A land half won: pain and the modern world

To the Editor: We thank Ashby for highlighting the need for multimodal treatment of persistent pain.1

He rightly suggests that we may never have sufficient specialist resources to meet the needs of people with chronic pain and that development of greater capacity in primary care needs to be a priority. This is a key recommendation of the National Pain Strategy, which calls for adoption of evidence-based interdisciplinary treatments supported by two-way communication between tertiary and primary care.2 However, the simplistic suggestion that modern pain specialists are polarised into centralists and peripheralists is completely at odds with contemporary training and examination requirements for Fellows of the Faculty of Pain Medicine.

Although the alternative (passive) therapies that Ashby describes may be helpful to some people, evidence-based treatments, such as cognitive behaviour therapy, constitute far more useful and responsible medical practice. There is also good evidence that patients who engage in active self-management strategies do much better over the longer term than those involved in passive strategies.3

However, while basic and clinical pain research remain seriously underfunded, gathering good supporting evidence for effective therapies will be difficult. The degree of funding neglect is striking: in the United States, cancer research gets more than 50 times the funding of pain research, although the prevalence of chronic pain conditions is greater than the combined prevalence of cancer, heart disease and diabetes.4 Obtaining comparable data for Australia is difficult as there is no National Health and Medical Research Council classification for pain as a research area.