Sunday, July 5

More studies needed on the human pain system


(From left) Mathew R D’Uva, Professor Lars Arendt-Nielsen and Dr Mary Suma Cardosa at a press conference on the sideline of the 8th Association of South-East Asian Pain Societies (ASEAPS) Congress 2019 in Kuching.

DESPITE rapid medical advancement where significant breakthroughs have made from time to time, there is currently still room for greater understanding of the human nervous and pain system.

The deficiency in this area of medical science has often resulted in inadequate treatment of chronic cases. And the problem is compounded by poor understanding of pain in society.

Changes occurring in the human nervous or pain system crimp the effectiveness of not only treatment but also that of post-treatment complications.

Dr Athena Tang opines that pain recognition in Malaysia is still in its infancy.

According to International Association for the Study of Pain (IASP) president professor Lars Arendt-Nielsen, the effectiveness of medical drugs prescribed these days to address pain is limited due to the abnormal changes taking place in the nervous system.

“That’s why pain management is so complicated. While we know a lot about the normal human pain system, the whole system is, however, changing. What we think that usually works in the system is no longer working,

“As a result, the healthcare community is not very good in diagnosing chronic pain. And one out of five people in the world is suffering from some kind of chronic pain,” Prof Nielsen told reporters on the sideline of the recent 8th Association of Southeast Asian Pain Societies (ASEAPS) Congress 2019 in Kuching.

Over 400 speakers and delegates from 36 countries were in attendance.

ASEAPS is a grouping comprising the chapters of the International Association for the Study of Pain (IASP) in the Asean region.

Prof Nielsen said pain was a widespread problem and while there were different opportunities in different regions of the world to manage the human body pain system, nothing much had changed as the same kind problem was still existed today,

International Association for the Study of Pain (IASP) chief executive officer Mathew R D’Uva said pain was placing a heavy burden on society as it had a big impact on a person’s well-being and ability to work.

“One of the things we talk about is the huge problem for society, resulting from pain, as lifestyles can be greatly impacted,” he added.

Prof Nielsen addressing the 8th ASEAPS Congress 2019 attended by over 400 speakers and delegates from 36 countries.

Sick days

According to the GlaxoSmithKline (GSK) Global Pain Index 2017, Malaysians take an average 2.5 sick days every year due to body pain – and on a global scale, sick days from body pain is costing about $245 billion annually to the world economy.

“So one of the things we’re working very hard on is trying to share practices to help patients cope with pain, and raise awareness among pain management specialists and global health organisations,” D’Uva said.

Eighth ASEAPS Congress 2019 organising chairwoman and Malaysian Association for the Study of Pain (MASP) president Dr Mary Suma Cardosa pointed out that people could experience pain in every region of their body and a specialist would usually be consulted to treat pain in a specific region.

“We usually treat a pain by trying to get rid of it but we know there are some kinds of pain that cannot be completely eliminated because of the changes to the body pain system.”

She said a more holistic approach should be preferred whereby a multi-disciplinary team was assembled to diagnose a patient’s pain problem and render treatment, including using a psychological approach and cognitive therapy.

She added that a strong medication like morphine would occasionally be prescribed to treat acute pain after a surgery because a patient would face a higher risk of developing chronic pain if the acute pain was not treated properly.


Still in infancy

Universiti Malaysia Sarawak (Unimas)  Associate Professor in Anaesthesiology and Pain Management from Faculty of Medicine and Health Science Dr Athena Tang Mee Yee opined that pain recognition in Malaysia was still in its infancy.

“Often, patients need to physically prove to doctors they are experiencing pain. We’re still looking for a lot of signs and external behaviours. Many patients sometimes feel they have to prove to us (doctors) they are actually in pain.”

Dr Tang said pain recognition was not just about physical symptoms since patients would be experiencing a great deal of emotional and psychological traumas at the same time.

“Because the recognition (of pain) is very poor, the assessment by doctors may not adequate. A paradigm shift is needed to help the greater population recognise pain from multiple perspectives.

“We should also recognise that besides the physical aspects (symptoms), we have to evaluate the emotional and psychological aspects as well to treat a patient as a person rather than as a disease itself.

She hoped the 8th Congress would be able to help healthcare professionals bridge the gap between diagnosing a patient’s illness and looking at how the illness might affect the patient.

“The patients themselves need to play a more active role during recovery while doctors had take a multi-disciplinary approach in dealing with the patients’ illnesses to maximise the chances of recovery,” she said.



Prof Nielsen lamented that scepticism on diagnosing pain was still prevalent in society which tended to want to “see” the patients’ pain first before believing them but the fact is that even the pain experienced by the patients would not show up in their x-ray results.

“I mean you may not be able to see it but you have to believe in it. You have to treat it based on what the patients are telling you. We try very hard to find the bio-markers but so far it has been very difficult,” he noted.

Dr Cardosa made a comparison between diagnosing pain and diabetes, saying in the latter, one only had to take a blood test to confirm the result whereas in the case of pain, there was a great tendency to believe patients might be using it as an excuse to “mask their laziness” even though they were actually in pain.

Prof Nielsen, meanwhile, observed that more and more people were experiencing new types of pain due to treatments administered for other illnesses.

“We’ve been having very good drugs in the market for the past 10 to 15 years but now, we’re starting to have a new group of patients who are experiencing pains due to the treatments administered.

“This is worrying trend and more resources are needed for research before the problem  spirals out of control,” he cautioned.

While medical advancement has its advantages, it is often juxtaposed with drawbacks.

According D’Uva, progress in medicine has led to a higher success rate of cancer diagnosis and treatment but an increasing number of patients are also experiencing chronic pain due to complications caused by the disease and its treatment.

He noted that one of the constraints faced by doctors was the lack of sufficient time to conduct a proper diagnosis and hoped the 8th Congress would be platform to discuss this and other pressing medical issues.

Themed “Building Collaborations in Pain Management’, the Congress was organised by the Malaysia Association for the Study of Pain with support from the Sarawak Convention Bureau, the Sarawak Tourism Board, the Ministry of Tourism, Arts and Culture, the Malaysia Convention and Exhibition Bureau and the Malaysia Tourism Promotion Board.


Breaking barriers

In her welcoming message, Dr Cardosa said the Congress aimed to break barriers and maximise the expertise of different healthcare providers to achieve synergy for better patient-centred outcome.

“The International Association for the Study of Pain (IASP) and the pain societies converging here are a mix of different clinicians.

“We have doctors, physiotherapists, nurses, psychologists, researchers and pharmacists –  a variety of people from different healthcare backgrounds,” she said.

ASEAPS was incepted with the signing of a Memorandum of Understanding (MoU) in 2004 by the presidents of pain societies in Malaysia, Singapore, Thailand, Indonesia and Philippines and Myanmar. These countries became members of the Association in 2015.

Founded in 1973, IASP works to support research, education, clinical treatment and better patients outcomes for all conditions with the goal to improve pain relief worldwide.

“Our headquarters is based in Washington DC where people in the office are assisting thousands of volunteers worldwide towards better pain management.

“It’s all based on volunteerism and commitment in moving this area forward,” Prof Nielsen said.

With 7,000 members from over 130 countries, 94 national chapters and 24 special interest groups, ASEAPS fosters exchange of ideas and education in advancing in the field of pain science.