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Taking control of pain

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Ruth Day, MA, BA (Hons), RGN

Nurse Consultant in Pain Management, Luton and Dunstable Hospital NHS Trust and University of Luton, Bedfordshire

IN THIS MONTH'S SUPPLEMENT. Childbirth is one of the most painful experiences that many women go through and midwives must balance the desire for pain relief of the mother with the best interests of mother and baby. Remifentanil can be self-administered in labour and the first paper in this supplement examines its use. The role of the nurse consultant in paediatric pain is considered in our second article, written by the first nurse to hold this post in the UK.

IN THIS MONTH'S SUPPLEMENT. Childbirth is one of the most painful experiences that many women go through and midwives must balance the desire for pain relief of the mother with the best interests of mother and baby. Remifentanil can be self-administered in labour and the first paper in this supplement examines its use. The role of the nurse consultant in paediatric pain is considered in our second article, written by the first nurse to hold this post in the UK.

'Anyone who has personally experienced severe acute or chronic pain will grasp its moral dimensions. But the challenge to pain reformers lies on the other side of that experience: moving people not in pain to acknowledge and treat those who are' (Blacksher, 2001).


This challenge taxes all of us who work in the field of pain management - how can we raise awareness of the issues? A recent statement by the Royal College of General Practitioners and the Pain Society may give us a way forward. Under the banner theme of 'Control pain: live life' they have made five pledges to help people living with persistent pain. These are that all patients should have:


- Active involvement in management of their pain


- Timely assessment of their pain


- Access to appropriate management and support


- Relevant information


- Access to adequate resources and facilities.


Of course, the delivery of these pledges cannot be undertaken by any one profession or person. While recognising this, there are points of action to be taken by parliamentarians, NHS service providers, the patients themselves, health-care professionals and health-care educationists.


The pessimists among us will point out the fact that this is an impossible agenda to delivery: there is no funding or the will among providers to make it happen. Chronic pain is not a sexy government target. But I ask you to return to Blacksher's paper - and her comment that how we think about pain is very influential. Do we think about it at institutional, regulatory and political levels as well as the conceptual? If not, she suggests, we will fail to transform services and patients' lives. This is the kind of thinking that the five pledges challenges us to undertake.


Will those of us working with people in pain rise to the challenge to enable a service, of which we can be proud, to be delivered? I may be one of life's optimists, but I really hope we can.

Blacksher, E. (2001) Hearing from pain: using ethics to reframe, prevent and resolve the problem of unrelieved pain. Pain Medicine 2: 2, 169-175.
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