NOTES FROM

"PAIN: NATURE AND MANAGEMENT IN MAN AND ANIMALS":

ROYAL SOCIETY OF MEDICINE SYMPOSIUM 2000

This symposium was attended by a variety of professionals, including doctors, nurses, vets, etc.

This article aims to present a broad overview of the conference and to cover the main points of relevance to sufferers of chronic pain.

WHAT IS PAIN?

(from "What is pain and why do we have it" by Professor Sir Michael Bond, President of the British Pain Society and of the International Society for the Study of Pain and "Patterns of chronic pain and its Management in humans" by Dr. Justins, co-founder of PANG, Pain and Nociception Group.)

The International Association for the Study of Pain (IASP) definition of pain is:

"An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage."

Professor Bond was the first of several speakers to refer to the above definition and discuss the associated clinical circumstances.

Pain is essential. There are individuals who are born without the ability to sense pain and there are those who lose pain sensation (e.g. in diabetic neuropathy): injury may go undetected which may have major consequences.

However, whereas acute pain signals damage, thereby focussing the attention, leading to avoidance and recovery behaviours, chronic pain is not in itself useful for survival. It may lead to changes in mood and a variety of behaviours, some of which may be adaptive, but often they are maladaptive.

As Dr. Justins pointed out, attempts to define chronic pain as that which persists after the normal healing time may be misleading. Several of the speakers agreed that pain may occur without evidence of tissue injury, or minor injury may cause major, seemingly disproportionate, disability.

Phantom limb pain is an example of chronic pain without ongoing tissue damage (or even the presence of the perceived source of the pain).

Dr. Justins summed up these situations thus:

ONGOING PATHOLOGY                                HEALED PATHOLOGY

                                CHRONIC PAIN