Pain and Injury: Preaching in a Wilderness

PAIN and INJURYPAIN and INJURYPreaching in a wilderness.Preaching in a wilderness.

Mark CranswickMark CranswickSenior PhysiotherapistSenior PhysiotherapistPain Management UnitPain Management Unit

““L’operazione Chururgica”(Gaspare Traversi, 1753/54)L’operazione Chururgica”(Gaspare Traversi, 1753/54)““L’operazione Chururgica”(Gaspare Traversi, 1753/54)L’operazione Chururgica”(Gaspare Traversi, 1753/54)

Data from 2006/07 New Zealand Data from 2006/07 New Zealand Health SurveyHealth Survey

1 in 6 (16.9%) of New Zealanders 1 in 6 (16.9%) of New Zealanders report chronic painreport chronic pain

Nearly half (48%) use some form of Nearly half (48%) use some form of medical treatmentmedical treatment

A fifth (21.4%) report severe or very A fifth (21.4%) report severe or very severe recent painsevere recent pain

Two-thirds (67%) have lived with Two-thirds (67%) have lived with chronic pain for 5 or more yearschronic pain for 5 or more years

EpidemiologyEpidemiology

N# 85,088 in 17 countriesN# 85,088 in 17 countries Between 10% and 42% report chronic Between 10% and 42% report chronic

back/ neck pain in the previous 12 back/ neck pain in the previous 12 monthsmonths

Between 20% and 45% of persons Between 20% and 45% of persons with back and neck pain also met the with back and neck pain also met the criteria for depressioncriteria for depression

Approximately 25% meeting criteria Approximately 25% meeting criteria for anxietyfor anxiety

““Pain is a passion Pain is a passion of the soul”of the soul”

Aristotle 300BCAristotle 300BC

““Pain is a passion Pain is a passion of the soul”of the soul”

Aristotle 300BCAristotle 300BC

Acknowledgement to:Lorna Fox

NZPS 2007

Acknowledgement to:Lorna Fox

NZPS 2007

Rene Descartes 1662Rene Descartes 1662Rene Descartes 1662Rene Descartes 1662

Acknowledgement to:Lorna Fox, NZPS 2007Acknowledgement to:Lorna Fox, NZPS 2007

DescartesDescartes DescartesDescartes

When it is not in our When it is not in our power to determine power to determine

what is true, we ought what is true, we ought to act according to to act according to

what is most probable.what is most probable.

Discours de la MéthodeDiscours de la Méthode

Acknowledgement to:Lorna Fox, NZPS 2007Acknowledgement to:Lorna Fox, NZPS 2007

“ “ What is Pain? ……What is Pain? ……

… …incapable of definition, incapable of definition,

or even of accurate or even of accurate

description”description”Lancet 1887Lancet 1887

“ “ What is Pain? ……What is Pain? ……

… …incapable of definition, incapable of definition,

or even of accurate or even of accurate

description”description”Lancet 1887Lancet 1887

In G D Schott Communicating the Experience of Pain : the Role of Analogy Pain 108 (2004) 209-212


““Pain … is known to us by Pain … is known to us by experience and described by experience and described by illustration … we have no illustration … we have no knowledge of pain beyond knowledge of pain beyond that derived from human that derived from human experience …”experience …”

Sir Thomas Lewis 1942Sir Thomas Lewis 1942

““Pain … is known to us by Pain … is known to us by experience and described by experience and described by illustration … we have no illustration … we have no knowledge of pain beyond knowledge of pain beyond that derived from human that derived from human experience …”experience …”

Sir Thomas Lewis 1942Sir Thomas Lewis 1942



DDefinition of Painefinition of PainIASP 1979IASP 1979

DDefinition of Painefinition of PainIASP 1979IASP 1979

Pain is an unpleasant sensory and Pain is an unpleasant sensory and emotional experience associated emotional experience associated with actual or potential tissue with actual or potential tissue damage, or described in terms of damage, or described in terms of such damage.such damage.

Analogy serves a remarkable Analogy serves a remarkable and unique function, enabling and unique function, enabling

the inexpressible to be the inexpressible to be communicated by reference to communicated by reference to something else. This is never something else. This is never

more important than in the more important than in the expression of painexpression of pain..



““Were it not for the possibility of Were it not for the possibility of sensing body states that are sensing body states that are inherently ordained to be painful inherently ordained to be painful or pleasurable, there would be or pleasurable, there would be no suffering or bliss, no longing no suffering or bliss, no longing or mercy, no tragedy or glory in or mercy, no tragedy or glory in the human condition.”the human condition.”

Antonio DamasioAntonio Damasio

From Descartes’ ErrorFrom Descartes’ Error

““Chronic pain turns a life into a Chronic pain turns a life into a mere existence. The effects are mere existence. The effects are devastating and often devastating and often demeaning. It has a negative demeaning. It has a negative impact on relationships inside impact on relationships inside and outside the home. It involves and outside the home. It involves the loss of independence, dignity the loss of independence, dignity and control”and control”

InternationalInternational Pain Summit IASP Montreal, Sept 2010 Pain Summit IASP Montreal, Sept 2010

Some observationsSome observations

We live in a time when science seems to We live in a time when science seems to be bursting with promisebe bursting with promise

We are told to expect curesWe are told to expect cures The hype serves to delude us into thinking The hype serves to delude us into thinking

that each of us is the sum of our genesthat each of us is the sum of our genes The hype drives a reductionist philosophyThe hype drives a reductionist philosophy Created industries based on diagnostic Created industries based on diagnostic

entrepreneursentrepreneurs

Some observations cntdSome observations cntd

Back pain in the workplace is just Back pain in the workplace is just one window on human predicamentone window on human predicament

Global illness narrative- the worried Global illness narrative- the worried wellwell

The illness of work incapacityThe illness of work incapacity If you have to prove you are ill, you If you have to prove you are ill, you

can’t get wellcan’t get well

Paradigm shiftParadigm shift

Adopt a “salutogenic model” with Adopt a “salutogenic model” with relationship understanding between relationship understanding between health, stress and copinghealth, stress and coping

““health-ease” versus “dis-ease’ health-ease” versus “dis-ease’ continuumcontinuum

The choice to be a patient is just that, The choice to be a patient is just that, a choicea choice

Accepting that to be “well” is not to be Accepting that to be “well” is not to be free of symptomsfree of symptoms

Paradigm shift cntdParadigm shift cntd

We should question just what in the We should question just what in the workplace is compromising their workplace is compromising their ability to copeability to cope

We should guarantee workplaces We should guarantee workplaces that are comfortable when we are that are comfortable when we are well and accommodating when we well and accommodating when we are illare ill

““common sense” is seldom common common sense” is seldom common and not always senseand not always sense

Pain isPain is

My pain as it grows, is an imperative, My pain as it grows, is an imperative, an obsession, a compulsion, a an obsession, a compulsion, a dominating, engulfing reality. Your dominating, engulfing reality. Your pain is a different matter. I observe you pain is a different matter. I observe you and listen to you. I sympathise with you and listen to you. I sympathise with you by guessed analogy . . .by guessed analogy . . .

Patrick D WallPatrick D Wall

Health & Medicine

Pain and Injury: Preaching in a Wilderness