FAQ's on Pain Management

Q- What is pain?

Ans- Pain is a protective/safety system of the body, where the nerves conveying pain signals to the brain, warn of impending or ongoing injury/insult to the body and to take appropriate action.

Q- What is Chronic Pain?

Ans- Chronic pain is the pain that lasts more than 3-4 months and is unresponsive to conservative treatment (Medications, physical therapy).

Q- What are the consequences of pain?

Ans- Chronic pain not only causes physical & mental suffering but also adversely affects family, social and professional life.

Q- What happens if pain becomes chronic?

Ans- Treating pain promptly can prevent it from turning into hard-to-treat chronic pain, when the nervous system becomes hypersensitive. Many times pain lasts beyond healing; when errant nerve impulses keep alerting the brain about tissue damage that no longer exists.

Q- Who treats pain?

Ans- Large number of generalized aches and pains responds to simple pain-killers but should be used with caution in patients with kidney/liver diseases/gastritis.

Moreover these conditions, to a large extent, are as a result of misuse or excessive use of pain-killers. Patients with obvious surgical conditions like trauma/ tumor etc will need surgery. However large number of patients, who were earlier treated with surgery, like sciatica, are now very well treated with minimally invasive procedures, by pain physicians. Most neuralgias and neuropathies {Diabetic neuropathy/Trigeminal/ Occipital neuralgia/ nerve entrapment/ischemic pain (due to poor blood supply)/abnormal behavior of nerves} will need specialized pain management; when only medications fail or produce unacceptable side-effects.

Q- How pain specialists treat pain?

Ans- Pain specialists are specially trained physicians, who diagnose exact source of pain or pain generators. For example back/leg pain can be due to muscles/ligaments, joints (facet joints/sacroiliac joints), tear in disc (annular tear/fissure), disc prolapse, Pyriformis syndrome etc; each of which require different treatment modality. Pain physicians non-surgically (Called Interventional Pain Management or IPM) deliver healing/numbing medications to the target. These procedures are generally safe in expert hands.

Q- Are any specialized equipments or devices used for managing pain?

Ans- Common pain interventions are performed in OT, using special imaging equipments/ contrast media & vital sign monitoring. However when the numbing medications at the pain source do not produce lasting effect, the offending nerves are destroyed with Radiofrequency generator; after testing and saving useful nerves. In few cases of intractable pain, a pacemaker like device, called Spinal Cord Stimulator with cordless remote control, is implanted inside the body, which converts the pain message to a pleasant feeling (Neuromodulation). In advanced cancer patients and patients with multiple sources of pain, pain medications are delivered directly into the central nervous system in the spinal cord, through an implantable device (Intrathecal Pain Pump with remote control) that needs only 1/300th of oral medications, thereby drastically reducing side-effects and providing excellent pain relief.

Q- Where can I find a pain specialist?

Ans- Pain specialists run pain clinics in majority of large hospitals in western countries but only in a few selected hospitals in India.

Q- What are the side effects & complications of Interventional Pain Management?

Ans- Like any drug or medical therapy, Interventional Pain Management has its share of side-effects. However they are very minimal in expert hands and mostly due to technical reasons. Drug related complications are very few. The amount of drug used is very less, it remains at the target site and does not circulate to other parts of the body.

Q- What next if IPM fails?

Ans- In some situations, like in long standing back pain where the prolapsed disc has hardened, surgery will be required.