About 70 per cent have been women with an average age of 35. The major conditions treated have been neck and back problems resulting from industrial and motor vehicle accidents. Other conditions treated included chronic headache, abdominal pain and repetitive strain injury.

In the early days, the link was established by the common interests within the University of Melbourne’s Department of Psychiatry and later by the involvement of a private psychiatric clinic.

A pilot programme was established to involve patients with chronic pain in a weekend pain management programme through the common interests of the various medical and para-medical people, such as psychiatrists, physiotherapists, general practitioners and psychologists involved in these areas.

From approximately 1979 until late in 1985, weekend pain programmes were held at the Melbourne Clinic on at least fifteen occasions. These have since been replaced by a longer, more involved programme. On each of these weekends, approximately ten patients would be admitted to the Melbourne clinic where they would be assessed by a multi-disciplinary team and given a virtual ‘smorgasbord’ of treatments over a two-day period.

These treatment methods included TENS therapy, laser acupuncture, hypnosis and biofeedback as well as orthodox physiotherapy. During this time, they were given lectures on the origin of pain, how pain affects the individual and how they could cope with their pain in the wider circle of their family, employers and friends.

The programme proved extremely helpful, with a large number of patients reaping rewards from relatively brief periods of hospitalisation. But it was recognised early on that there were deficiencies within the programme since there was little follow-up and patients often returned to country homes. In so doing, they lost the impetus they had gained from the programme.

In late 1985, the Melbourne Clinic established a ten-bed inpatient programme. This is now called the Pain Management Unit. Traditionally, chronic pain units have been established by anaesthetists, surgeons and physicians with the occasional clinical psychologist being involved.

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The myth that narcotic drugs should be avoided until the pain becomes severe has resulted in a great number of patients suffering unnecessarily. It is important for those suffering from pain associated with cancer and their medical practitioner to know that if pain is controlled early in the cancer by adequate tailoring of the dose, tolerance and rapid escalation of dose should not occur.

The narcotics used for cancer pain include morphine and methadone. Although these cause some depression of respiration (breathing) in some , dependence should not be a problem when supervision is adequate.

Other narcotics, such as Endone and its suppository equivalent Proladone, are useful pain relievers and may be of more value in the early stages prior to hospital admission. These drugs appear to act for a similar period as morphine.

A slow release form of morphine has been available outside of Australia for some time. At the time this book is being written its introduction here has been held up by bureaucratic involvement.

Administering the drugs

Where sufferers cannot tolerate continuing or massive amounts of injections of strong pain-killers or when even large doses have been ineffective, the drug can be administered on demand through direct injection into the spinal fluid or under the skin. The drug can be introduced by a tube which can be inserted into the spine and left in place. The drug is then introduced under the control of automatic battery driven pumps.

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The major inconvenience which occurs with TENS is an allergic reaction to the TENS electrodes. Changing electrode types or gels is the major way in which this problem can be overcome. In a very small group the rash can be bad enough to prevent the use of TENS altogether.

However TENS should not be used by a person with a demand-type heart pacemaker. Also:

• Electrodes should not be placed over the front of the neck because of the risk of stimulating the nerve receptors in the carotid arteries which control the blood pressure.

• The electrodes should never be placed directly over the heart because of the almost negligible but slight possibility of micro-electrocution.

• Special care should also be taken in anyone with coronary artery disease.

• TENS electrodes should be applied around the eye with caution.

• Care should be taken when the wearing a TENS unit and driving. The intensity should be decreased as it is possible that changes in pressure on the electrodes can suddenly increase the stimulation.

• The machine and its electrodes should be kept dry to prevent damage to the machine, and to stop the unwanted spread of the electric current over a wider area of the skin than prescribed.

• It is probably advisable not to use the TENS unit during sleep owing to the possibility that pressure on the electrodes may change leading to the stimulus being too strong or unevenly applied.

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