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Australian Journal of Pharmacy : November 2005
chronic pain Knowledge is power over pain Knowledge of chronic pain has undergone a revolution in recent years, with new information dramatically changing not only how we view chronic pain but also its management. LISA OFFORD reports T HE latest insights into the physio- logical pathways of pain and its treatment were presented in Sydney at the recent World Congress on Pain. Australian pain specialists Dr Raj Sun- daraj and Associate Professor Milton Cohen were among the 5,000 attendees from 90 countries. Dr Cohen, rheumatol- ogist and pain physician at St Vincent’s Hospital in Sydney and Dean of the Fac- ulty of Pain Medicine of the Australian and New Zealand College of Anaes- thetists, said the congress was ‘pretty over- whelming’. ‘There is a lot of work being done at the molecular level and identifying new ther- apeutic targets,’ Dr Cohen said. ‘I was most impressed by the progress being made at the cellular level in work- ing out just how tissue damage activates nociceptors. ‘Another main theme was nociception from viscera of internal organs—there is a lot of work being done there too, identify- ing which stimuli stimulate viscera and how those messages are being transmitted. ‘I was also impressed by the interde- pendence between those mechanisms that signal pain and the immune system and the endocrine system,’ he said. ‘There is a lot of very good basic science work being done, [which is] yet to trans- late into new therapies, but very impor- tant, very relevant and really quite excit- ing,’ Dr Cohen said. Head of the pain service at Nepean Hospital and senior clinical lecturer at Sydney University, Dr Raj Sundaraj said in his view one of the ‘glaring’ pieces of research to come out of the congress was in the area of paediatric pain. ‘Often in the past doctors have felt that newborn children don’t feel as much pain as older children and adults, and we now know that it is completely false,’ Dr Sun- daraj said. ‘We have always believed it was false but now it has been proven by brain scan results, PET [positron emission tomogra- phy] scanning techniques and fMRI [func- tional magnetic resonance imaging]. They feel pain even in-utero,’ he said. Dr Sundaraj said this had to be respected, not only on humanitarian grounds but because of the consequences of how children perceived pain and dealt with painful situations later in life. ‘There is higher incidence of the chil- dren who have been exposed to severe pain [and] suffer from chronic pain in the later part of their life because it activates a system within the memory bank of the brain,’ he said. Dr Sundaraj said other significant research projects highlighted during the congress focused on genetic coding and the under-treatment of acute pain in hos- pital settings. ‘There is a small sub-population—we believe it is anywhere between 10 and 20 per cent—that has a specific gene type that makes that group more prone to THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 NOVEMBER 2005 ? 875