Tackling the pain points
When Dr Mary Abraham and Dr Vandana V. Prakash first thought of writing a book on pain, it wasn't born out of any desire to see their names as authors. What rather troubled them was the lack of awareness related to pain. There were patients who had been on analgesics and even antidepressants for prolonged periods to experience the "feel good painless existence." Many a time patients experienced pain despite surgery undergone to correct their underlying problems. The patients they met knew they had pain but were clueless about how to treat it.
"The book was inspired by many considerations. While working together in a pain clinic, we encountered many patients with pain who had definite emotional and psychological problems, which were actually perpetuating the pain. We also found that many a time psychological problems was the genesis or the root cause for pain. We soon realised that most patients with chronic pain did not know where to go, whom to seek and how to get respite from their pain," says Dr Abraham.
Their book Conquering Pain, published by Harper Collins last month, tells the reader how to prevent pain, treat it and lead a better life. "We felt that together as a pain specialist and a clinical psychologist, writing a book on the multi-faceted aspects of pain quoting real life stories would improve awareness about the nuances of pain not only among the general public but amongst doctors as well. We both wanted to put across the fact that a holistic approach to pain always leads to better functional outcomes," adds co-author Dr Prakash.
In 1996, the American Pain Society declared pain to be the fifth vital sign, the other four being pulse, blood pressure, respiration and temperature and, therefore, it needs to be as closely and regularly monitored and treated as the other four vital signs. The Declaration of Montréal, a document developed during the First International Pain Summit in 2010, states that access to pain management is a fundamental human right. "It is the obligation of medical professionals and health care institutions to relieve patients of their pain and failure to do so is a breach of this human right," explains Dr Prakash, a psychotherapist and neuropsychologist.
Pain is something that most people encounter at some point of time in life, some more than others. Pain specialists come at a level where medicines offer little help and surgery is not an option. Despite the enormity of the problem and the frequency of its occurrence, people rarely realise the need to address it.
There are two main types of pain - acute pain which occurs after trauma or surgery and chronic pain when it persist beyond the expected healing period of an injury, illness or surgical incision. Chronic pain usually persists for more than three months.
"Pain is in fact considered in recent times as a neurological disease and not just a symptom as it involves a gamut of symptoms and is not just a solitary symptom. One needs to understand the concept of total pain to advocate biopsychosocial approach to effectively treat pain," says Dr Preeti Doshi, consultant, Pain Clinic at Jaslok Hospital and Research Centre, Mumbai.
Acute pain, which is the pain experienced in peri-operative period is mainly managed by an anaesthesiologist with a combination of modalities. Chronic pain is managed by a dedicated chronic pain specialist who manages it in an optimal manner by combination of different modalities like specific drugs, image guided by interventional procedures, physical therapy, psychotherapy and so on. "We still have very few dedicated pain management centres managed by skilled and trained interventional pain physicians who can perform the whole spectrum of pain interventions to manage different chronic pain syndromes," adds Dr Doshi.
According to the World Health Organisation's Global Burden of Disease study, every fifth person is suffering from some form of pain. In a survey done by the National Institutes of Health in the US, it was found that 27 per cent of Americans said low back pain was their most common type of pain, followed by headaches (15 per cent). And yet pain isn't given its due. "People tend to be ashamed and feel they would be stigmatised if they talk or even acknowledge the emotional distress that they are experiencing because of pain," says Dr Abraham. "Since pain is a biopsychosocial phenomenon it was important to highlight the psychological aspects of pain too," adds Dr Prakash.
Pain management is a subbranch of anaesthesia and one of the youngest specialities in medicine. Since is relatively a new area of specialisation in India the awareness levels are still low. "Yes, pain management and palliative care as a separate specialty finds only limited presence in India. This is because it is one of the youngest specialties in medicine and any young specialty takes time to find ground," says Dr P. Venkata Krishnan, Internal Medicine and Physician, Paras Hospital.
The Indian Society for Study of Pain, a national body was established about three and a half decades ago with an objective of translating knowledge into improved pain relief. "It is a rapidly growing and evolving body with about 2,000 members most of them being pain specialists," says Dr Doshi.
Pain specialists feel people need to be made aware of the existence of pain management specialists and how and why pain affects different people differently. "A large segment of our society is unaware of the role the mind plays in the genesis and perpetuation of pain and of the necessity of a multi-disciplinary and holistic approach to pain management," says Dr Abraham.
In the past few years, pain clinics have started coming up in urban areas though in small cities it remains a rarity. More and more people are now browsing websites and the internet for information regarding pain management and, thus, reaching out to pain specialists.
"Quite a few people are being referred to pain specialist by various speciality doctors for pain management. Lastly, and most importantly, patients are getting aware of pain clinics by word of mouth from people who have themselves benefited from such services," says Dr Prakash.
Also there are tertiary care super speciality hospitals which offer dedicated comprehensive pain management services. "They offer multi-disciplinary care with various specialists working in conjunction to offer the best possible pain control and rehabilitation in a variety of different pain conditions. Pain Management now is indeed an independent speciality with structured fellowship training available at few select centres like ours at Jaslok Hospital," says Dr Doshi.
If it's pain, it needs to be handled with care.