OTHER PEOPLE’S PAIN AND SOCIETYGiven the slow start of the professions in facing the challenge of pain, it is not surprising that most governments have trailed behind. The largest medical research centre in the world is the National Institute of Health in Bethesda, Maryland. The size of at least ten medical schools, it contains institutes dedicated to the major conditions such as cancer, heart disease and so on, but not even a section concerned with pain. The French national medical research organization has one excellent unit on pain problems, the Germans have two but the British have none.Charities are crucial in the support of medical research. In Britain, the Wellcome Trust alone funds as much research as the government’s Medical Research Council, and the cancer charities support more cancer research than the government. In any country, a multiplicity of charities finance research and the well-being of those with many types of illness, including some with very obscure diseases. Yet no country in the world has a major charity devoted to those in pain. Why is that so? It could be that people wish to see their money spent on fundamental cures not on symptoms. There are societies who reasonably seek a cure for arthritis, knowing that if they succeed the pain will go. The Multiple Sclerosis Society does not divert funds to determine why those who suffer multiple sclerosis are in pain. The International Spinal Research Trust has in its charter that money may be used only for research on the regeneration of nerves in the spinal cord, and may not be applied to symptom relief. There are headache and migraine societies but headaches could be considered self-contained entities.This insistence on fundamental cure may be a partial explanation for the absence of pain charities but I believe that it cannot be complete. After all, there are many excellent, powerful charities for the blind, the deaf or amputees, with the side intention of enriching their daily lives and with no talk of cure or restoration. I suspect that the entire subject of pain encompasses one of the last taboos. It is not a topic of easy conversation. Better to speak of something else which offers a chance of control. I have written this entire book with trepidation. Has it skimmed over an abyss of dark horror which hides a terrible threat? Presumably the reader who has reached this far has found some method of coping with their own distaste of so disturbing a topic. One may read about cancer from a psychologically isolated refuge even if you have cancer, as I do. When I see someone in pain, I confess that I still react with horror and would prefer to retreat. My response is the occupational therapy of working on the topic. I do not believe one can ever be familiar with pain. It is too deep.Society is not kind to people in pain. Fifty million Americans are partly or totally disabled for periods ranging from a few days to weeks or months. Some are permanently disabled. A significant proportion of chronic pain problems relate to the lower back. Some 60 per cent of the British population take more than a week off work for back pain during their working life. In a telephone survey of 1,254 adult Americans, 56 per cent reported some back pain in the preceeding year with 3 per cent reporting low back pain for more than a month. Surveys of this type have been carried out in many countries and always show the presence of very large numbers of people in trouble with pains, of which back pains, headaches and arthritis are the most common. The fact that a proportion are suffering from very prolonged episodes means that available treatment must be ineffective.One might think that such a vast problem would be a subject worthy of media attention but in practice there is a wall of silence. The reason for this neglect may be that everyone is so familiar with the problem in themselves or in their friends and relatives that the unpleasant facts are ignored in favour of something new and the evanescent breakthroughs which enchant the press. It may also be an example of a taboo subject from which we cringe.While silence reigns in public, some doctors have been paying close attention and some label low back pain as an epidemic. Attacks of low back pain are usually of sudden onset. In a ten-year survey of all workers in the Boeing aircraft factories, attacks were found to be equally common in shopfloor workers engaged in heavy lifting and in clerical workers whose occupation involved only light work. Some 80 per cent of the victims had a relief of pain within two weeks but 10 per cent were still in pain five months later. Even the brief episodes tend to recur and may become more frequent and prolonged. Very careful testing of people with sudden-onset low back pain reveals up to 15 per cent may have one of five disorders which may explain the pain: slipped discs, displaced vertebrae, overgrowth of bone, unstable vertebrae, and fractures, tumours and infections. This leaves 85 per cent of the victims in the highly unsatisfactory category of ‘nonspecific low back pain’.Many countries have set up commissions to give official guidelines on how to cope with these people. The most recent and infamous is entitled Back Pain in the Workplace. The Management of Disability in Non-specific Conditions and was written by an international team of experts. Society intrudes to form an unholy coalition of employers, insurance companies, lawyers and workers’ compensation bureaux with puzzled doctors. They emphasize the ruinously rising costs of lost work hours, sickness benefits and insurance plans. Because the doctors could define no traditional cause for the pain and disability, many of the inspecting alliance were eager to turn to the attitude of the victims as the cause of their pain. A recent survey of the