Pain – A Four Letter Word

Some time during life, most of us will suffer from at least one episode of pain. 

The lucky ones will have the pain resolved within a few days with minor or no treatment. However, for some of the not-so-fortunate folks this pain will persist for months to years and for a few - the rest of their lives. This type of pain, also called "chronic" pain is perhaps the most debilitating pain as it impacts the quality of life for them as well as family members. Some of the sufferers will also exhibit signs of depression as the feeling of hopelessness takes over. This is generally because unlike the "acute" or immediate type of pain, the treatment options for chronic pain are only a few and not so effective.

However, advances in medical field are slowly changing this situation. Specifically, injections of medications around the spinal column are being considered for a lot of pain sufferers. In some of the patients these types of treatments can substantially decrease pain and thus improve quality of life. There are other techniques, such as radio-frequency, implantation of electronic pumps and electric impulse generators. While these devices are extremely expensive now, the emerging science of interventional pain management is very likely to make these technologies cheaper and therefore more accessible to all.

Why Anesthetists as pain management specialists? An anesthetist's function is mainly to provide a pain free state for a patient undergoing surgery, thus they know pain better than most other specialists. Besides, a lot of treatment options in chronic pain management involve inserting needles around the spinal cord. The anesthetists by their training are already familiar with the spinal and epidural injections and thus inserting needles comes naturally to them. One may think that all the anesthetists should be able to do that. The big difference is that it takes additional knowledge and training to learn about chronic pain and the injections are technically very precise. These injections are used for diagnosis and treatment of back problems. Such injections have to be placed at the exact point where the disease process is suspected and that requires use of sophisticated equipment including x-ray machines.

Whenever there is injury to any part of the body, a process called inflammation occurs. Essentially this is body's natural response to protect and heal the injured area. While in acute pain, this process may be beneficial, whereas in chronic pain, this process continues and results in ongoing pain and discomfort. Anti-inflammatory medications play an important role in treatment of chronic pain. Steroids are the most potent anti-inflammatory medication available. This medication when injected at the correct place should have the best outcome. Injection of long acting steroids (depo-steroids) is one of the major tool of Interventional Pain Management Specialists. Anti convulsants and anti depressant medicines are also effective in chronic pain.

While steroids in correct amount and placed at the affected site can be useful, indiscriminate use of such medication - such as excessive injections and improper placement of medication can actually harm someone. Steroids placed inside the spinal cord can cause nerve damage and excessive steroids can cause weight gain and worsen diabetes if present already. Today, most treatments are decided by "evidenced based medicine" - which essentially establishes the guidelines for practicing medicine. These guidelines are based on reviews of thousands of studies around the world and then coming to conclusions on what works and what does not, thus guiding physicians to the best treatment options to available to their patients.

The patient population includes those with:

  • Back pain and neck pain
  • Post Surgery Pain that persists
  • Pain arising from nerves or neuropathic pain
  • Reflex sympathetic dystrophy, Sympathetic maintained pain/CRPS
  • Craniofacial Pain, Migraine & Atypical Headaches
  • Cancer Pain

The multimodal treatment options include medication management, physiotherapy, psychological counseling and cognitive behavior therapy or coping strategies, accupuncture & surgical intervention where applicable.

Find out more about PMC@TTSH.