It is the most common reason for people to consult their doctors and one of the main causes of absenteeism from work. Pain is increasing among the population, and it is sometimes described as “the silent epidemic”.
Increased life expectancy, certain habits in today's society - such as bad posture at the computer or a sedentary lifestyle - and the desire to reach old age in as good a physical condition as possible means that nowadays an increasing number of people are asking for specialist attention because of a condition which is affecting their everyday lives.
When pain goes on for between three and six months it is considered chronic. About 20 per cent of the population in Spain aged between 18 and 29 are affected by this, and more than 40 per cent of over-65s, according to the Spanish Pain Society (SED).
Under the Andalusian Plan of Attention for People in Pain, when it is intensive and GPs are unable to treat it the patient is referred to a Pain Unit, where professionals try to improve their quality of life through medication and different techniques.
More than 11,000 people with chronic pain attend the specialist units at the Civil and Clínico hospitals in Malaga every year, where teams of anaesthetists and nurses, with the collaboration of colleagues in other departments, try to alleviate their suffering.
The heads of these departments, which are part of the anaesthesiology sections of the hospitals, know that it is very difficult to eliminate pain completely; it is something that can only be achieved on certain occasions. This comes as a severe blow for patients when they ask their doctor “Will this pain go away one day?”
“I always tell them I want to improve their quality of life, not make the pain go away. I can eliminate it with drugs but that would make them continually sleepy and that is no life. It's like a balance: you have to weigh up the benefits of the analgesics against their side effects and look for a mid-point where the medication works and the side effects are tolerable,” said Mariano Fernández, coordinator of the Pain Unit at the Civil Hospital, which was set up in the 1980s.
Nearly all the patients who go to the unit are suffering from depression and/or anxiety because for years they have been putting up with a pain that affects all areas of their lives, personally and at work; and it doesn't only affect them, but their families as well.
“They feel desperate when they come here; they are suffering, tired of the system, depressed and their family lives have deteriorated,” said Dr Fernández.
He says that on average when a patient comes to his unit he or she has already spent two years seeing GPs and specialists.
“Many people are already at the end of their tether, and when someone is in continual severe pain they can develop a complex syndrome of chronic pain with anxiety and depression which is very difficult to treat,” said José Manuel González Mesa, coordinator of the Clínico Hospital's pain unit, who says state of mind is important in cases such as these.
“I would say it is like a type of switch which affects the intensity of the pain,” he said. These patients often feel very alone and they isolate themselves, which makes the pain even worse.
Most of the patients they see (90 per cent) are not cancer patients and the most prevalent condition is lumbago, which affects 70 per cent of them, followed by neuralgias, neuropathies and pain in the joints and skeletal muscles, explained Dr Fernández. Some people, about one per cent of the total, are suffering from post-operative pain. As the number of people undergoing surgery is constantly increasing, more are affected.
Dr Fernández said some pains are caused by bad habits. “Sitting in the wrong position at the computer can cause neck pain or lumbago which becomes chronic over time,” he explained.
With regard to age, it varies widely from children to the elderly, although the biggest group is the over-60s. There are also more women than men, which Dr Fernández said is due to the greater prevalence of degenerative illnesses in females.
As well as medication, the doctors often use inverventionist techniques such as infiltrations or devices to relieve the pain. “We do everything from simple things like infiltrating a knee or shoulder to very complex techniques like putting an electrode in place to treat the pain in a hand or foot,” he explains. Intrathecal morphine pumps and radiofrequency are also used.
“We are improving a great deal in this aspect, although we still have a long way to go,” said Dr Fernández. He believes the pain unit needs to be enlarged in order to be able to attend to everyone who needs it.
“There is a waiting list because we have so many patients; every day we have more referrals because people are asking to come,” he said. He also believes that all medical students should be given specific training about pain as part of their degree courses.
The baby boom
His counterpart at the Clínico hospital, José Manuel González Mesa, agrees. He says anyone who is studying Medicine needs to know a lot more about pain. He would also like more space in his unit, where an average of 30 patients a day are seen and 12 techniques are carried out.
“When a specialist refers a patient to us they normally have to wait between 15 days and six months for an appointment, depending on their problem,” said this anesthesiologist, who also warns that the 'baby boomers' are getting older now and this is reflected in the number of people asking doctors and specialists for pain relief.