UNDERSTANDING PAIN

Pain is an everyday happening. Acute pain may be severe but usually managed quickly but chronic pain which is quite common is very challenging to manage. Most of the physicians fail to provide significant relief despite their best efforts. The first problem is a precise diagnosis. Despite highly advanced tools of investigation, accurate diagnosis might evade in a large number of cases. The history given by the patient too is mostly confusing hence, it might not be easy to pinpoint the tissues involved. Even the definition of chronic pain is full of controversies and differences of perceptions. For some physicians, any pain which lasts more than three months is chronic pain while others are adamant on pain of six months’ duration. A small group believes that any pain which extends beyond normal tissue healing time should be considered as chronic pain.

As the tissues involved might be muscle, nerve, brain, bones, joints, ligaments or some internal organs, it might not be possible for a single general physician to reach a final diagnosis. A multidisciplinary approach is needed and this costs a lot. When so many specialists are involved, the treatment becomes cumbersome and depressing.

Chronic pain is a humongous personal tragedy. People who suffer are mostly in a depressed mood, the quality of sleep is poor, fatigue is overpowering and the power to concentrate is lost. In a large number of sufferers, the libido is impacted which may lead to excessive intake of drugs and even alcohol. Many times, the feeling of dependence on other people causes more suffering than the impairment itself.

Loss of employment leads to severe anxiety and mood swings which may, ultimately, lead to clinical depression. In many cases, family life becomes negatively affected and patients may become hypochondriac and start doing somatization of symptoms.

The management as told earlier is frustrating. But some relief can be provided by medicines and physiotherapy. Here again, it should be very clear that painkillers have significant side effects and hence, should be considered only under guidance of an experienced and updated physician. Role of psychology is very important though, only few avail it due to ignorance and cost of treatment. Remember, there is no miracle in management of chronic pain. One has to be psychologically very strong and counselled to bear the suffering.

THE VIEWS EXPRESSED BY THE AUTHOR ARE PERSONAL

DR RAMAVTAR SHARMA The writer is a Physician and Columnist