We all experience pain.

It is a companion, sometimes a constant one.

As Marcia Meldrum put it, pain is our ‘oldest medical problem’.

Physiotherapy as a disciple is devoted to understanding patients’ pain and how to alleviate, manage and prevent it.

Across all the areas in which physiotherapists work, pain is the common factor.

The impact of chronic pain is felt not only by the person experiencing it, but by those around them.

Every one of us who experiences chronic or severe pain, or lives with someone who does, knows exactly what I’m saying.

It is fascinating delving into the history of how pain has been viewed and treated historically.

The English word ‘pain’ is derived from the Latin poena, which meant ‘punishment’ or ‘under punishment’ but also implied a ‘penalty’ or ‘retribution’.

(In Late Latin, poena also meant ‘torment, hardship, suffering’.)

The Ancient Greek word for pain—poinē—was also synonymous with retribution and penalty.

Since ancient times, pain has been understood as a personal suffering, a punishment that the individual endures because it was somehow their fault. 

For most of human history, ‘treatments’ caused worse pain.

It wasn’t until the 1900s that opioids became the accepted treatment for pain, with the invention of morphine and heroin as painkilling medications.

One of the most influential (and controversial) figures in the field was the French physician Dr Albert Schweitzer (1875–1965), who famously proclaimed that ‘Pain is a more terrible lord of mankind than even death itself’.

He wrote this in the 1930s when modern healthcare was just emerging. 

Dr Schweitzer did most of his work in the small African nation of Gabon, which was then part of an area known as French Equatorial Africa.

He was awarded the Nobel Peace Prize in 1952.

In Africa he treated patients with every conceivable health condition, from leprosy and malaria to sleeping sickness and conditions now treated with antibiotics and pain medication.

He described those in chronic pain as being members of a ‘fellowship’ who ‘have learnt by experience what physical pain and bodily anguish mean… they are united by a secret bond’.

Pain is no longer a secret.

Our understanding of the causes and treatment of pain has advanced and pain management looms large in the daily work of a physiotherapist.

The challenge of helping patients is now to be found in overcoming a traditionalist approach that relied on dispensing pain medication. 

Australia has made significant moves to address this and available data shows a reduction in the prescription of opioids for acute pain.

In 2018, the government made codeine-containing products available only on prescription.

Even so, the Therapeutic Goods Administration reports that there are nearly 150 hospitalisations and 14 emergency department admissions involving opioid harm every day in Australia and that pharmaceutical opioids cause more deaths and poisoning than illegal opioids such as heroin. 

In the US, we have seen the impact of oxycodone, pushed as a ‘blockbuster painkiller’ that would cure the pain of the estimated one-fifth of Americans living with chronic pain.

It is a tragedy that drugs like oxycodone and fentanyl, designed to relieve pain, have caused such widespread misery.

Pain treatment has also always been complicated by the relationship between physical and mental pain.

Pain exacerbates anxiety and mental health problems, which is difficult to address in a fragmented system of healthcare that divides the physical and mental in ways that make no sense.

As a society, we must invest more in pain education and in promoting alternatives to addictive pain medicines.

Physiotherapy is a significant player in this endeavour.

As we read in this edition, physiotherapy is front and centre in pain management and in educating patients on how to understand and live with chronic pain.

Simon Tatz
General Manager, Policy and Government Relations