Pain, no matter how trivial, is an unwelcome guest. It can be associated with undue suffering and disability which everyone would like to avoid. It is helpful to understand the types of pain one may experience. Pain can be categorized as acute or chronic pain.
Acute pain is the pain that is present after an injury until healing occurs. Pain in this situation is a protective response bringing our attention to the affected area and helping us protect, rest the affected tissue providing an opportunity for healing. As the tissue heals, the pain gradually abates.
Chronic or persisting pain is pain that persists even after the usual time required for healing. It is important to understand that chronic pain does not always signify on-going damage. Nerves have a memory (plasticity in medical terms) whereby they develop changes that remain even after the original inciting problem is corrected. A simple example to explain this is persisting leg pain even after the amputation of the affected part. There are numerous mechanisms to explain this and your doctor can help you understand these better.
The impact of chronic pain is not limited to the involved person but also affects their loved ones and family members. The longer it persists the more chances that it will have an impact on multiple aspects of your life including your ability to work, sleeping pattern, mood, social life, relationship with family and friends, etc. Hence it is important to take corrective measures to reverse or control the condition as soon as possible.
The management varies depending on the actual pathology, severity, comorbidities, patient preferences, available resources/ expertise, and many other factors. At your first consultation with me, you can expect a detailed assessment including history, examination, and review of investigations. This is aimed at identifying the underlying reason for pain so that an appropriate personalized management plan can be made. Some more tests may be requested as necessary. Close liaison with specialists in other fields such as neurology and surgery is maintained to formulate the best plan tailored to your condition and requirements. Some of the common pain treatment modalities include:
I normally review your current medications and any existing medical problems prior to suggesting new medications or changes to current medications. Therefore it is a good idea to carry a detailed list of your medications and make of list of the ones you may have tried previously. Doses of medications tried previously are equally important as some medications if not used in right doses for the required duration are unlikely to be effective.
Different types of pain may need treatment with different medications, for example pain of inflammatory origin maybe be effectively managed with anti-inflammatory medication and pain due to irritation of nerve may need medication which help to desensitize the nerves. Hence the importance of identifying the likely pain generators prior to prescribing medications.
In certain situations I suggest procedures such as
- Injections/ radiofrequency procedures that help to reduce the pain signals being transmitted by the nerves to your brain
- Injections directly into a joint space/ around the area of problem such as a tendon or bursa which can help reduce the inflammation more effectively than medications taken orally. These procedures along with being therapeutic may also help the consultant confirm diagnosis
Regenerative medicine has opened new avenues where cells from your body are used to promote healing and reduce pain. Awareness of options such as Platelet-Rich Plasma (PRP) and stem cells is increasing and new research in this area is improving our understanding day by day.
Some interventional procedures can be done in the outpatient setting, whereas others will require a day case admission. This depends on the procedure being performed and your general health, other medical problems. We aim to reduce your pain as much as possible by offering you most appropriate interventions keeping your goals and preferences in mind and with an integrated multi speciality team approach based on biopsychosocial model of pain you have best chances of managing your pain.
Role of Physiotherapy
There are few common elements in management of most chronic pain situations like weakness accompanied by disuse of affected part for long time will require gradual mobilization and strengthening. A good chronic pain physiotherapist offers more than physiotherapy. They play an important role in
- Patient education regarding their condition, do’s and don’ts specific to their condition,
- Setting realistic goals-dividing exercises into smaller achievable steps
- Help patients understand and implement pacing of activities
- Promoting compliance, increasing confidence and making you self reliant
- Challenging your unhelpful thoughts, mitigating any false believes and minimising catastrophisation
Role of Psychology
Chronic pain can generate significant distress, anxiety and depression and all these, in turn, can magnify perceived pain. This is a normal human reaction which is often more visible to friends and family. Addressing these factors can help in reducing perceived pain and in improving quality of life. Psychologists can help you by challenging maladaptive beliefs, attitudes and emotions. They can help by
- Teaching coping and self-help strategies
- Relaxation techniques- these can be a useful tool especially in dealing with sleep disturbances and periods of increased pain
- Cognitive Behavioural Therapy (CBT)
Dr. Amod Manocha is a Senior Consultant and Head of Pain Management Services at Max Multispecialty Hospital, Saket. He is trained as a Pain Management Specialist and an Anaesthetist in the UK. He has over 13 years of work experience in the UK including working as a Chronic Pain Consultant in many UK hospitals.