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Meaning and medication needed to treat chronic pain

Treatment for people with neuropathic pain needs to expand to include emotional and spiritual strategies because medication at best leaves more than half of sufferers with only partial relief. This is the challenge addressed by HammondCare pain specialist, Professor Philip Siddall, who spoke on ‘Living well with neuropathic pain: from medication to meaning' at the National Pain Week Conference, Westmead Hospital, last Friday.

Prof Siddall told the conference that even with the best available medications, most people living with neuropathic pain – which results from nerve damage such as through shingles – will achieve less than 50 per cent relief.

And advances in neuropathic pain medications appear to have plateaued with three major studies in the past 15 years showing little gain in the effectiveness of drug treatments in terms of providing significant relief.

“I’m not saying there isn’t a place for pain drugs but the reality is many people who experience pain from nerve damage, including those with spinal cord injury, are left with significant ongoing pain despite our best efforts with medication.

If that is the case, we need to find other ways to help people facing the challenge of living with neuropathic pain.” he says.

Prof Siddall says that alongside lifestyle approaches such as exercise and relaxation, and other skills that are used as part of cognitive behavioural therapy, there is growing interest in the potentially positive role of the spiritual dimension in living with pain.

“Our recently published research has shown that people with high levels of spiritual wellbeing – particularly meaning and purpose – can be experiencing high levels of pain without it impacting significantly on their mood and leading to depression,” Prof Siddall says.

“This is a significant breakthrough because we know all too often changes in mood such as depression and anxiety can be an additional burden for people living with pain.”

“Our research makes it very clear that enhancing spiritual wellbeing is a powerfully protective measure for the psychological wellbeing of people living with pain making it more possible for them to enjoy a good quality of life. Let’s be clear, strong spiritual wellbeing may not fix your pain, but it makes you a great deal more resilient in the face of pain.” he says.

Prof Siddall says neuropathic pain is difficult to treat because once a nerve was damaged, it was hard to find any drug that would stop its abnormal pain signals.

Also neuropathic pain tended to be complex, involving a range of mechanisms so even if one part was treated successfully, other factors continued to contribute to pain.

“We have much more success in treating acute pain and even cancer pain –most people in these situations can get good relief with available medication.” he says.

Professor Siddall is the lead clinician for the Greenwich Hospital Pain Clinic and state spinal cord injury pain telehealth service as well the author of The Pain Book and The Spinal Cord Injury Pain Book.

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