Last month, I headed over to Umhlanga with some of the other Pain lab members for the annual PainSA Congress. PainSA is the South African chapter of the International Association for the Study of Pain and the Congress is a meeting of health care professionals and scientists from across the country who work with pain.
In the pain lab, we’re always going on about how pain is under-recognised and under-treated in African HIV+ patients. Every PainSA congress, the sentiment that access to opioids in Africa for severe pain is woefully inadequate is repeated. Yet at this year’s congress we heard the opposite angle. US. Professor Tracy Jackson, medical director of outpatient pain clinics at Vanderbilt, gave hard hitting talks about the ineffectiveness of current chronic pain therapies despite the US spending $630 billion a year on the problem. She spoke about the over-reliance on opioids in a country that uses 80% of the world’s stock and where opioid overdose is the leading cause of accidental death.
Tracy is a big advocate of non-pharmacological interventions including functional rehabilitation programmes. These programmes are residential and involve an entire multidisciplinary team of healthcare professionals aimed at getting patients back to being functional, even if that means their pain staying the same. Her new take on these programmes is to offer ‘Relief retreats’ where restoration programmes are held at retreat centres rather than in a typical clinic setting.
Tracy is really entertaining to listen to. Follow this link for a TEDx talk she gave in Nashville very recently on the topic of non-pharmaceutical treatment of chronic pain.
The theme of getting patients with chronic pain back to work was echoed throughout the congress. Dershnee, an MSc student in the pain lab, gave a workshop on the topic. Dershnee has a background in occupational therapy. Through her current work in medical insurance she knows only too well that absenteeism from work costs South Africa R12 billion a year.
Peter, the head of our pain lab, gave a plenary talk on “Neuropathic Pain: so many people, so few drugs”. Sean Chetty, a pain lab PhD student and anaesthesiologist, gave a plenary on pain management being a human right. In the largest research paper session a PainSA congress has had, I spoke about the effect of HIV stigma on pain, and Prinisha presented some of her PhD data about the pharmacological treatments that are actually being used in the clinic for HIV-associated sensory neuropathy. Prinisha won the joint first prize for best talk along with Tory Madden a new postdoc at UCT. Well done Prinisha!