Pain is one of the biggest health problems today, with almost 30% individuals suffering from pain worldwide. Despite its ubiquity, pain is grossly under treated and greatly neglected by health care systems across the world.
Only this year, the International Classification of Disease, 11th revision (ICD-11) has proposed, for the first time, a coding system for Chronic Pain, thus improving the representation of painful disorders.
Quoting Robert J Wiersema, “ The trouble with chronic pain is that it is so easy to become accustomed to it, both mentally and physically. At first, it is absolutely agonizing, it’s the only thing you think about, like a rock in your shoe that rubs your foot raw with every step. Then the constant rubbing, the pain and the limp all become part of the status quo, the occasional stabbing pain just a reminder. You are so set to endure, hunched against it – and when it starts to ease, you don’t really notice, until the absence washes over you like a balm”.
Most of the time patients ignore their pain and try to live with it. If it becomes unbearable, they go and buy ‘painkillers’ from the nearby pharmacy. It is known that as high as 68% of the Indian population takes over the counter drugs for chronic pain, 95% of that is NSAIDs.Even preparations containing tramadol, which has been called “the dangerous opioid from India”, are easily and widely available. On the other hand, a large fraction of the patients suffering from cancer pain continue to be denied of getting adequate morphine for pain relief.
The science of medicine originated with an intent of relieving human suffering and pain.
Overcenturies, we specializedand super specialized, and now that arc has come full circle, giving birth to a super specialized branch dedicated to the management of pain: Pain Medicine.
According to the American Society of Interventional Pain Physicians (ASIPP), it is a “discipline of medicine devoted to the diagnosis and treatment of pain related disorders”. Most doctors practicing pain are anesthesiologists, super specialized as Pain Doctors. They have an important role to play inthe multidisciplinary management of chronic pain conditions. They know how to judiciously use various groups of pain medications, including opioids and anti-neuropathic drugs. They are adept at performing minimally invasive techniques specifically designed to diagnose and treat painful conditions, includingmusculoskeletal injections, nerve root blocks, radiofrequency ablation of nerves and neurolysis of nerve plexuses. Most of these techniques are performed under C-arm or USG guidance, and are done as day care procedures. Advanced techniques like intrathecal pump and spinal cord stimulators are available at limited specialized centers.
In addition, good rehabilitation and physiotherapy remains an integral part of managing most of these conditions. Chronic pain can even lead to clinical depression, and psychological counselling for the emotional component of pain may sometimes be required.
Very few patients with chronic pain require surgery.