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 which
remain even after the original inciting problem is corrected. A simple example
to explain this is persisting leg pain even after amputation of the affected
part. There are numerous mechanisms to explain this and your doctor can help
you understand these better.
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 aspect 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, co morbidities,
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 personalised 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:
Medical
management
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.
Interventional
procedures
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)
Consult
Best Pain Specialist In Delhi, Dr. Amod Manocha.
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