Dáil Éireann debate -
Thursday, 29 Jun 2000

Vol. 522 No. 4

Adjournment Debate. - Pain Management Services.

Mr. Wall

I thank the Chair and the Minister for taking this important motion, namely, the need for the for the Minister for Health and Children to outline the current position on facilities for people with chronic pain and the plans for improving these facilities. I raise this matter because I have received a number of representations from constituents who, sadly, are constant sufferers from chronic pain syndrome. These people are gravely concerned that the future is very bleak because they see little in the way of facilities or personnel to help them overcome the terrible situation in which they find themselves.

I understand that a person with spinal damage could be waiting an inordinate length of time for treatment due to lack of facilities. I know the Minister's attitude towards developing the Department of Health and Children is very positive and that waiting lists are a priority for him. However, the figures I have encountered are not acceptable given that a person in chronic pain suffers for 24 hours every day, seven days a week, 52 weeks a year. I unearthed a number of worldwide statistics in relation to chronic pain. They show that 10% of the world's population suffers from chronic pain and that 1% are severely disabled, with 22% of the total figure being over 65 years of age. To alleviate the pain many sufferers turn to drugs. Sadly, due to the extent of pain and the reliance on drugs, as many as 60% become addicted. Such sufferers, if out of work for one year, have little chance of ever returning to the workforce.

I ask the Minister to investigate the problem and provide proper facilities and personnel to deal with this frightening problem. In many cases chronic pain is the result of failed spinal operations or is suffered by cancer patients or people who have had strokes. In many cases the patient can become suicidal. I am sure some hospital within the remit of the Eastern Regional Health Authority could be designated as a centre for such cases and that it could have the proper trained personnel to deal with the unfortunate victims. I am sure that proper pain management services could be put in place and I ask the Minister, with the assistance of the Eastern Regional Health Authority, to make every effort to achieve this. I again thank the Minister for his attendance and I look forward to a positive reply.

Minister of State at the Department of Health and Children (Dr. Moffatt)

I thank Deputy Wall for raising this issue. I have great sympathy for those who suffer from chronic pain and appreciate that it can affect all aspects of one's life. Patients suffering from chronic pain can be referred for treatment by medical staff with specialist knowledge and expertise. Pain medicine is a sub-specialty which has evolved in this country over the past two decades. In terms of development it has followed a similar pattern to other European countries and North America. Traditionally within Ireland and the UK it has evolved from within hospital divisions of anaesthesia and is a consultant led service.

International studies suggest that one in seven adults will be partially or permanently disabled due to pain. Back pain accounts for a substantial portion of this figure. In the USA it has been estimated that billions of dollars are lost in terms of wages and medical expenses incurred each year due to persons suffering from chronic pain. It is evident, therefore, that the condition constitutes a significant medical and socio-economic problem.

Patients requiring treatment for chronic pain can be seen in a number of different settings. The majority of patients are treated on an out-patient basis at our major acute hospitals and return home after treatment. Where required, patients are also treated on a day care or in-patient basis under a more intensive and structured treatment programme. I understand that departments of pain medicine have been established to varying levels across the acute hospital sector. Funding is allocated on an annual basis to anaesthetic services by health agencies from within their respective financial determinations. I am aware that specific funding has been allocated for the provision of a range of specialised new treatment devices, for example, spinal cord stimulators.

There is an increasing level of demand, nationally and regionally, for this service. For example, within the eastern region approximately 7,000 patients received hospital treatment for chronic pain during 1999. At St. Vincent's Hospital, Elm Park, approximately 140 new patients are received each year by the pain management service. I am also aware that although not designated or established as a national centre for pain management, the service provided at St. Vincent's Hospital receives a significant number of referrals from outside the hospital catchment area. At the Mater Hospital, the department of pain medicine has been in existence for 13 years and has evolved into a significant service delivered from within the division of anaesthesia. In excess of 600 day case procedures were performed last year together with approximately 1,500 out-patient referral cases. A full assessment with multi-disciplinary input takes place before treatment interventions are carried out. This can involve the neurology, radiology and psychiatry services where appropriate.

I should point out that the provision of services for people suffering from chronic pain is a matter in the first instance for each relevant health agency. Decisions on the development of the service need to have regard to overall service priorities and must also be seen in the context of the general development of anaesthetic services within each catchment area.

Pain medicine has evolved in Ireland over the past 20 years. The need for adequately trained health care providers and pain management facilities is fundamental to the future provision of a comprehensive chronic pain service. From an educational and training perspective, I understand that consideration is being given to the setting up within the next year of a formal examination in pain medicine which will result in the awarding of a diploma in pain medicine to successful participants. The demand for the service continues to rise, resulting in increased demand for associated therapeutic and diagnostic services. In this regard, the service should develop on a regional basis and be accessible locally to patients who require treatment.