British civil service showed absenteeism to be relatively low among the top-grade executives and the lowest grades, such as postmen, whereas the middle ranks, who face daily hassles, had the highest rate. The Boeing survey identified job dissatisfaction as predicting those most likely to complain to the company of back pain. It seems to me such obvious common sense that those who hate their job and the company will complain to the company. It is hardly worth the trouble of a vast survey.Ignoring this common-sense explanation, the report on back pain in the workplace concludes that dissatisfied workers cause their own pain. In order to treat this common problem, the report proposes specific treatment. For the first six weeks, the victim of nonspecific low back pain is permitted only a day or two of bed rest, after which movement is vigorously encouraged with professional help and with minimal analgesic medication. It is quite true that the majority recover during this conservative regime, at least until their next episode. The commission is even more specific about the proper treatment of those still in pain after six weeks. The diagnosis of back pain is to cease and the patients are now to be labelled ‘movement intolerant’. I take this phrase to be a politically correct neologism implying a work-shy shirker. Furthermore, it recommends a cessation of all further medical treatment on the grounds that it positively encourages patients to consider themselves sick. In order to reinforce this, it proposes an abrupt end to the payment of sickness benefit and the relabelling of workers as unemployed.This report is the considered opinion of a very eminent international grouping of establishment experts. They conclude that the problem is no longer for traditional medicine but is instead a social, psychological epidemic and should be treated as such. The Canadian Pain Society objected strongly to the report. All societies contain large numbers of ‘experts’ who have diagnosed precisely the causes of what is wrong with their societies. Immigrants, minorities and criminals are popular explanations for society’s ills.One popular idea is that society is sinking under a mass of people who live a life of ease and luxury supported by social benefits. The Australian psychologist Pilowsky invented the term ‘hypochondriophobia’ to label the tendency in our population to suspect and fear the validity of people on prolonged sickness benefits. For example, Italians love to repeat a press fabrication about a man who was on a pension for the blind while also being paid as a traffic policeman. In this atmosphere, in which social and sickness benefits are considered mainly in terms of cheating, fraud, hypochondria and lack of moral fibre, governments concentrate on ways to reduce their social-security budgets. This is not a good atmosphere in which to mobilize the mass of good-hearted citizens who would love to take part in social action to help and encourage the lonely abandoned folk who live in pain. *84\219\2*
OTHER PEOPLE’S PAIN AND SOCIETY
Given the slow start of the professions in facing the challenge of pain, it is not surprising that most governments have trailed behind. The largest medical research centre in the world is the National Institute of Health in Bethesda, Maryland. The size of at least ten medical schools, it contains institutes dedicated to the major conditions such as cancer, heart disease and so on, but not even a section concerned with pain. The French national medical research organization has one excellent unit on pain problems, the Germans have two but the British have none.
Charities are crucial in the support of medical research. In Britain, the Wellcome Trust alone funds as much research as the government’s Medical Research Council, and the cancer charities support more cancer research than the government. In any country, a multiplicity of charities finance research and the well-being of those with many types of illness, including some with very obscure diseases. Yet no country in the world has a major charity devoted to those in pain. Why is that so? It could be that people wish to see their money spent on fundamental cures not on symptoms. There are societies who reasonably seek a cure for arthritis, knowing that if they succeed the pain will go. The Multiple Sclerosis Society does not divert funds to determine why those who suffer multiple sclerosis are in pain. The International Spinal Research Trust has in its charter that money may be used only for research on the regeneration of nerves in the spinal cord, and may not be applied to symptom relief. There are headache and migraine societies but headaches could be considered self-contained entities.
This insistence on fundamental cure may be a partial explanation for the absence of pain charities but I believe that it cannot be complete. After all, there are many excellent, powerful charities for the blind, the deaf or amputees, with the side intention of enriching their daily lives and with no talk of cure or restoration. I suspect that the entire subject of pain encompasses one of the last taboos. It is not a topic of easy conversation. Better to speak of something else which offers a chance of control. I have written this entire book with trepidation. Has it skimmed over an abyss of dark horror which hides a terrible threat? Presumably the reader who has reached this far has found some method of coping with their own distaste of so disturbing a topic. One may read about cancer from a psychologically isolated refuge even if you have cancer, as I do. When I see someone in pain, I confess that I still react with horror and would prefer to retreat. My response is the occupational therapy of working on the topic. I do not believe one can ever be familiar with pain. It is too deep.
