A land half won: pain and the modern world

In reply: The pioneering work of Cousins and colleagues is internationally recognised, and I agree that the Faculty of Pain Medicine training is world-leading; it is first-rate and well balanced.

The peripheralist–centralist debate was actually the subject of a dedicated session at the 2011 Spring Meeting of the Faculty of Pain Medicine.1 It is perhaps an oversimplified polarisation of a more complex interface in science and practice. However, it is my observation that many patients with persistent pain go on looking for solutions that they never find because they are not assisted in confronting the reality of the absence of drug or procedural solutions to their persistent pain problems after multiple treatment “failures”.

I certainly do not advocate so-called passive therapies and, for instance, strongly advocate the roles of physiotherapy and exercise physiology. The benefits of cognitive behaviour therapy have been extensively reported. However, a relative absence of psychodynamic work means that the cracks in damaged lives are often only papered over, without enduring healing and change.

I gave but one example of an active, alternative, holistic community-based approach worthy of consideration,2 as evaluation of novel approaches is surely always useful in such a challenging field.