823. Longest running medical journal in the world.
A British Cardiologist. Cliché: Pain is a learnt response. This is however not useful for those with chronic pain. Pain is always personal and always cultural.
Geoffrey Schott. National Hospital of Neurology and Neurosurgery Queens Square, London
A Portuguese Behavioural Neurologist and Neuroscientist working in the USA. His main interest is in the neurology of the mind, especially neural systems which subserve memory, language, emotion, and decision making
Pain may keep us from working, push us in to a role of invalid, drive away friends, and wall us up in a personal prison of isolation.
We just have to ask Professor Google. We are not well equiped for what happens when our pills fail. Our culture has succeeded in persuading us that pain is simply and entirely a medical problem. When we think about pain we almost instantly conjure up a scene that includes, doctors, drugs, ointments, surgery, hospitals, laboratories and ACC forms.