Society is not kind to people in pain. Fifty million Americans are partly or totally disabled for periods ranging from a few days to weeks or months. Some are permanently disabled. A significant proportion of chronic pain problems relate to the lower back. Some 60 per cent of the British population take more than a week off work for back pain during their working life. In a telephone survey of 1,254 adult Americans, 56 per cent reported some back pain in the preceeding year with 3 per cent reporting low back pain for more than a month. Surveys of this type have been carried out in many countries and always show the presence of very large numbers of people in trouble with pains, of which back pains, headaches and arthritis are the most common. The fact that a proportion are suffering from very prolonged episodes means that available treatment must be ineffective.
One might think that such a vast problem would be a subject worthy of media attention but in practice there is a wall of silence. The reason for this neglect may be that everyone is so familiar with the problem in themselves or in their friends and relatives that the unpleasant facts are ignored in favour of something new and the evanescent breakthroughs which enchant the press. It may also be an example of a taboo subject from which we cringe.
While silence reigns in public, some doctors have been paying close attention and some label low back pain as an epidemic. Attacks of low back pain are usually of sudden onset. In a ten-year survey of all workers in the Boeing aircraft factories, attacks were found to be equally common in shopfloor workers engaged in heavy lifting and in clerical workers whose occupation involved only light work. Some 80 per cent of the victims had a relief of pain within two weeks but 10 per cent were still in pain five months later. Even the brief episodes tend to recur and may become more frequent and prolonged. Very careful testing of people with sudden-onset low back pain reveals up to 15 per cent may have one of five disorders which may explain the pain: slipped discs, displaced vertebrae, overgrowth of bone, unstable vertebrae, and fractures, tumours and infections. This leaves 85 per cent of the victims in the highly unsatisfactory category of ‘nonspecific low back pain’.
Many countries have set up commissions to give official guidelines on how to cope with these people. The most recent and infamous is entitled Back Pain in the Workplace. The Management of Disability in Non-specific Conditions and was written by an international team of experts. Society intrudes to form an unholy coalition of employers, insurance companies, lawyers and workers’ compensation bureaux with puzzled doctors. They emphasize the ruinously rising costs of lost work hours, sickness benefits and insurance plans. Because the doctors could define no traditional cause for the pain and disability, many of the inspecting alliance were eager to turn to the attitude of the victims as the cause of their pain. A recent survey of the British civil service showed absenteeism to be relatively low among the top-grade executives and the lowest grades, such as postmen, whereas the middle ranks, who face daily hassles, had the highest rate. The Boeing survey identified job dissatisfaction as predicting those most likely to complain to the company of back pain. It seems to me such obvious common sense that those who hate their job and the company will complain to the company. It is hardly worth the trouble of a vast survey.
Ignoring this common-sense explanation, the report on back pain in the workplace concludes that dissatisfied workers cause their own pain. In order to treat this common problem, the report proposes specific treatment. For the first six weeks, the victim of nonspecific low back pain is permitted only a day or two of bed rest, after which movement is vigorously encouraged with professional help and with minimal analgesic medication. It is quite true that the majority recover during this conservative regime, at least until their next episode. The commission is even more specific about the proper treatment of those still in pain after six weeks. The diagnosis of back pain is to cease and the patients are now to be labelled ‘movement intolerant’. I take this phrase to be a politically correct neologism implying a work-shy shirker. Furthermore, it recommends a cessation of all further medical treatment on the grounds that it positively encourages patients to consider themselves sick. In order to reinforce this, it proposes an abrupt end to the payment of sickness benefit and the relabelling of workers as unemployed.
This report is the considered opinion of a very eminent international grouping of establishment experts. They conclude that the problem is no longer for traditional medicine but is instead a social, psychological epidemic and should be treated as such. The Canadian Pain Society objected strongly to the report. All societies contain large numbers of ‘experts’ who have diagnosed precisely the causes of what is wrong with their societies. Immigrants, minorities and criminals are popular explanations for society’s ills.
One popular idea is that society is sinking under a mass of people who live a life of ease and luxury supported by social benefits. The Australian psychologist Pilowsky invented the term ‘hypochondriophobia’ to label the tendency in our population to suspect and fear the validity of people on prolonged sickness benefits. For example, Italians love to repeat a press fabrication about a man who was on a pension for the blind while also being paid as a traffic policeman. In this atmosphere, in which social and sickness benefits are considered mainly in terms of cheating, fraud, hypochondria and lack of moral fibre, governments concentrate on ways to reduce their social-security budgets. This is not a good atmosphere in which to mobilize the mass of good-hearted citizens who would love to take part in social action to help and encourage the lonely abandoned folk who live in pain.
*84\219\2*
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