Pain medicine: advances in basic sciences and clinical practice.

The meeting from which this issue stems celebrates advances made in ‘pain science’ translating to practice in man and the birth of The Faculty of Pain Medicine of The Royal College of Anaesthetists. With some imagination, it could be argued that the programme for a meeting such as this was set almost 350 yr ago by the philosopher and mathematician Rene’ Descartes who described human pain as ‘Fast moving particles of fire . . . the disturbance passes along the nerve filament until it reaches the brain . . . Descartes (1664).’ The 2008 meeting contained some excellent presentations covering: the sensing of pain (fast moving particles of fire), spinal processing/neuropathic pain (disturbance passes along the nerve filament), central processing (reaches the brain), and pain medicine/management (an extension of which Descartes would no doubt approve). Pain causes significant suffering and distress, is feared by patients, is often poorly understood, and hence poorly managed by clinicians. Acute pain is the most common reason for a medical consult and .50% of the population will make this consult during their life. A survey for The British Pain Society (2005) of 975 people reported that 21% experienced pain every day or most days. This equates to 10 million across GB! In terms of chronic pain, the picture is not much better with figures for incidence of chronic pain being very variable. For example, in 1999, Elliott and colleagues surveyed 29 GP practices (3605 questionnaires covering 5036 patients) in the Grampian region of the UK and described an age-related increase in the self-reporting of chronic pain with an incidence of approximately one-third in 25–34 yr olds and a little less than two-thirds in those over 75 yr old. In March this year, Rivara and colleagues surveyed more than 3000 trauma patients in 69 USA hospitals and found that 63% still reported pain 12 months after injury. Pain is one of the most common symptoms associated with cancer. The prevalence of cancer pain is approximately 30–50% among patients with cancer who are undergoing active treatment for a solid tumour and 70–90% among those with advanced disease. Eighty-eight per cent of cancer patients in the last year of their life are in pain and 47% of those treated for pain by their GPs said their treatment only partially controlled their pain. Certain types of cancer pain can be particularly challenging to control, such as neuropathic pain and cancerinduced bone pain. Current treatments may have limited efficacy and there is a need for developing new strategies for managing cancer pain. Indeed, the use of nerve block in palliative care was discussed by Chambers. Chronic pain, in particular, is a major socioeconomic drain. One example is chronic back pain that has been estimated to cost .£4 billion in terms of healthcare and social costs, including lost production costs. A recent study of the prevalence of back pain in Germany found a life-time prevalence of 85.5% with 18.2% having severe pain. Musculoskeletal pain in general is common, with 20% of people reporting widespread pain, and up to 50% reporting back pain in a 1 month period. Population factors such as education and socioeconomic variables and individual factors (smoking, diet, etc.) may all contribute to chronic musculoskeletal pain. – 13 Disappointingly, community-based psychosocial interventions, although superficially attractive, have not been of major benefit, although there are some examples of population-based interventions that may positively alter attitudes to back pain. – 17 Neuropathic pain, which is particularly challenging to treat effectively, is found in similar patient groups as those affected by back pain, with a prevalence of 8%. It is clear that we need to improve our understanding of modifiable risk factors that predispose to developing chronic pain, in order that we can structure our services to prevent chronic pain developing or target it early in its course. 20 Adequate and appropriate pain assessment in the clinic is an important prerequisite in formulating a pain management plan, although there is considerable evidence that this is often not done outside the specialist setting. 22 Both the importance of pain assessment tools and their