VICDOC Winter 2022 - Magazine - Page 17
MENTAL HEALTH
––
Up to 60 per cent of people referred to Alfred
Health’s Pain Clinic and other pain services around
Australia, suffer moderate to severe depression in
association with their pain. A/Prof Arnold says part
of the treatment is to address their mental health as
well as their pain and their function.
“Sometimes people who are depressed have
no energy to take things forward. These patients
practise avoidance, or might be inactive or socially
withdrawn. We have to treat a depressed patient
before we can address the management of pain
because we need self-motivation and energy from the
patient. That is the challenge. If you don’t start your
discussion with the patient in a good way, they reject
your suggestions and say, “You think it’s all in my
brain. I’m going somewhere else.”
A/Prof Arnold says the body and the mind
cannot be separated in pain medicine. “A lot of
the focus in medicine is on the body as a standalone item and it’s really not the way it is. We’re
understanding much more about how amazing the
nervous system is but also how incredibly powerful it
can be when it gets out of kilter. The nervous system
becomes sensitised and it gives all the wrong messages
and perpetuates the pain. Persistent pain is very, very
complex. It can get into a cycle. You have to break
into this cycle to change it.”
THE DEVELOPMENT OF PAIN MEDICINE
IN AUSTRALIA
––
One in five people in Australia experience chronic or
persistent pain at some stage in their lives, and as a
result, pain medicine is a fast growing specialty.
With her primary training in rehabilitation
medicine, A/Prof Arnold recognised the potential
of pain medicine early in her medical career and has
been pivotal in championing its growth. She was the
first female President of the Australian Pain Society
(2003-2006), the multidisciplinary organisation that
first promoted pain practice in a multidisciplinary
way in Australia.
When the Faculty of Pain Medicine of
the Australian and New Zealand College of
Anaesthetists was established in 1998, A/Prof
Arnold was elected as a Foundation Fellow. It
was the first multidisciplinary medical academy in
the world devoted to education and training in pain
medicine. She grew the specialty through tireless
dedication to the work of the examination, research
and training unit accreditation committees. Pain
medicine was recognised as a specialty in Australia
in 2005 (and 2012 in New Zealand) with both
countries now considered global pioneers in the field.
A/Prof Arnold says the treatment of pain
has changed over the decades. “It’s certainly
more recognised. There’s been a growing body
of knowledge about pain, how it begins, how
it develops, what maintains it and different
approaches to treatment for it. Many chronic pain
conditions were poorly understood in the past and
sometimes that meant patients were sometimes
not considered credible in their symptoms or
considered to have a psychological problem rather
than a physical problem. I think we’ve become more
sophisticated in our approach. We’ve developed an
understanding that sometimes a multidisciplinary
approach is what is needed rather than more
surgery or more pharmacology. A whole-of-person
approach is required including psychological skills
and the management of common or uncommon
musculoskeletal or neurological conditions.”
VI CD O C WI NTER 2022
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