NHS: Pain Management Services

Lord Walton of Detchant Excerpts

Wednesday 7th July 2010 Lords Chamber

[Lord Walton of Detchant]

My Lords, I, too, am grateful to my noble friend Lord Luce for initiating this crucial debate because pain is one of the most distressing of human experiences. I shall concentrate on the importance of accurate diagnosis of the cause of pain before an appropriate programme of treatment can be initiated.

Everyone recognises chronic pain in osteoarthritis and multiple arthritis and in patients with cancer and terminal illness, but a number of chronic pains are recurrent and not continuous. The noble Baroness, Lady Gardner, referred to trigeminal neuralgia, which is a momentary acute lancinating pain in the face that may be precipitated by touching the face, by washing, by cold winds, by chewing. It is momentary and lancinating, and is a very severe and distressing pain that must be distinguished from the chronic low-grade continuous pain in the upper jaw that is not uncommon in middle-aged people and that has been shown to be a psychogenic regional pain that not infrequently responds to anti-depressive agents once dental causes have been excluded.

There is another form of pain called cluster headache in which people, every few months, may have every night—often at the same time, such as two in the morning—a hugely intense pain around the eye and in the face lasting for about half an hour, or a full hour, which wakes them from sleep time after time. It disappears after two or three months and then comes back again two or three months later. It is not migraine, but it, too, is a special headache syndrome that remarkably has been shown to respond to a drug called indomethacin. Accurate diagnosis is crucial, which is why the education of medical students, of young post-graduate doctors and of other healthcare professionals in the recognition of the different pain syndromes is so important.

Several speakers have stressed the importance of multi-disciplinary management. I, too, stress that because, in my experience, some people with chronic low-back pain have become so anxious and tense because of it that it builds up a kind of vicious circle in which the pain is accentuated by anxiety and tension. This can sometimes be helped enormously by the prescription of anxiolytic drugs and anti-depressives, alongside analgesics. That is why the multidisciplinary approach is crucial.

There are, of course, many physical methods of treating pain, including manipulation, injections, occasionally acupuncture and cutaneous nerve stimulation. There is a huge number: far too many to mention in this setting. However, at the same time, the recognition of the nature of the pain is crucial.

Another curious pain, proctalgia fugax, is an agonising pain in the anus that lasts for five to 10 minutes. It may recur completely out of the blue and for no reason at all. I have experienced it and so have two of my daughters. It is totally benign; it is alarming but of no serious significance. Its recognition is important.

I simply stress, as have others, the important work of the Chronic Pain Policy Coalition. It has highlighted five areas of action which I hope will be accepted in principle by the Government. I also hope that the vital report by the previous Chief Medical Officer, which contained so much invaluable material, will be accepted by the Government as a principle and will not only persuade local health authorities of all kinds—primary care trusts and so on—to embark on a programme of improving the establishment of pain clinics across the country, but will be used by educational bodies for the education of healthcare professionals.