Pain is disturbing, disabling, and frightening…We all relate and feel the vice-like grasp of pain but do not know how to fight it. One of the primary reasons behind this suffering is that the cause of pain is unknown. While we may speculate the causes, we do not know the exact origin of the pain. In order to release and eliminate pain, better understanding and knowledge of pain is important. We spoke to Dr. Gaurav Gomez, Specialist – Pain Medicine at KMC Hospital, Dr B R Ambedkar Circle, Mangaluru for a deeper understanding about pain and how you can become pain-free.
Pain is now considered to be the fifth vital sign. Vital signs are important parameters evaluated first in emergency rooms- body temperature, blood pressure, pulse rate and breathing and now Pain. A pain ‘generator’ can be any tissue- skin, muscle, ligament, tendon, bone, disc, nerve etc, having numerous reasons why pain generates.
What is acute pain?
Acute pain is our body’s helpful, protective mechanism promoting healing. Contrarily, chronic pain is a maladaptive, counter productive process that is unhealthy. The feeling of acute pain starts at the site of injury. With the progress of time nerves modulate abnormally at the level of brain and spinal cord which then become drastically more difficult to treat.
Also Read: 5 Effective Tips To Get Rid Of Neck Pain
What is chronic pain?
For Chronic pain,a multi-pronged, multi-speciality, multimodal treatment acting via different pain control mechanisms is the most effective treatment. This needs to be tailored as per your requirements.
Steps for pain management and treatment
Along with Orthopaedics, Neurology and other specialities, we are seeing the dawn of a new speciality in India - Pain Medicine, which is already well established in the west.
Step 1- Pain Assessment
It requires a thorough evaluation of potential causes of pain, after which oral medication and conservative steps are started as we climb the ‘analgesic ladder’ to stronger options. But, if pain is too severe or tests our patience or is not willing to release his grasp easily, it might need to be ‘shot’ with injections which deposit medications directly into the targeted pain generator. It thus has a faster, more pronounced effect with lesser side effects as compared to oral medications or routine intramuscular injections which after absorption circulate in the blood and act on the body as a whole. Surgery is indicated only in certain conditions.
Step 2- Medication
Know that virtually all Pain can be managed to a great extent using a combined medical armamentarium of oral medications, targeted injections and other modalities. Injections act like ‘guns’ trained directly on the area where pain lives. Our guns are advanced as we do not shoot blindly anymore. We now have a ‘scope’ or ‘sight’ at our disposal in the form of ultrasound or X-ray imaging guidance whereby we can accurately target the goal injection site, visualise structures, the needle and limit our ‘collateral damage’ i.e. complications.
Step 3- Surgery
Patients unfit for surgery or not willing for surgery can also avail of specialised injection options to reduce pain eg. in the cases of knee osteoarthritis, etc.
Also Read: Suffering From Sciatica Or Lower Back Pain? Here's When You Might Need Surgery
Know that shooting pain won’t hurt much- numbing medication is injected before the targeted injection via a needle as thin as the needle used for Coronavirus vaccines after which there is virtually no sensation of the injection, thus most procedures feel no more painful than a vaccine shot.
Though it may take time and patience, active efforts are required from you to be resolute and committed to the prescribed plan. Chronic pain management requires patience and dedication as the treatment is a stepped titration and tailoring process.
Common conditions to evict pain are– Sciatica (disc prolapse, Lumbar canal stenosis), Joint pain (Osteoarthritis, Rheumatoid arthritis, Frozen shoulder), chronic back pain or neck pain, Carpal tunnel syndrome, Tennis elbow, De-Quervain’s, Plantar fasciitis, Neuralgias (Trigeminal, Glossopharyngeal, Post herpetic neuralgia etc), Cancer related pain, Sacroiliitis, atypical headache, Peripheral vascular disease pain, Causalgia/CRPS, Coccydynia, Fibromyalgia etc.