1 in 3 people in Ireland are living with chronic pain. Prof. Dominic Hegarty, Consultant in Pain Management and Neuromodulation, Mater Private Hospital Cork and Clinical Director of Pain Relief Ireland discusses living with the life-altering condition with Newstalk's Pat Kenny.
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PK: According to chronicpain.ie one in three people in Ireland are living with chronic pain the condition is often life altering and can really affect quality of life.
I'm joined now by pain consultant Dr. Dominic Hegarty, good morning and welcome.
Good morning Pat. Thank you very much for taking the opportunity to chat.
PK: Now first of all, you might give us the definition of chronic pain. Like when does it become chronic?
Yep, in a very short window within about three months of an individual who has an acute pain on a regular basis - it can then reach the definition of chronic pain. And that's pain that annoys or irritates people on a regular basis so much so that they have to take medication on they genuinely are trying to do something about it at that stage.
So you can see very quickly this catches up on people.
PK: Now does chronic pain have to be severe pain?
No, not at all. I think that's sometimes what people miss a little bit. It can be it can vary in intensity. But also in type. So someone who has a leg pain, a sciatic or a low back pain, that's chronic pain, but you can have migraines, you can have constant, constant headache pain or chronic pelvic based pain that also meets the criteria and there's a whole range of pain intensities because after all, pain intensity is your own pain score. So my seven out of 10 score is not the same as yours, etc. So it's quite impacts on a day to day basis.
We could do tend to find this pitches in around mid range between five and seven out of 10. That'd be where people would say that's enough. I need to do something about it at that stage. And that's really an impact on day to day activities.
PK: Do you distinguish between an ache and pain?
Well, yes, I think by the time they would make it into my office, they have very clearly gone through quite a lot of other strategies to try and deal with the ache bit in fairness. Primary care GP, take an awful burden, burden and a brunt of this. You must remember 60/ 70% of times people go to see their GP is actually about pain. Usually it isn't that level of an eche level its annoying. And then strategies such as physiotherapy, massage, exercise, maybe some low level medication strategies can deal with that and deal with it very effectively and then once it begins to escalate that's when, when they start getting into the next level which is you know, more intense physio, or speaking of physios or Pain Physicians, consultants neurosurgeons etc.
PK: Yeah, because surgery may be the way out of your pain. But otherwise it's medication, I suppose. Maybe some people can manage it with even hypnosis or yoga or other techniques, but medication is normally the way and there are different kinds of medication. Does it determine where your pain is and what's causing it which medication you take?
Yes, you're quite right. There are a range of medications and it can be from simple anti inflammatories is probably one of the more common products people would use and either over the counter or prescription and then escalating through some form of an opioid. Now that's a you know a dirty word in present language, but essentially they can escalate upwards to controlling the pain of these agents and then if we have certain features of the pain, for example, if there's pins and needles burning sensation, electrical activity, that brings it to the next level of what we call neuropathic pain, pain within the pain system itself, that warrants a different type of medication to deal with that aspect to itself.
So ultimately, Pat really it’s listening to the individual, hearing what they describe their pain pattern is, and then choosing off the criteria of what the best match product to that is.
PK: You'd hope that you will get to the cause of the pain. And address the cause rather than the symptom.
That is the ultimate goal. Because obviously, if you can get the primary cause under control, things move forward. Sometimes that's very, very practical, and it's very useful. For example, if you've is protrusion, you've ruptured a disc, you've got a nerve pain is going down your leg. Well it's the disc now maybe you need surgery, maybe not. Maybe you need a pain focused injection to the area to solve the problem and heal the territory. And that ultimately can give you the long term outcome you want. On other types of pain it's not as easy as that because the pain patterns are different, the networks of pain can be quite diverse and can be very focused. So again, it's very often from my perspective, and trying to listen to the pain pattern identified nerve fibers and sequences of nerves that we can intervene and stop the signal and give people the chance to respond. Sometimes you must remember Pat, the source of the pain may be over. For example, you might have sprained your ankle, fractured your ankle, that may have healed you may have had surgery, you may not have had surgery, but you may have persistent pain, post it so the source of the pain is fixed, but the actual nerve fibers themselves have now become reprogrammed if you like, so now they are hypersensitive. They're overreacting to the situation. And that's where the challenge comes in. Because people then come in, they get a whole battery of MRI scans, X ray scans, everything looks normal. And of course that's the last thing a chronic pain patient want to hear you say is Oh, we can find nothing for you, when in fact it's the nerve fiber pain that's the problem. And and that's where you know speaking to people who can understand this for the individual to try and work with them to try and find a solution. And people are fantastic Pat because if you can reduce their pain symptoms by about 50% that can make such a big impact on their quality of life. Their activity levels, their sleeping patterns, and that might be all they're looking for that little bit of relief to give them the right direction.
PK: Now do you think GPs are expert enough in pain management or even understanding pain? Do they have enough training in pain management in understanding what’s best?
They do their very best to deal with a whole range of pain from day to day they struggle to be fair, because again, they've inherited what we've learned over the years and pain is changing. I'm lucky I'm in the area specialising for years to I get to sit on top of it. And you're always trying to bring GPs up to speed. They're a fantastic group that really do try and learn and make things forward. But they can only do so much as well. Because you'll remember they have only a prescription pad and maybe a physiotherapy strategy. And there's other options and sometimes that's where you want the GPs to be aware of saying look, I'm not winning here. We're not doing well. We need you to see someone in the area who can intervene with an intervention or some form of strategy from there.
PK: We're always talking about technological fixes. I mean, are there technological fixes like I know superficially, you can use things like Tens machines, but are there implants pain management implants?
Indeed Pat, this is really where the leading lights of, of pain medicine is going into the future. The med tech industry which we're very lucky in this country, we have Medtronic, Boston Scientific, producing equipment that helps us deal with these pain. So we can intersect the pain pathways using electrical or other devices. So yes, there's one of these aspects called spinal cord stimulation. Now, this isn't for everyone it is for a very select cohort. But again, for those people who can benefit from it, it's it's a fantastic opportunity. And this is something that people then a little bit like cardiac pacemakers. I describe it to my patients as being a pain pacemaker. You could control the pain on a day to day basis. And now we're pushing the technology forward so that we can program people at distance. We can monitor their health activities, we can see how much they're using the equipment, so we can really become clever, and take this to the next level. It is for a group of patients but more people could benefit from it if the knowledge was out there. So Ireland are leading the way in many ways in this area itself. It's used globally. And there's a lot of a lot of evidence to say that this is the way we should be thinking about it because of course it's drug free. It's user friendly, and individuals have control they control the pain treatments they get on a day to day basis. And that's always the first thing people are most worried about. When they when they come and meet me is the pain is dominating their life and they want to get some control back onto it. And this is a fantastic way of doing that.
Fantastic and of course it can impact on mental health, constant pain, no doubt about that. Dr. Dominic Hegarty consultant in pain management, and neuromodulation at the Mater Private Hospital in Cork and Clinical Director of Pain Relief Ireland thank you very much.