Braemar Hospital was recently featured in the Waikato Business News.
Conrad Engelbrecht is used to seeing people on the ‘medical merry-go-round’. By the time they get to him they may have spent years visiting GPs, specialists, osteopaths, chiropractors, physiotherapists and acupuncturists, searching for the ‘Holy Grail’ that will take their pain away.
“Most of the time, it is an endless round of tests, scans, operations and medications, some of which may be helpful but others that are not. It can be frustrating and depressing. In the end, patients end up in ‘Stuckville’ with no further options. It is not a pleasant place to be.”
Dr Engelbrecht specialises in pain management, a field that has interested him since he completed his medical studies in South Africa and worked as a GP before joining Waikato DHB as an anaesthetist and pain management specialist. He has just opened a pain clinic at Braemar Hospital.
He says pain management is a complex area. “Acute pain is the body’s warning system. It has a real purpose in warning us that something is not right and needs to be checked out. Once the cause has been diagnosed and treated, unless it is a serious disease, the pain normally goes away within three months. But some pain persists, even when it has outlived its usefulness and has no further purpose.”
When that happens, patients assume something is still wrong and begin an endless round of tests and procedures, searching for the cause. “We live in an age when people feel they should be able to find a cause and cure and have pain-free lives. Whereas 30 years ago, we might have accepted we had back pain and nothing much could be done about it, people now spend years – often on Google – searching for the Holy Grail. It’s an awful spiral. They get worried and fearful; they become less
active, and socialise less; they take more sick leave and may give up work. Their anxiety promotes more pain. Some may even take their own lives.”
The result is a huge cost in healthcare and lost productivity. “Estimates are that one third of the world’s population has chronic back pain; eight out of 10 will have some incident of chronic pain in their lifetime. “
Pain management, he says, can be the circuit breaker. “It opens the door to acceptance – not resignation – that a person has a health problem for which no cure exists, but which they can manage with good results.” A parallel would be a person with diabetes. “They need to have meds, be screened and monitored and make significant changes to their life, but they can still have an incredible quality of life.”
He says some people find it hard to accept they have run out of options for a cure and that they may have to interpret their health differently. They may also resent any implication that the pain is not real or ‘all in their head’ if a cause cannot be identified. “We reassure them that what they are feeling is real and explain how pain is woven through the brain.”
He says getting to the root cause of the pain is essential. “It’s like peeling away the layers of an onion. It’s hard to peel off the layers to get to the core. Pain may be seated in stress that has sensitised the nervous system, heightening tension and contributing to discomfort.” An example could be a young labourer on ACC with a back injury, who may be stressed about finances, caring for his family and future work. “If I ask him to rank his pain out of ten, he may say 9, because stress is contributing to his pain, whereas his pain may be moderate. Patients often use pain scores to demonstrate their distress.”
He says his aim is to get to a person to a place where life expands and pain becomes a smaller component. “Pain is side-lined. It is no longer central to their lives.” This can be achieved through pain relief, medication, pain psychology such as distraction techniques, mindfulness and cognitive behaviour therapy, and physical therapies that get people to move again in a way that doesn’t aggravate their pain. “You control what you do rather than the pain controlling what you do.”
The field of pain management is a biopsychosocial, spiritual model of care and hugely rewarding, he says. It has parallels with a GP practice, “where you can build a relationship with patients”. Seven out of 10 patients that get the right mix will improve after 12 months.