Dr David Jones
A poorly understood condition suffered by up to one in
five New Zealanders finally gained its own scope of practice
last month when the Medical Council formally recognised pain
medicine. Dunedin anaesthetist and pain medicine specialist Dr
David Jones had led a six-year campaign to ensure the specialty
achieved the status it has in Australia, where it has been
recognised since 2005.
''Recognition is the first step in legitimisation. There's
still other specialists around who say: `Oh, there's no need
for that, we look after pain ourselves'.''
Resources for chronic pain - Dr Jones prefers the term
persistent - are limited, doctors lack knowledge, and
patients often get wrong or contradictory advice.
Awareness of chronic pain had been emerging on the radar of
health administrators as the indirect costs of pain were
It was a ''long road'' to acceptance by the Medical Council.
''They put us through a fairly tight hoop. There's not been
any mateship, I can tell you.
''However, they have a role to protect the public, so they
were especially interested that we had adequate processes to
ensure maintenance of professional standards for our fellows,
an area in which we can all lift our game.''
He hoped recognition was another step on the way to
increasing resources for pain medicine.
A key task was educating doctors, both those in practice and
those in training.
Pain medicine was given ''one afternoon'' in fifth-year
clinical medicine and, for some, a little bit of on-the-job
work with anaesthetists.
Most persistent pain management was left to GPs, who did not
have sufficient training.
Drugs were inappropriately or poorly prescribed, particularly
opioids and benzodiazepines, which were both addictive.
What medical school failed to teach was the body's
sophisticated pain-suppression system, which could be
stimulated by exercise.
''Move, move and move'' was one of Dr Jones' favourite
Dr Jones has a lot of time for therapies such as yoga, mind
focus, improving sleep quality and not using pain to limit
He is interested in the psychology of pain. It was
''rubbish'' to assume a focus on psychological elements meant
denying the reality of pain, he said.
''I think pain's part of life.
''Resting, or falling into the take-it-easy trap, does not
help natural pain-suppression systems work optimally, yet it
is commonly dished out as advice.''
It was important to recognise the mind's ability to control
pain, which was usually more realistic than aiming to
''People make decisions based on what they believe, many of
which are not correct, yet they affect the course of their
life with the pain problem.''
He admits to frustration with some doctors, who can display
the ''lazy'' side of human nature that does not like change.
To illustrate this point, he said he circulated a paper
around relevant specialty areas in Dunedin Hospital that
demonstrated diazepam was ineffective for back pain, and
could even make it worse.
A year later, however, he was still seeing prescriptions of
diazepam for back pain.
''How long does it take to change a generation's
knowledge?''Dunedin had two of the country's 25 pain medicine
specialists, as along with Dr Jones, Dunedin obstetrician and
gynaecologist Prof Wayne Gillett specialised in persistent
pelvic pain in women.
The New Zealand committee would work closely with its much
bigger Australian counterpart as a single Faculty of Pain
Medicine within the Australian and New Zealand College of
Anaesthetists. What is chronic or persistent pain, and why is
it a somewhat vexed topic?Pain lasting more than three months
was considered persistent, said Dr Jones, who prefers the
word ''persistent'' to ''chronic'' because it is less
Early intervention was the key to reducing long-term
An area of keen interest was post-surgical nerve pain.
Due to a ''quirk of biology'', some patients suffered this
and others did not, but it was more likely in nerve-rich
areas of the body. It did not reflect a surgeon's competence.
It affected about 20% of post-surgical patients and there was
now more awareness it would not go away with time.
Dr Jones said a survey at Dunedin Hospital a couple of years
ago discovered 23% of post-Caesarean mothers suffered
post-surgical nerve pain six months or more after the
A more detailed study was being planned.
Dr Jones did not want this story to be about the ''injustices
of the world'' - a caveat made during a discussion of the
Accident Compensation Corporation.
The corporation, which once ''embraced pain'', had legislated
away some of its liability, notably in post-surgical nerve
pain. It was also in a position to call the shots in an area
Patients whose pain was caused by an accident (and who were
accepted as such by ACC) received prompt treatment from
providers. Legislating away its responsibilities regarding
pain meant more patients fell on the Ministry of Health
Medical Council chairman Dr John Adams said recognising pain
medicine would lead to increased interest in the specialty,
and more training places opening up in New Zealand.
The development would be of ''great help'' to New Zealanders
who suffered from persistent pain, he said.