Dealing with pain can be daunting. But, we do have pain management to our rescue, says Dr K. Hari Prasad
We have all experienced pain in some way or the other. Varied conditions, starting from a simple stress induced headache, to a complex brain tumor or a heart attack or a slipped disk in the spine, all manifest as pain in the affected region. Apart from the pathological reasons of pain, psychological elements also result in pain either as a primary symptom or enhance the pain of a pathological cause of pain.
Pain — A clinical condition
Although pain is a common symptom it must be viewed with a positive perspective, as it is often the first indication of a clinical condition that needs treatment. Certain situations like cancer where there is no pain in early stages in most cases, hinders the diagnosis of the condition at an early stage thus impacting the outcome.
Pain is also the most neglected symptom and in most cases, self-medication is the preferred option. This is not good as taking pain killers without consulting a physician may actually mask a clinical condition which needs treatment. Therefore, self-medication for pain must be discouraged.
In most situations pain is a manifestation of an underlying pathological condition. Depending on the location, type, severity and other features of pain the patient needs to be investigated to arrive at a diagnosis.
How is pain treated?
Once the diagnosis is established the primary condition must be treated. For example, chest pain is a symptom of different conditions, it could be a heart attack, it could be gastritis or it could be a muscular pain. When an individual has chest pain, he or she must immediately seek medical help to ensure that serious conditions like a heart attack are diagnosed and treated early. Any delay in seeking help or self-medication will delay treatment and lead to further complications, some of which could be life threatening. Pain is often an indication of some underlying disease, do not neglect it.
How do I understand pain?
Pain is often classified as acute and chronic pain. Acute pain is where the pain starts suddenly and is severe in nature. For example, pain due to a bone fracture is an acute pain.
Chronic pain is longstanding in nature with varying degrees of severity. For example, pain in the knee joint due to degenerative disease in the knee. Management of both these types of pain differs depending on the cause of pain. For a patient with acute pain due to appendicitis, a surgical intervention may be required and for chronic knee pain, medications and physiotherapy may be the first line of treatment.
Are there pain specialists?
Pain management is a specialty today and we now have qualified pain specialists. Pain Clinics are almost always multi-disciplinary with the involvement of pain specialists, psychologists, physiotherapists, etc. In addition, they have access to other specialists like orthopedic surgeons, neurosurgeons, etc.
A pain specialist is usually an anesthesiologist, a physician with special training in evaluation, diagnosis, and treatment of all different types of pain such as acute pain, chronic pain and cancer pain, and sometimes a combination of these. Also, the pain management specialist plays an important role in coordinating additional care such as physical therapy, psychological therapy, and rehabilitation programmes.
Do I see a pain specialist for any kind of pain?
All pains do not need a pain specialist, but certain type of pains which are not relieved by routine methods, are longstanding and are affecting activities of daily living and quality of life of an individual will definitively benefit from the skill and expertise of a pain specialist.
What about chronic pain?
Diagnosis for the cause of pain is critical to the management of chronic pain. On many occasions, this could be frustrating for the patient as it could take time and multiple investigations and consultations before the cause of pain is confirmed. Pain specialists are specially trained to understand the complexities of chronic pain and arrive at an appropriate diagnosis.
How can pain be managed?
Various options are available for management of pain and depending on the cause and nature of pain, one or a combination of the following may be used:
Medications: There are a variety of medications used for pain management such as brufen, steroids, opioids and even anti-depressants.
Injections: Local anesthetic drugs, combined with a steroid are used to relieve some chronic pains.
Nerve Blocks: When a particular nerve or a group of nerves cause pain to a specific area, blocking these nerves with injections could be helpful.
Physical and aquatic therapy: A physiotherapist may help in certain exercises to decrease pain. Other techniques like ultrasound, whirlpool and deep muscle massage also may be used.
Electrical Stimulation: Transcutaneous Electrical Nerve Stimulation uses small battery-operated devices, for pain relief in chronic conditions.
Acupressure and Acupuncture: These ancient Chinese techniques are useful in certain types of chronic pains.
Counselling: Many patients need psychological support and counselling as a part of treatment of chronic pain.
Relaxation techniques: In addition to counselling, other forms of relaxation like yoga help in reducing stress and pain.
Surgery: This may be an option to relieve pain in certain situations. Spine surgery, when the pain is due to a disc prolapse impinging or knee replacement surgery, when all other conservative methods have failed, are examples of surgical requirement to relieve pain.