It’s easy to assume that we know what pain is. We’ve all experienced pain, from scraped knees and toothaches to migraines and heart attacks. When people suffer around us, or we witness a loved one in pain, we can also begin to ‘feel’ with them. But is this the end of the story?
In the three videos below Joanna Bourke, author of The Story of Pain: From Prayer to Painkillers, talks about her fascination with pain from a historical perspective. She argues that the ways in which people respond to what they describe as ‘painful’ have changed drastically since the eighteenth century, moving from a belief that it served a specific (and positive) function to seeing pain as an unremitting evil to be ‘fought’. She also looks at the interesting attitudes towards women and pain relief, and how they still exist today.
On the history of pain
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How have our attitudes to pain changed?
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On women and pain relief
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Joanna Bourke is Professor of History at Birkbeck College, University of London. She is the prize-winning author of nine books, including histories of modern warfare, military medicine, psychology and psychiatry, the emotions, and rape. Her book An Intimate History of Killing (1999) won the Wolfson Prize and the Fraenkel Prize, and ‘Eyewitness’. She is also a frequent contributor to TV and radio shows, and a regular newspaper correspondent. Her latest book is The Story of Pain: From Prayer to Painkillers.
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The post Does pain have a history? appeared first on OUPblog.
With the WHO Executive Board recently adopting the resolution ‘Strengthening of palliative care as a component of integrated treatment within the continuum of care’, which is to be referred to the World Health Assembly for ratification in May, Nathan Cherny puts the current global situation in perspective and lays out the next steps needed in this crucial campaign to end suffering to millions.
By Nathan Cherny
In the curious trail that has been my life thus far, some would say that there was a certain inevitability that I would end up working for cancer patients’ right to access medication for adequate relief of their suffering. As a medical student I suffered terrible cancer-related pain from a thoracotomy to remove lung metastases for testicular cancer. As an oncologist and palliative care physician in the Middle East, my current work allows me to look after both Israeli and Palestinian patients. My profession has also taken me to caring for many “medical tourists” from Eastern Europe as well as foreign workers from Thailand, India, Nepal, and the Philippines. Oh, and I was born on Human Rights Day, 10 December 1958!
I hate pain. I am appalled by the global scope of untreated and unrelieved cancer pain. At the initiative of its Palliative Care Working Group, the European Society for Medical Oncology (ESMO) has taken this on board as a global priority issue. ESMO facilitated the first comprehensive study to evaluate the barriers to pain relief in Europe, which highlighted the distressing situation in many Eastern European counties.
Nathan Cherny
In follow-up, a large collaborative group was formed for an even more ambitious study. The Global Opioid Policy Initiative (GOPI) combined the work and talents of ESMO, the European Association for Palliative Care (EAPC), the Union for International Cancer Control (UICC), the Pain and Policies Study Group (PPSG) of the University of Wisconsin, and the World Health Organization (WHO), and 17 other leading oncology and palliative care societies worldwide.
The GOPI studied opioid availability and accessibility for cancer patients in Africa, Asia, the Middle East, Latin America, and the Caribbean. The results were published in a special supplement of the Annals of Oncology in December 2013. The seven manuscripts in the special issue highlighted the global problem of excessively restrictive regulations regarding the prescribing and dispensing of opioids — ‘catastrophe born out of good intentions’.
In order to prevent abuse and diversion, most patients with genuine need to relieve severe cancer pain cannot access the appropriate medication. Millions of people around the world end their lives racked in pain, harming not only the patients but also their families who bear witness to this torturous tragedy.
On 23 January 2014, the WHO Executive Board adopted a stand-alone resolution on palliative care which will be referred to the World Health Assembly for ratification in May 2014. This is great news for all those campaigning to improve access to medication to end suffering to millions. There is still much to be done on this long, winding road, yet we can still be proud. Thanks to our united efforts and the evidence provided by the GOPI data, our voices are being heard.
Overregulation of opioids is not the only problem impeding global relief of cancer pain. In many places around the world there is major need to: educate clinicians in the assessment and management of pain; educate the public regarding the effectiveness and safety of opioid analgesia in the management of cancer pain; and secure supplies of affordable medications.
The next steps: The GOPI Collaborative Group is now writing to Ministers of Health in the many countries where we have identified major over-regulation with a 10 point plan to help redress the problem, covering education, restrictions, limits, professional standards, monitoring, and prescription.
Tell us what actions you can take to incorporate these next steps in your country. Can you contact your Ministry of Health? What could be inspirational for others to know? We make more noise if we all shout together.
