As a (semi-retired) consultant in pain medicine I welcome Claire Caruana’s article on chronic pain (The Sunday Times of Malta, September 23). The statistics she quotes have been around for a very long time, and were first revealed both by IASP (International Association for the Study of Pain) and by the Pain in Europe Survey (2004).
It is totally unrealistic for anyone to expect the management of chronic pain to be an exclusive problem for the secondary and tertiary services of the health service. General practitioners who provide primary care need to take a more active role in the management of this serious problem.
It all has to start at university where more time needs to be devoted to teaching both medical and nursing students about chronic pain as a disease in its own right. General practitioners need to attend regular seminars to educate them in the proper prescribing of drugs that relieve pain.
Many doctors in primary care lack the confidence to prescribe the correct drugs and/or to escalate the dosage should the starting dose not be sufficient, thus discarding potentially very useful medication. Intense training by experts will instil the confidence needed to deal with this.
The problem of musculoskeletal pain, as highlighted by your correspondent, is a very real one. What has struck me about the health sector in Malta (as opposed to the UK, where I practised for over 40 years) is how general practitioners under-use physiotherapy services. With monotonous regularity, patients suffering from musculoskeletal pain are sent by their doctor to the pain clinic ‘for an injection’ when they have not yet been assessed and treated by a physiotherapist.
In addition, many patients who are referred to a physiotherapist fail to carry out the home exercises recommended to them. They expect an instant cure for their pain, which, they firmly believe, only an injection, as recommended by their own doctor, will help. Obesity, which certainly contributes to musculoskeletal pain, is another factor that many patients fail to acknowledge and deal with.
A seamless integrated chronic pain care pathway plus ongoing public education is the answer. With goodwill and dedication at all levels of the healthcare sector, it can be achieved.