Data is collected through the visual analogue scales described earlier in this book and the McGill pain questionnaire of Melzack and Torgerson. Pain teams everywhere are getting much better at assessment but this is made more difficult as experimental and clinical pain are not the same.

And as pain is an individual experience it is virtually impossible to categorise it.

Following up

Successful as modern pain clinics are at helping so many people manage their pain, a major drawback is that they do not have the resources to make long-term assessments. A research assistant would need to work full-time for the preparation of information and with the project taking up to two years. Yet, this is petty cash compared to the huge sums it would save federal and state governments and the insurance industry.

Such a statistical analysis would precisely define the problems and allow policies to be devised to keep the modern epidemic of pain complaints to an absolute minimum.

The present vague ideas by officialdom about how to combat pain are largely educated guesses. Australian taxpayers are paying dearly for this statistical fog about the numerous preventable, acute and chronic pain complaints.

Little is being done about the overwhelming need to find answers to minimise the epidemic of pain complaints, most of which are avoidable — everything from chronic headaches to disabling lower back pain and RSI.

The several thousand new patients Australian pain clinics see every year have the sort of information which, if available in their medical records, could be available through later studies.

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‘Sleep is a healthy state of inertia and unresponsiveness that is recurrently imposed by unknown mechanisms within the nervous system.’

Insomnia or inability to sleep affects most of us at one time or another. It is rarely a lasting problem, however, unless there is some medical or psychological condition which makes it chronic. The incidence of chronic insomnia appears to be greater in women, people of ‘nervous temperament’ and among older people. They consume the greatest amounts of sleeping pills.

People who complain of lack of sleep actually sleep more than they suppose. Some people say that they ‘never sleep’. When studied in sleep laboratories with all night brain wave recordings, it is found that they actually sleep all of the night! But their normal deep slow wave sleep is’contaminated’ with brain waves characteristic of wakefulness. This means that their sleep is not restful and they are often aware they have been awake through the night.

Brief episodes of sleeplessness are characteristic of periods of stress. This can occur on the night before an examination, before a trip or a major work-related event.

Insomnia is often more long-lasting after major stresses such as shifting house, changing jobs or the loss of a loved one.

Medical problems such as chronic pain and heart failure, and psychological problems such as chronic anxiety or depression often lead to chronic insomnia.

There is no standard amount of sleep necessary for everyone. Many people say they require 8-10 hours per night while others do well on 6 hours or less each night. A good average seems to be about 7 hours per night.

If you are not feeling fatigued you are probably getting enough sleep. On the other hand there are many other reasons for feeling chronically tired than lack of sleep.

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• Direct suggestions of pain relief by telling pain sufferers under hypnosis that the pain will disappear and will not return in the waking state, may be effective.

• The hypnotic transfer of pain from one part of the body to another, where it is less disabling, may benefit those patients who have a psychological need for the pain to continue whether for sympathy or to get a greater financial settlement. For example, such patients may be able to transfer their pain from their abdomen to a finger.

• Hypnosis can be used to change pain sensations into more easily tolerated sensations such as tingling, or feelings of warmth or cold. It can be suggested that the pain will be experienced as a pleasant ‘buzzing’ or ‘warmth’ sensation rather than an acute or deep sensation.

• Under the hypnotic state, people use their imagination to think of their pain as an interesting experience — neutral and distinct from the suffering it may produce. It may be suggested that the pain is changed to a ‘pleasant sensation’, incompatible with pain or suffering. People are asked to hallucinate these sensations, to dream them or to project them on to a movie screen in their imagination. For example: ‘Imagine that you’re sitting comfortably in front of a screen. Now, imagine that on the screen you can see yourself — not as you’ve been, but as you would like to see yourself — without pain — and able to function at your maximum capacity.

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Qualified masseurs are often found these days working with the pain unit. Massage can range from the typical European style of massage to the Oriental-style Shiatsu therapy now popular with patients attending pain units. The main difference from conventional massage is that Shiatsu uses the points and principles of acupuncture.

Recently, with the epidemic of repetitive strain injury in Australia, massage has been found to be extremely effective with many patients.

Occupational therapy

Occupational therapy, as mentioned in the chapter on pain clinics, is useful both to provide patients with assistance in the necessary activities of daily living. This may be done by assistance in the provision of aids such as tap turners, special chairs or rails which can be used by some patients in the home to increase mobility.

The occupational therapist can also help reassess capacity for work, make visits to work sites to assess suitability and to make ergonomic assessments.

Social workers

Social workers play an important role in helping to direct attention to necessary welfare arrangements and accommodation.

Because of the far-reaching problems associated with chronic pain, it is sometimes advisable for the social worker to make direct contact with the family of the pain patient, the employer or even friends.

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