Pain Management: A Superspeciality
“It is easier to find a man who will volunteer to die, than to find those who are willing to endure pain with patience” Julius Caesar
Remember:-“No one dies of pain but many die in pain and many more live with pain”
“Control pain before it controls you” as “Pain begets pain”
“Sweet is death that takes away pain” is true for cancer pain.
“Pain is more terrible master than death itself”
“For all the happiness man can gain, is not in pleasure but freedom from pain”. Remember “Freedom from pain is patient’s right”
Pain is 5th vital sign as per W.H.O. Pain is now understood as primary medical condition.
“The neurosignature of pain experience is determined by the synaptic architecture of the neuromatrix”
Pain Medicine, a super-specialty, deals with the management of these difficult chronic painful disease states including treatment of cancer pain. A majority of complex chronic painful states, unresponsive to conventional treatment are being successfully treated at Pain Clinics. The very concept of a Pain Clinic is based on the conviction that the effective management of difficult pain conditions is possible only through well-coordinated efforts of a specialist possessing knowledge and skills to diagnose and treat pain.
A Pain Clinic uses services of specialties such as neurology, psychology, physical therapy, orthopedics, anaesthesiology and neurosurgery. “Comprehensive multidisciplinary pain management centre” is the highest pain management facility/ centre of excellence, which is equivalent to super specialty cardiac / neuro / nephrology centre.
Thus, Pain Clinics are specialized areas that are now assuming the role of an essential service as they meet a need unmet by any previously existing medical facility. They help by simultaneously treating the physical, emotional, cognitive, behavioral, vocational and social aspects of chronic pain cost-effectively.
Chronic pain is a disease, a syndrome not just a symptom.
Chronic pain can lead to depression, anxiety, marital & interpersonal problems, decreased productivity, unemployment, compromised social roles, isolation, financial burden, dependence, prolonged analgesics usage, decreased self esteem with behavioral changes adversely affecting quality of life (QOL) & activities of daily living (ADL).
“Pain has the thousand teeth”.
“The pain of mind is worse than the pain of body”
“Chronic pain is something you wear on inside, not on the outside”
“Not tonight, dear. I have a backache.” Backache is second only to headaches as the most common location of pain.
Pain is one of the most common reasons for patients to seek medical attention and one of the most prevalent medical complaints in today’s world.
Some 75 million Americans experience persistent pain and at least nine per cent of the USA adult population is estimated to suffer from moderate to severe non-malignant pain. Patients with chronic (or “persistent”) pain can be especially difficult to treat. In one survey conducted for the American pain society, 47 per cent of those with moderate, severe or very severe pain had challenged physicians at least once since their initial visit for pain relief. When asked why, they cited continued suffering (42 per cent), the physician’s lack of knowledge (31 per cent), not taking the pain seriously enough (29 per cent), and unwillingness to treat it aggressively (27 per cent) as reasons for the change. Situation in India is not very different from this one.
Despite these startling statistics pain still remains inappropriate & inadequately treated. Although tremendous scientific & technological advances have been made, the knowledge & techniques are highly underutilized. This is due to lack of dissemination of information to clinicians. “It’s easy to be paranoid when you hurt like hell and you are on the mercy of healthcare system”.
The clinicians must learn to make distinction between acute and chronic pain before embarking upon treatment. The skill of proper pain management lies in not in ability to perform difficult advanced blocks but in the determination of appropriate diagnosis & therapeutic modalities
The treatment of the acute, chronic & cancer pain is demanding & challenging. Effective pain management presents a significant challenge for physicians, other healthcare professionals, and their patients.
A problem arises when chronic pain feels like acute pain, is described to (and is accepted by) physicians and therapists as acute pain, and is then treated as acute pain. When this happens results are apt to be disappointing to both the patient and the physician and both may end up feeling quite frustrated. To both recover from, and to treat, chronic pain requires taking a different approach.
“Take two aspirins & go to bed” dictum of old days is over “What can’t be cured has to be endured” has changed with the role of the interventional pain specialist. It’s a “medical necessity”
There have been many advances in the understanding & usefulness of an intervention at right time in selective patients producing excellent results.
Our ultimate goal is to cure & care people suffering from pain, make them productive human beings for the society and increase their self esteem so that they can live life as normal individuals.
Interventional pain procedures scores over both medicine and surgery, as they do not have side effects like medicines. Surgeries for pain, have now limited indications, usually as a last resort.
The interventional pain procedures produce immediate pain relief, can be performed with ease by pain physicians without anesthesia as outpatient or daycare and adequate duration of pain relief obtained and suitable for surgically unfit & debilitated patients, procedure can be repeated safely if required.
In the absence of proper education among health care professionals and lack of awareness in the public mind in India, there is misuse of painkillers resulting in high incidence of complications like gastritis, kidney failure, and bone marrow depression.
The Indian health care scene has a curious mix of paradoxes. Advances in cardiovascular surgery or high-tech investigative facilities in India are on par with any advanced country, at least in some cities. Though skills, advanced equipments are available, still pain relief is not available to majority of its population. At least a million people in India suffer unrelieved cancer pain. The number of people suffering other chronic pain conditions is anyone’s guess. Paradoxically, India stands high chance to become the health destination for pain management for the world, by using interventional pain therapies and very effective traditional therapies unique to India.
