NHS: Pain Management Services

Lord Alderdice Excerpts

Wednesday 7th July 2010 Lords Chamber

[Lord Alderdice]

My Lords, the noble Lord, Lord Luce, who introduced the debate, and an astonishing number of other noble Lords have described how their own personal experiences have given them a profound insight into the importance of the dread subject of chronic serious pain. They have also shown an understanding and deep appreciation of the possibilities of treatment of this disorder.

In the short time available to me, I wish to stress three points. The first is the biopsychosocial aspect of pain. I hope that my noble friend will help the department to understand, as the noble Lord, Lord Walton of Detchant, pointed out—so clearly as he always does—the hugely important physical and biological aspect of much pain, and as other noble Lords have pointed out, its psychological aspects, particularly the noble Baroness, Lady Masham of Ilton. Others have pointed out the social aspects, as did the noble Baroness, Lady Morris of Bolton. Pain of this kind is sometimes largely physical in its origins, but, at other times, the psychological and the social components play a very important role as well. They do so not only in its origin but also in its treatment and management. All those elements are extremely important. There is a tendency sometimes to think that the biological side of things is only about pain relief in the form of medication. There are other kinds of physical approach to the treatment of pain. My first point then is the need to understand the biopsychosocial nature of the disorder and its treatment.

My second point is the need to pay attention to the needs and wishes of the patient, as the noble Baroness, Lady Pitkeathley, pointed out. In principle, at least, that is not so difficult when the patient’s cognitive function is intact and they are able to communicate. Many patients suffer from pain, but their cognitive function is impaired and they may be suffering from dementia. Many elderly people suffering from dementia do not have their pain understood and attended to because they are not able to communicate it clearly. That is also true at the other end of the age scale. Many children are unable to communicate their pain clearly because they cannot even understand what is happening to them. Their pain is not properly dealt with and their misbehaviour is sometimes treated inappropriately. Likewise, the pain of those with psychiatric disorders is sometimes simply dismissed—“Oh, it is all in their head”—and is not properly dealt with. Those with learning disabilities also have great difficulty in communicating the nature of their pain. As the noble Baroness said, attending to the needs and wishes of the patient is crucial, but it is not always easy, and I trust that my noble friend the Minister will be able to assure us that it is appreciated that attending to the needs and wishes of patients is more complex than simply listening to them.

My third point is that, although it is extremely important to have expert pain clinics, only a minority of patients will ever be able to get to them. What can be very helpful to doctors, nurses and other clinicians who deal with patients with pain is to be able to contact such clinics and ask over the telephone directly for advice on how they might handle them. We shall never be able to train all our practitioners, GPs, community nurses and so on in the most up-to-date and complex ways of dealing with these patients, but we can make sure that they have access to those who are up to date. When I was a psychiatrist, it was possible to contact other clinicians who understood how to deal with such things and to receive advice from them and then make it available to my patients. I trust that my noble friend will be able to reassure us that practitioners will be able and encouraged to make such contact, and that it will be seen not as a failure of their professional ability but as a fulfilment of it if they do so.