Some of the world’s best anaesthesiologists and neurosurgeons have just attended the four-day 21st Annual Advanced International Pain Conference and Practical Workshop in Budapest.
Hip, knee, head, back, shoulders, spine, and teeth – they sometimes ache. Pain is good because it indicates there is a problem somewhere in the body; it is bad because it hurts. Half of those who go to doctors have some kind of pain. It is very difficult to get rid of pain completely but one’s quality of life can be improved, and it is possible that patients do not have to live in perpetual pain.
Some doctors know a number of the many reasons that cause it – and a few even know how to treat it. These physicians are called “Pain Doctors”. About 100 of them from 38 countries gathered in Budapest for their annual conference, where 40 lecturers spoke on various methods of pain intervention.
What is the Pain Conference? Medical science has always concentrated mostly on pain, with doctors specialising in every part of the body but not on the whole complex question. In the 1970s some doctors realised that this should also be a separate field of study, leading to specialisation. Knowing what causes pain leads to the obvious question: how to get rid of it? The doctors are passionate about better quality treatment for patients suffering from intractable chronic pain. Their annual meetings are the Pain Conferences.
Why was this conference organised for the 21st time in Budapest? Answers to this question are as diverse as the number of participants, but these are the most common replies: Budapest is a good place for conferences, being easily accessible. The town is beautiful, the facilities are excellent and the prices compared to elsewhere are not too high. The lectures are high quality and the whole conference has a friendly get-together feeling. The programmes to entertain participants are well organised. So, even those who have already passed their Fellow of Interventional Pain Practice (FIPP) examinations still return year after year.
The participants whom we managed to talk to agreed that above all, Hungary has been hosting the events due to the work of one man: Professor Gábor Rácz. He created a method of intervening with pain called the Rácz Catheter that is well known internationally. At these conferences he runs a training scheme with an FIPP examination at the end. Passing it is proof that the person knows the subject and his treatment is safe.
How has the Pain Conference changed over the years? Regular participants say everything improves every year: the quality, attendance and speakers. The doctors who complete the courses and master the interventional pain techniques receive their certificates. They return to their different countries and cultures having become experts in the field. In their own countries they become ambassadors for the superb facilities of Hungary, with its beauty, very high standard of medical training and friendliness. About 1000 Pain Doctors around the world received their qualification in Budapest, but many countries remain in dire need of them yet cannot afford to pay to participate. There have been occasions when Professor Rácz, with the funds of the World Institute of Pain (WIP), has helped the needy. Since the field of pain intervention is growing, new techniques are invented and the equipment is becoming smaller.
What is new? Professor Rácz, in describing the exciting developments in the procedure named after him – Rácz Procedure or Lysis of adhesions in the treatment of back and leg pain, also neck and arm pain – gave credit to the fine work of Professors C. Birkenmaier and Ludger Gerdesmeyer, two great orthopaedic surgeons from Munich. Japanese Professor T. Matsumoto discovered that a small calibre but well-constructed Versa Kath can enter scar tissue for the Lysis Procedure but that the larger usually used catheters could not. Gerdesmeyer produced the best study to show why the Lysis Procedure should be carried out first to improve the outcome of surgery, and in many cases eliminate the need for surgery altogether.
Why are the Pain Doctors mostly neurosurgeons and anaesthetists? The anaesthetists concentrate on the nerves and are masters of injecting and controlling the fluid that lessens pain. They use the epidural procedure during childbirth.
How many doctors from Hungary were at the conference? This year, six. How they learnt about pain intervention and the Rácz Procedure is an exciting topic for an article in itself. Dr. Edith Rácz (no relation of Professor Gábor Rácz), the Director of Pain and Anaesthology at the Péterfy Sándor Hospital, learnt about it through a TV programme. She became interested, contacted Professor Rácz, and took part in the courses and learnt the techniques. The Hungarian pain programme is due to her efforts. She introduced Dr. Agnes Stogicza – an Assistant Professor at the University of Washington – at that time also at the Péterfy Hospital in Budapest, and Dr. Lorand Erőss – Head of the Functional Neurosurgical Department and Centre of Neuromodulation at the National Institute of Clinical Neuroscience in Budapest – to the programme. Dr. Erőss, in his presentation, summarised the neurosurgical treatment modalities of chronic pain where medicines offer no intervention. He detailed the electrical stimulation techniques performed on pacemakers that are similar but are used to treat heart disease, but not pain. Dr. Bertha and Dr. Bokrétás took their FIPP Examination last year.
The next “Hungarian” doctor taking his FIPP exam this year is a colourful figure – Dr. Muhammed Amin from Dubai. In his appearance he is Persian but his speech and sense of humour are Hungarian. He was born in Iran, brought up in Dubai and travelled through Hungary when still a student in 1989. He studied medicine in English at the University of Debrecen. He completely contradicts people who say Hungarian is not a language one can learn unless from birth. Dr. Amin speaks Hungarian with no trace of an accent. He has been working in Dubai since 2004 as an anaesthologist, and he became interested in how many doctors are dealing with chronic pain; but since there was no Pain Doctor in his hospital he has been attending the Budapest conferences since 2006.
One of the doctors coming from a Muslim country told me: “Budapest Is the Pain Conference mecca. At the institute where I work patients arrive in tears because they are in so much pain; when they leave they have tears because they are so grateful at having no more pain. We are almost getting good at it.”
Professor Rácz was at Texas Tech University Health Center Lubbock for three years and is now at the University Baylor Medical Centre Dallas, Texas; he is the Grover Murray Professor, Professor and Chair Emeritus in the Department of Anaesthesiology and Co-Director of Pain Services. He is Director of the Annual Advanced Pain Conference since the first meeting in 1996. He is a Founder and past the President of World Institute of Pain and serves on the WIP Executive Board.
