Chronic Pain Relief Available Options

By: Dr. J. Gnanaraj, H. Charles Richard M.P.T. | Published: Sep 2017 Volume: 6

INTRODUCTION

Pain is the most common reason for visiting doctors or health care facilities. Pain lasting for over a month is called chronic pain and those with such pains were often told that they are hypochondriacs and the problem was in their heads. Such pain can cause anxiety, depression and can have serious implications.

Traditionally only pain relief medicines were given for these chronic or long term pain. Later anxiolytics and antidepressant medicines were added empirically.

Thanks to the arrival of functional MRI [Magnetic Resonance Imaging] there is more insight now into chronic pain. For instance we are now aware of the emotional centers that are involved in the brain. We know why side effects like sleep are associated with some of the medication for pain. It might be difficult to switch off the pain transmitting nerves without causing seizure or heart rhythm problems. We have been able to find out how massage or acupuncture works and how emotional response can modify treatment. We have also learnt about supplements like Fish oil, Glucosamines, and evening primrose oil, etc.

How can I make use of these new techniques and knowledge?

The first and most important step is to find out what is causing the pain. Pain management as a specialty developed only recently. It is important to be evaluated by doctors who have special training in pain management and physiotherapist who understand recent advances. They could work out specialized treatment methods.

What are the options that are available for treating chronic pain?

1. MEDICATION: Plain painkillers might not be sufficient. Medications could be titrated through pain killers, NSAIDS, antidepressant group of medicines, anticonvulsant medicines, muscle relaxants and opioids. With proper diagnosis and the correct combination of medicines they are much more effective than empirical use of pain medication by non-specialists.
2. NERVE BLOCK PROCEDURES: A variety of these procedures are available and the common ones are the following:
   1. Epidural Steroid Injections: These are very effective procedures done under x-ray guidance. Traditionally the C-arm is used and at SEESHA a special low-cost safer technique using air is available
   2. Facet Joint Injection: These are more specialized injections and require C-arm guidance and are available at Coimbatore and Dr. Sekar can give the guidance
   3. Lumbar Sympathetic Block: These are used for Complex Regional Pain Syndrome and needs special x-ray guidance
   4. Celiac Plexus block: These are carried out for very severe pain especially those associated with cancers
   5. Stellate Ganglion block: These are used more for upper limb pain and require great expertise
3. TRIGGER POINT INJECTIONS: These special injections work on tight spots in the muscle and give effective pain relief for 4 weeks to one year. SEESHA has developed a technique of ultrasound guided diagnosis and injection.
4. RADIO FREQUENCY ABLATION: This acts on nerves that send signals to the brain. This is the most modern and specialized treatment for pain and requires an expensive machine.

Are there any concerns of safety?

These procedures are generally safe if carried out by properly trained personnel. These procedures have been available for many years but were not commonly used earlier because of the safety and accuracy concerns. However, the modern equipment like the ultrasound guidance or C-arm fluoroscopy guidance make these procedures safe.

Conclusion

The bottom-line is that any pain lasting for over a month needs evaluation by an expert in the field and with proper evaluation and with modern treatment modalities there is no need to suffer.

What are the options available at SEESHA?

Dr. Michael Sekar, the anesthesiologist at the Karunyanagar facility has had special training in Pain Management. Although C-arm fluoroscopy unit is not available, the innovative use of ultrasound and the regular x-ray machine makes the special injections possible at the hospital and the Radio frequency ablation machine is available at SEESHA during Dr. Sekar’s visits.

Gnanaraj, J. and H. Charles Richard M.P.T., (2017), Chronic Pain Relief Available Options, mdCurrent-India, Volume 6. Available online at: http://mdcurrent.in/patients/chronic-pain-relief-available-options/ This is a peer-reviewed article.

Dr. J. Gnanaraj MS, MCh [Urology], FICS, FARSI, FIAGES is a urologist and laparoscopic surgeon trained at CMC Vellore. He has been appointed as a Professor in the Electronics and Instrumentation Engineering Department of Karunya University and is the Director of Medical Services of the charitable organization SEESHA. He has a special interest in rural surgery and has trained many surgeons in remote rural areas while working in the mission hospitals in rural India. He has helped 21 rural hospitals start minimally invasive surgeries. He has more than 150 publications in national and international journals, most of which are related to modifications necessary for rural surgical practice. He received the Barker Memorial award from the Tropical Doctor for the work regarding surgical camps in rural areas. He is also the recipient of the Innovations award of Emmanuel Hospital Association for health insurance programs in remote areas and the Antia Finseth innovation award for Single incision Gas less laparoscopic surgeries. During the past year, he has been training surgeons in innovative gas less single incision laparoscopic surgeries.

H. Charles Richard M.P.T. (ORTHO), M.I.A.P Physiotherapist at the SEESHA Karunya rural community hospital in the Karunya University campus, Coimbatore: The department specializes in treating a variety of sports injuries and has weight reduction programs.