With the advancement of technology and science, we have unveiled many aspects of the pain and its treatment. We have to work hard to spread the knowledge of interventional pain techniques. Our goal is to help people suffering from pain, make them productive human being for the society and increase their self esteem so that they can live life as normal individuals.
Unfortunately awareness about pain management among medical professionals is very limited. In contrast to USA and other developed countries Indian medical community is not aware of interventional pain management techniques which can be helpful for many patients suffering from intractable chronic pain.
“You purchase pain with faulty lifestyle” “All pain is a punishment”
Pain treatment is tailor-made & no single treatment fits all.
Under treatment of pain is a major public health concern. It is a silent epidemic, don’t let this happen to someone you love.
Untreated pain destroys people’s lives. I have had patients come in who couldn’t work or sleep or play with their children. Good pain management gave them their lives back.
It is cruel to deny people in pain access to effective pain treatment. People should not be suffering needlessly.
“Pain is real & treatable — There is no merit in suffering!”
CONTROL PAIN BEFORE IT CONTROLS YOU!
FOR ADVANCED PAIN MANAGEMENT OF:-
CHRONIC INTRACTABLE PAIN SYNDROMES
BACK PAIN / LEG PAIN (DISCOGENIC/SPINAL CANAL STENOSIS)
FACET JOINT SYNDROME/SPINAL ARTHRITIS
SPINE (AXIAL) PAIN (CERVICAL/LUMBOSACRAL/THORACIC)
SACROILITIS / STRAIN & COCCYDYNIA
DISC DISEASES (HERNIA/PROLAPSE/RUPTURE/SLIPPED)
REDICULOPATHY / SCIATICA
NEURALGIC PAINS / PLEXOPATHIES
HERPES ZOSTER PAIN /NEURALGIA (PHN)
TRIGEMINAL / CRANIAL NEURALGIAS
SPASTIC CEREBRAL/SPINAL PALSY
FRACTURE SPINE (COMPRESSION # OF VERTEBRA)
REFLEX SYMPATHETIC DYSTROPHIES (RSD)
COMPLEX REGIONAL PAIN SYNDROMES (CRPS 1 & 2)
FAILED BACK SURGERY SYNDROMES (FBSS)
MUSCULOSKELETAL / MYOFASCIAL PAIN SYNDROMES
VASOSPASTIC ISCHEMIC PAINS
CERVICOGENIC / TENSION/CLUSTER HEADACHES
POST SURGICAL / POST TRAUMATIC / SPORTS INJURY PAINS
CENTRAL PAIN STATES
CANCER PAIN/ END OF LIFE PAIN / AIDS PAINS
CHRONIC VISCERAL / PELVIC PAIN SYNDROMES
OSTEOPOROSIS / METASTATIC / PAGET`S DISEASE BONE PAINS
HYPERHIDROSIS (WET HANDS/UNDERARMS/FEET)
REMEMBER: NO ONE DIES OF PAIN BUT MANY DIE IN PAIN
AND EVEN MORE LIVE WITH PAIN!
NON SURGICAL TECHNIQUES OF SPECIALISED
FLUOROSCOPIC/ULTRASOUND/NERVE STIMULATOR/CT GUIDED
PERCUTANEOUS INTERVENTIONAL PROCEDURES
FOR DIAGNOSTIC/THERAPEUTIC/NEUROLYSIS OF:–
DIAGNOSTIC EPIDUROGRAPHY FOLLOWED BY
TRANSFORAMINAL / INTERLAMMINAR EPIDURAL MEDICATION AT
CERVICAL / THORACIC / LUMBAR / SACRAL / CAUDAL LEVELS
SELECTIVE NERVE ROOT SHEATH BLOCK (SNRB)
PROVOCATIVE DISCOGRAPHY & INTRADISCAL INTERVENTIONS
LUMBAR/CERVICOTHORACIC SYMPATHETIC BLOCKS / NEUROLYSIS
PERCUTANEOUS VERTEBROPLASTY (PVP)
FACET JOINT/ SACROILIAC JOINT / PIRIFORMIS BLOCKS
DECOMPRESSIVE NEUROPLASTY / EPIDURAL ADENOLYSIS
INTRATHECAL OPIATE/BACLOFEN PUMP IMPLANTS
SPINAL CORD STIMULATOR/NEUROMODULATION IMPLANTS
CRANIAL NERVES BLOCKS / NEUROABLATIONS
SOMATIC NERVE / MYOFASCIAL / MYONEURAL BLOCKS
TRIGGER POINT INJECTIONS WITH STEROIDS/BOTOX/NEUROLYTICS
STELLATE/CELIAC PLEXUS/HYPOGASTRIC/IMPAR NEUROLYSIS
INTERPLEURAL CATHETER /SPLANCHNIC BLOCKS
PARAVERTEBRAL / PSOAS COMPARTMENT BLOCKS
SHOULDER & KNEE JOINTS BLOCKS
NERVE SHEATH & PLEXUS CATHETERISATION & MEDICATION
LASER LESSIONING / RADIOFREQUENCY (RF) NEUROABLATIONS