When it is chronic...

Managing chronic pain takes proper diagnosis. You needn’t suffer it in silence anymore, informs Dr Madhu S Yelameli.

Any pain which persists beyond the point of healing is termed ‘chronic pain’. The International Association for the Study of Pain (IASP) describes pain as an ‘unpleasant sensory and emotional experience associated with actual or potential tissue damage’.

 Typically, pain of any nature lasting for more than three-six months is categorised as chronic pain. Recently, extensive studies have been carried out by large, reliable organisations around the world to understand the prevalence of chronic pain. In India, it has been estimated to be anywhere between 20-30 percent. Obviously, you are not alone if you are one among those silently suffering with chronic pain.
Pain is a very personal or private experience. You may believe that no one knows or understands how you feel. You may be frustrated with the treatments that don’t help. You may feel afraid, angry or sad, and wonder what the future holds. Often, patients consult several doctors searching for explanations. This can lead to multiple investigations and often patients are put at risk. Self-medication, taking non-prescription medicines, like pain killers, regularly, can lead to serious side-effects. With unresolved pain, patients can develop other physical and emotional problems. Often patients can experience chronic pain without even evidence of tissue damage, and to add to the patient’s misery, the emotional toll can, in turn, worsen the pain!

The key to managing chronic pain is to make a proper diagnosis. Doctors specialised in chronic pain management are trained to evaluate a patient thoroughly and arrive at the right diagnosis and locate the most likely pain generator in the body. They are taught to correlate the results of lab and imaging studies with the clinical features. A pain specialist is also trained to include neurologists, rheumatologists, neurosurgeons, orthopedic surgeons, psychiatrists, psychologists, physical therapists and other specialists as per the patient’s case requirements. 

The main goal of pain management is to improve the quality of life, enabling individuals to engage in day-to-day activities. Most of the time, a chronic pain patient needs help to think and feel better, regardless of the pain situation; self-management programmes catalyse this by teaching people different ways of thinking about and responding to pain. Acute pain, often occuring in the joints, neck or back, is self-limiting, and may respond to simple measures like rest, minor analgesics for a short period of time, local application of heat or cold, elevation, and the like.

If unresolved after a week or two, simple imaging studies, like X-ray, can be done to rule out major complications or injuries, before starting a series of physical therapy sessions. If still unresolved, further imaging, involving CT scans or MRI of the affected region may need to be done. At this point, patient may be advised surgical options, depending up on the outcome of such investigations. If surgery is not an option, for any reason, or if surgery does not help, advanced pain management may be required. 

There are very few hospitals in India, and even fewer dedicated centres, dealing in the treatment and management of chronic pain. Currently there are barely any trained professionals and no recognised training programmes and lack of awareness among the masses and physicians alike. As a result, patients continue to suffer in silence. Thankfully, chronic pain has now become a matter of concern to health professionals, and care is being taken for chronic pain, lest it negatively impact the quality of life, and decrease productivity, of the patient.
(The writer is an interventional pain specialist, and founder & director, RELIV  Center for Chronic Pain Management, Bangalore)