Mark Cranswick Senior Physiotherapist, Waitemata District Health Board (P11, Thursday, NZI 4 Room, 12.30-1)

1. PAIN and INJURY
Preaching in a wilderness.
Mark Cranswick
Senior Physiotherapist
Pain Management Unit

6. “L’operazione Chururgica”(Gaspare Traversi, 1753/54)

10. Data from 2006/07 New Zealand
Health Survey
 1 in 6 (16.9%) of New Zealanders
report chronic pain
 Nearly half (48%) use some form of
medical treatment
 A fifth (21.4%) report severe or very
severe recent pain
 Two-thirds (67%) have lived with
chronic pain for 5 or more years

11. Epidemiology
 N# 85,088 in 17 countries
 Between 10% and 42% report
chronic back/ neck pain in the
previous 12 months
 Between 20% and 45% of persons
with back and neck pain also met the
criteria for depression
 Approximately 25% meeting criteria
for anxiety

12. “Pain is a passion
of the soul”
Aristotle 300BC
Acknowledgement to:
Lorna Fox
NZPS 2007

13. Rene Descartes 1662
Acknowledgement to:
Lorna Fox, NZPS 2007

14. Descartes
When it is not in our
power to determine
what is true, we ought
to act according to
what is most probable.
Discours de la Méthode
Acknowledgement to:
Lorna Fox, NZPS 2007

15. “ What is Pain? ……
…incapable of definition,
or even of accurate
description”
Lancet 1887
In G D Schott Communicating the Experience of Pain :
the Role of Analogy Pain 108 (2004) 209-212

16. “Pain … is known to us by
experience and described by
illustration … we have no
knowledge of pain beyond
that derived from human
experience …”
Sir Thomas Lewis 1942
In G D Schott Communicating the Experience of Pain :
the Role of Analogy Pain 108 (2004) 209-212

17. Definition of Pain
IASP 1979
Pain is an unpleasant sensory and
emotional experience associated
with actual or potential tissue
damage, or described in terms of
such damage.

18. Analogy serves a remarkable
and unique function, enabling
the inexpressible to be
communicated by reference to
something else. This is never
more important than in the
expression of pain.
In G D Schott Communicating the Experience of Pain :
the Role of Analogy Pain 108 (2004) 209-212

19. “Were it not for the
possibility of sensing body
states that are inherently
ordained to be painful or
pleasurable, there would be
no suffering or bliss, no
longing or mercy, no tragedy
or glory in the human
condition.”
Antonio Damasio
From Descartes’ Error

20. “Chronic pain turns a life into a
mere existence. The effects
are devastating and often
demeaning. It has a negative
impact on relationships inside
and outside the home. It
involves the loss of
independence, dignity and
control”
International Pain Summit IASP Montreal, Sept 2010

21. Some observations
 We live in a time when science seems
to be bursting with promise
 We are told to expect cures
 The hype serves to delude us into
thinking that each of us is the sum of
our genes
 The hype drives a reductionist
philosophy
 Created industries based on diagnostic
entrepreneurs

22. Some observations cntd
 Back pain in the workplace is just
one window on human predicament
 Global illness narrative- the worried
well
 The illness of work incapacity
 If you have to prove you are ill, you
can’t get well

23. Paradigm shift
 Adopt a “salutogenic model” with
relationship understanding between
health, stress and coping
 “health-ease” versus “dis-ease’
continuum
 The choice to be a patient is just
that, a choice
 Accepting that to be “well” is not to
be free of symptoms

24. Paradigm shift cntd
 We should question just what in the
workplace is compromising their
ability to cope
 We should guarantee workplaces
that are comfortable when we are
well and accommodating when we
are ill
 “common sense” is seldom common
and not always sense

25. Pain is
My pain as it grows, is an imperative,
an obsession, a compulsion, a
dominating, engulfing reality. Your
pain is a different matter. I observe you
and listen to you. I sympathise with you
by guessed analogy . . .
Patrick D Wall