Those of us in the porfession for many years know how easily a patient can transfer from acute post operative pain to chronic pain if they are not warned of the risks, educated, and “buy in” to the speedy reduction of painkillers and exercise. However, chronic pain relief and psychiatric conditions all need therapists… and these vital people have been rationed out. We should take a leaf out of the French solution, where only psychotic demented patients get drugs, and the money saved is spent on therapists. Since much of this “chronic pain” is iatrogenic, as a nation (and commissioners), we need to face up.. Without changes in the rules though, the commissioners and managers are impotent.
MEDICINE FOR PAIN
Sir, I note the recommendations from the National Institute for Health and Care Excellence about chronic pain (“Don’t give paracetamol to patients, doctors told”, Aug 4) but am surprised that the Nice guidance committee was chaired by a psychiatrist, given that we have a Faculty of Pain Medicine. As a retired consultant in pain medicine I developed one of the early multidisciplinary pain clinics. This included psychological and supportive therapy input emphasising the minimal medication approach with pain behaviour techniques, unless there was an underlying specific problem to target.
However, as so often is the case, the acute and surgical specialties have received the principal funding in the health service while chronic illness has had “Cinderella” recognition. On the other hand, patients continue to visit primary and secondary care on a long-term basis. It is to be hoped that this report might increase resources, but one wonders if the therapists are available.
Dr Richard Atkinson
Ret’d consultant in pain medicine, Sheffield