Why Suffering from Chronic Pain is Optional
“Pain is inevitable. Suffering is optional”- Japanese author Haruki Murakami
What is the most frequent type of chronic pain you treat in your practice?
The most common type of pain we come across in our pain practice is back pain, especially lower back pain. Back pain is a very common symptom, especially seen in men and women in their fourth and fifth decades, and the incidence goes on increasing with age. In addition to the natural degeneration and aging of joints, muscles, ligaments and bones, many other factors such as incorrect posture, sedentary lifestyle, perimenopausal hormonal imbalances in females, deficiency of vitamins and micronutrients, stress play a significant role in the causation of back pain.
After back pain, we see knee pain. Knee is a weight bearing joint, and pathology of any structure that contributes to the knee joint such as the cartilage, the joint capsule, the menisci, the ligaments, the muscles, can lead to knee pain. We also come across patients with intractable pain, such as pain from cancer, in whom pain can be abolished by performing nerve or plexus blocks with absolute alcohol to relieve the pain and give the patient a better quality of life.
When should someone see a pain management specialist instead of just pushing through the pain or relying solely on general over the counter painkillers?
In our society, tolerating pain is seen as a sign of strength and expressing pain, a sign of weakness. However, pain is an important sign our body gives to us that something is abnormal, and hence it should be heeded to. Pain does not just affect the physical being, but it also has a great impact on psychological wellbeing. Approaching the right specialist is equally important as quackery is very rampant in our society. Patients can consult an Orthopaedician or a Pain physician. Over the counter pain killers do offer temporary relief from pain, however they have side effects which might manifest if they are taken for prolonged periods without medical supervision.
Beyond medication, what other therapies like physical therapy, nerve blocks or psychological support play a major role in your treatment plans?
Beyond the usual medications, pain interventions range from various nerve/joint injections (such as spine nerve root blocks, joint injections in vertebral joints, Sacroiliac joint injections for back pain, Genicular nerve blocks for knee pain, etc), Sympathetic ganglion blocks for cancer pain, Intermittent muscular stimulation, Myofascial trigger point injections for pain of muscle origin to regenerative therapies like injection of PRP (Platelet rich plasma), prolotherapy for inflammation of tendons and fascia. Now newer ways of blocking nerves such as radiofrequency ablation, cooled RF have added to the armamentarium of a pain physician. Basically, the pain physician tries to diagnose the exact pain generator that is causing pain, and the pain intervention is planned accordingly.
However, intervention is just a small part of pain management. Healthy nutrition, supplementation of vitamins and micronutrients, psychological counselling, practicing Yoga, physiotherapy, all together form an inseparable part of pain management. CBT or cognitive behavioural therapy has been found to be extremely effective in dealing with psychological issues in pain patients.
To summarise, Pain is a subjective sensation, and it must be diagnosed and treated. Every pain can be reduced with a good approach towards the patient’s condition, targeting overall physical and mental well being.
Dr Ketaki Nirkhi (Patwardhan)
Additional Professor of Anaesthesiology and Pain,
Rajiv Gandhi Medical College and Chhatrapati Shivaji Maharaj Hospital, Kalwa
Thane.