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At the clinics surveyed the main pain-producing pathologies seen were neurological and those of the muscles and skeleton. The least frequent was endocrinological — that is, involving various internal secretions or hormones.

The pain clinics most commonly saw chronic lower back and chronic head and neck pain with all of the clinics reporting that they had treated physically caused chronic head and neck pain.

Jaw-joint pain, or TMJ syndrome, was the most frequent pain syndrome encountered in the area of head and neck. This is the most common chronic pain syndrome with a dental origin.

Post herpetic neuralgia, that is, the pain after shingles (herpes zoster) was seen by 93 per cent of the clinics, 60 per cent seeing it often. Depressive, or abnormal, facial pain was seen by 93 per cent of clinics ‘often or sometimes’.

Other frequently occurring syndromes were trigeminal neuralgia, cervical spondylosis (arthritis of the neck) and referred pain. Migraine and tension headache were less prominent than expected.

The clinics hardly ever see patients with pain from cerebral tumour, diabetic cranial nerve palsy or giant cell arteritis (a blood cell disorder).

All syndromes were seen often — with the exception of postsurgical abdominal pain, phantom limb pain and psychologically caused gynaecological pain, which were encountered only sometimes.

Most clinics used drug therapy with the majority of patients. Non-surgical and anaesthetic procedures tended to be performed where the relevant specialists were heavily involved in the pain clinics.

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Not poppy nor mandragora, Nor all the drowsy syrups of the world,

Shall ever medicine thee to that sweet sleep,

Which thou owedst yesterday.

Shakespeare (Othello)

Much of what has been said earlier in this book relates just as well to the pain associated with cancer. But there are major differences in emphasis in the treatment of cancer pain and the pain associated with non-malignant conditions.

The provision of pain relief for those with terminal disease, and cancer in particular, remains one of the great challenges in medicine today. To be dying from a terminal disease presents great psychosocial difficulties, but, to be in pain as well is often an intolerable burden.

Despite great advances in the understanding of the ways in which opiate or narcotic medication works in the body and the introduction of newer types of powerful pain-killers there are still many who suffer intolerably and perhaps unnecessarily towards the end of their lives.

The 1988 Australian National Health and Medical Research Council devoted much of its report on Management of Severe Pain to the problem of cancer pain. It makes the point that cancer pain is poorly controlled in many cases.

The report states that 40 to 80 per cent of severe cancer pain is unrelieved, when a level of five percent or less of unrelieved pain is attainable. -

It goes on to assert that poor management of cancer pain is often the result of failure to appreciate the degree of suffering which is present, failure to diagnose the cause of the pain, use of weak or inappropriate pain-killers, fear of narcotic addiction both by doctors and patients; and the largely incorrect conviction or belief shared by doctor and patient alike that cancer pain is inevitable and untreatable.

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By focusing your thinking, you can make your fingers feel numb. Put your left hand in your lap with the palm facing up. Keep your eyes closed so you can focus fully on all the sensations in the fingers of your left hand. Now try to imagine, and feel, as if pain-killing Novocaine has just been injected into the side of your left hand next to the little finger. Your little finger will begin to feel like it does when it falls asleep. Now focus your attention on that little finger. Become aware of every sensation and the slight, little changes as you think of the Novocaine slowly beginning to move into your little finger. Very slowly moving. Notice the slight little changes as the little finger is becoming numb as you think of the Novocaine moving ever so slowly. Now think of the Novocaine moving into the second finger, next to the little finger. Tell yourself that the second finger is getting duller and duller. More and more numb as you think of how the Novocaine is beginning to take effect. Tell yourself that these two fingers are beginning to feel kind of rubbery and are losing feeling and sensation. As you think of the Novocaine moving in faster, your fingers feel duller and duller and more and more numb. Dull, numb and insensitive. As you think of the Novocaine taking effect, your two fingers feel duller and duller, more and more numb. Dull, numb and insensitive as you touch those two fingers with your thumb. As you touch your two fingers with the thumb of the same hand notice how they feel duller and duller, more and more numb, more and more insensitive. Dull, numb, rubbery and insensitive. Now tell yourself it’s all in your own mind and that you’re going to get the feeling back. Bring the feeling back into those two fingers!

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Typical TENS units cost in the area of $400 to $500 each and the best units presently available include the Israeli-made Agar 10K, the American 3M TENZCARE 6880, and the Medtronic Eclipse .

There are many units available on the Australian market and the range is expanding almost monthly. Twin-channel TENS units which stimulate 4 points at a time are likely to be far more effective than single-channel units.

In addition the last year or so has seen the introduction of two completely novel types of TENS devices. The first of these to be introduced was the Likon — a briefcase sized machine which produces electrical pulses which are said to feel subjectively deeper than conventional TENS stimulation.

Patients treated at a major Melbourne pain clinic have found the Likon stimulation produces more intense and longer lasting pain relief than the smaller and more convenient TENS, no matter how sophisticated the latter are. The Likon costs $700 and can be rented on a trial basis for about $80 per month.

The second exciting device recently introduced onto the Australian TENS market is the Araddin. This is a totally self-contained device the size of an Australian 50 cent coin (about 5cm diameter). The Araddin has no wires and can be worn under clothing.

It has a preset sophisticated computer chip which changes the nature of the stimulation so the body and therefore the pain cannot develop tolerance to the stimulation. This small device even has an intensity control to ensure that the wearer obtains the strength of stimulation necessary to block pain.

The current price of the Araddin in Australia is $290. This gives the purchaser, not only the main unit, but also a slave unit and a variety of electrodes which extend the area which can be stimulated.

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