Nathan Cherny was the Chair of the ESMO Palliative Care Working Group since 2008 and has been a member of the working group since its inception in 1999. He was the main driving force in the creation of the ESMO Designated Centre of Integrated Oncology and Palliative Care Programme which was launched in 2003 and last year had its 10th Anniversary. Nathan also wrote the ESMO 2003 Position Paper: ESMO Policy on Supportive and Palliative Care. Watch the Advocacy in Action 2013 video on: Palliative Care & Quality Of Life Care: Redefining Palliative Care.
Opioid availability and accessibility for the relief of cancer pain in Africa, Asia, India, the Middle East, Latin America and the Caribbean: Final Report of the International Collaborative Project was published as an Annals of Oncology supplement in December 2013.
Annals of Oncology is a multidisciplinary journal that publishes articles addressing medical oncology, surgery, radiotherapy, paediatric oncology, basic research and the comprehensive management of patients with malignant diseases. Follow them on Twitter at @Annals_Oncology.
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Image credits: (1) Photo of Nathan Cherny, via ESMO; (2) GOPI banner, via Global Opioid Policy Initiative/ESMO
The post Global Opioid Access: WHO accelerates the pace, but we still need to do more appeared first on OUPblog.
What do anaesthetists do? How does anaesthesia work? What are the risks? Anaesthesia is a mysterious and sometimes threatening process. We spoke to anaesthetist and author Aidan O’Donnell, who addresses some of the common myths and thoughts surrounding anaesthesia.
On the science of anaesthesia:
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The pros and cons of pain relief in childbirth:
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Are anaesthetists heroes?
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Aidan O’Donnell is a consultant anaesthetist and medical writer with a special interest in anaesthesia for childbirth. He graduated from Edinburgh in 1996 and trained in Scotland and New Zealand. He now lives and works in New Zealand. He was admitted as a Fellow of the Royal College of Anaesthetists in 2002 and a Fellow of the Australian and New Zealand College of Anaesthetists in 2011. Anaesthesia: A Very Short Introduction is his first book. You can also read his blog post Propofol and the Death of Michael Jackson.
The Very Short Introductions (VSI) series combines a small format with authoritative analysis and big ideas for hundreds of topic areas. Written by our expert authors, these books can change the way you think about the things that interest you and are the perfect introduction to subjects you previously knew nothing about. Grow your knowledge with OUPblog and the VSI series every Friday!
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5. Right Livelihood
Right livelihood means that one should earn one's living in a righteous way and that wealth should be gained legally and peacefully. The Buddha mentions four specific activities that harm other beings and that one should avoid for this reason: 1. dealing in weapons, 2. dealing in living beings (including raising animals for slaughter as well as slave trade and prostitution), 3. working in meat production and butchery, and 4. selling intoxicants and poisons, such as alcohol and drugs. Furthermore any other occupation that would violate the principles of right speech and right action should be avoided.
These days I'm earning my livelihood primarily by way of my retirement benefits from Social Security and a small pension from That Insurance Company for which I worked. I also work a number of part-time jobs. I edit books, screenplays, stage plays, and other materials; I work as a patient model (also known as a standardized patient) once in a great while; I dogsit for a select clientele; and even more rarely, I catsit. I write almost every day of the year, but that doesn't bring in a lot of dough. Still, it definitely meets the criteria of Right Livelihood: it is legal, peaceful, and righteous. I harm no one with my writing, as I do my best to write as I speak, aiming to hurt no one.
There are many people my age who are resorting to selling their prescriptions in order to buy food or pay their mortgages. A person can understand how one can be driven to desperate thinking. But if one is living a Buddhist life, one cannot consider that type of livelihood, any more than working for the OLCC, or working as a meat wrapper for Fred Meyer, or a butcher for Whole Foods. A job as a bartender, or cocktail waiter would also violate the principles of right livelihood for a Buddhist. As would working at a place that sells medicinal marijuana, I think. And I think this because I believe that people choose to stay there to use the marijuana. If people picked up their drugs as they do from a pharmacy and left, that would be a different matter. As a person who lives with pain on a regular basis, I feel no need or desire to socialize with other sufferers while I take my medicine and seek relief. Therefore, I don't understand why medical marijuana users need a socializing area either. I believe this hurts the cause. Well, that was a tangent. I could be wrong. Seriously though, people who need and receive morphine for their pain, do not need a cafe in which to "enjoy" their morphine. They pick it up or have it delivered, and get relief. Period. Why wouldn't marijuana be the same when used for the same purpose?
