September, 2016

Pain Management - Sakra World Hospital

Your Challenges in Managing Pain -Dr Hirachand Shripad Mutagi

Pain is inevitable problem in everybody’s life, fulfilling an important function of warning us of illness / injury. However, when it persists even after body healing (Chronic Pain), it present significant challenges for the sufferer. Apart from personal physical, emotional, social and financial suffering; the journey to find the pain source and treatment takes him/her from pillar to post. Modern medicine’s trend for super specialization is good at addressing short term problems easily diagnosed by sophisticated investigations. However, problem in function (non-structural problems) tend to get missed.

Modern healthcare medicine focuses on specialization and your doctors looks for pain sources in internal organs, bones and joints. The muscular, ligaments and nerve problems tend to get missed. Pain is defined as an emotional experience, and precisely emotional impact of pain and suffering need to be identified, assessed and addressed. In summary, your pain specialist can be viewed as your helping hand who understands hidden causes for pain, its emotional and social impact on your life. If you have had blood tests and scans, not demonstrating the cause of your pain (medically Unexplained pain), the pain specialist may be able to help you.

Our body is complex, further complicated by the mind that interacts in shaping your pain experience. Your pain specialist will use his experience, knowledge and individualized examination to guide you in managing your pain. He may have to resort to precise needle techniques to identify your pain source, a big step towards addressing the problem. His goal remains in helping you deal with challenges in managing your pain.

In chronic pain, it is often the inability to do simple day-to-day things that hurt more than the pain itself. Your pain specialist’s main focus remains in reducing your dependence on your family and participate in the family’s wellbeing. The physiotherapy form an important spoke in the treatment pain. Your pain physician will work with his team of physiotherapist, psychologist and occupational therapist to find the best combination of treatments for you.

The pain physician has the following tools to assist you:

1. Identifying the source of the pain by thorough examination and on occasions on precise placement of numbing agent near anticipated pain source.
2. Interrupting the pain pathway – by using chemical or precisely delivered heat treatment.
3. Resetting the pain nerve circuitry –eg. Spinal cord stimulation or sacral stimulation.
4. Stabilizing dynamic problems in spine / joints – eg. Internal fixation of fractured vertebrae (vertebroplasty) due to injury / cancer.

                           PROBLEMS                                           SOLUTIONS

1. Lack of awareness among medical personnel prevents delivery of proper pain and palliative care

1. Disseminate basic information on palliative care through branches of the Indian Medical Association

2. Lack of awareness of pain care in the public creates delays in bringing patients to palliative care units

2. Educate the public about the possibilities of pain care through the press, radio and television

3. Opiophobia creates fear of turning patients into addicts

3. Teach physicians and the public that opioids are safe to relieve pain

4. Lack of availability of opioids

4. Generate pressure from the public to simplify existing complex rules and regulations

5. Silence about cancer diagnosis can prevent patients from seeking treatment

5. Discuss cancer diagnosis openly with patients and their families

6. Imitate only Western models of care

6. Create model of care adapted to Indian economy, culture and traditions, based on care at home and empowering families

7. Co-existence of multiple systems of medecine (modern medicine, ayurveda, homeopathy, naturopathy)

7. Do not emphasize rivalry, but complementarity in India's rich medical heritage which can benefit patients

8. Poverty

8. Encourage medical personnel to take the patients' financial position into consideration when planning treatment

9. Transportation problems (inadequate roads) can hamper patients' travel to pain center

9. Rely on strength of the Indian family structure to treat patients 'by remote control' with help of relatives

Dr. Hirachand Shripad Mutagi
Senior Consultant - Pain Management
Pain Management