Long term pain leaves a person so disturbed that one cannot even recollect when it started. Further, if there were actually period of time without the pain.
Pain is that unpleasant feeling one gets when a part of the body is hurt. It is a perception of the brain. If the hurt/ injury is fresh, the pain is called acute pain. Old injuries or certain diseases also send out pain stimulus to the brain through our nerves to say that something is wrong and needs to be fixed.
There are many more reasons of pain. The pain may be felt as a prick, sting, burn, tingling, heaviness, crushing, stabbing or throbbing. It can happen in any part of the body. The pain might subside to reappear sooner or later. It may even be continuous.
A pain which lasts over three months is termed Chronic Pain. If left untreated, it interferes with routine tasks. A vicious cycle is formed with sleep which becomes disturbed. Inadequate sleep may, in turn, increase the pain.
Chronic Pain may lead to depression, anxiety, fatigue, mood swings and insomnia. Frequent job absenteeism and behavioural changes in society may also occur. This puts additional load on the family.
IS CHRONIC PAIN VERY COMMON?
It is estimated that one person out of ten (10%) is in pain at any time in the world. However, in a large study in Indian adults over 45 years of age, the incidence of Chronic Pain was around 20%.
The incidence is over 40% in senior citizens, i.ee above 60 years of age. Women suffer more than men. The rural population and those of lower socio-economy class have lesser access to medical facilities, hence their percentage is higher than others. The incidence is also higher in those who are obese and those who stay single in their old age.
HOW DO WE FEEL PAIN?
When we touch a sharp object, a special receptor (pain receptor) is activated and it sends a message (of pain) through nerves, first to our spinal cord, which causes a reflex action of pulling back our hand. Through the spinal cord, it goes to the brain where the message is read and perceived as pain. Pain is also perceived when it is due to burns, inflammation or excessive use of muscles/ tears of ligaments or stretching which causes lowered blood supply to internal organs.
Some people may feel more pain for the same stimulus/ tissue damage than others. The suffering of pain is a highly complex behaviour of individuals. It is linked to psychosocial behaviour and also to emotional status. This factor is not being discussed any further in this blog.
CAUSES OF CHRONIC PAIN
Chronic pain is usually due to a cause as discussed above. It is scientifically divided into two:
1. Primary Chronic Pain.In some cases, the actual cause cannot be found despite detailed examination and investigations. Such long term pain is called Primary Chronic Pain. Examples are some types of headaches, generalised bodily pains in which no cause is found - Primary Fibromyalgia. This, however, does not mean that the person's pain is unreal. It does require treatment as well as better understanding by care giver.
2. Secondary Chronic Pain. It is due to many causes, described below-
- Arthritis or Joint pains. Rheumatoid Arthritis as well as Osteoarthritis of old age gives life long pain in joints.
- Backache and Cervical/ neck pains are due to a host of causes.
- Muscular, ligament or other tissue pain after an injury/ trauma may last weeks or even months.
- Headaches due to identifiable causes and migraine.
- Post herpetic neuralgia is the pain which continues much after the patient has recovered from herpes zoster.
- Secondary Fibromyalgia is diagnosed when a cause is found for muscular pains.
- Neurogenic pains due to nerve damage.
- Post surgical/ operation pain in operated area.
- Pain at scar sites of deep burns.
- Pain in testes as well as uterus (fibroids) can be long lasting, if not treated.
- Cancers and non cancerous tumours.
- Pain due to long term inflammation in internal organs. Most common are our teeth, ear, throat etc if infections are left untreated.
A PERSON'S REPORT OF PAIN SHOULD ALWAYS BE RESPECTED.
MANAGEMENT OF CHRONIC PAIN
Chronic pain often does not respond to medication alone. There are specialised pain clinics in large hospitals in the metros. However, for most of our populace, the basic medical officer is the first to treat.
- Pain relief drugs, creams, ointments, oils and special bandages (where required) are widely prescribed in the initial stages. Some respond better to injectable rather than oral pills.
- Detailed medical investigations should also be done simultaneously to find the cause. If a specific cause is found, it needs to be treated accordingly.
- Anti-depressant medication may be required for long term patients in whom no cause is found and who find no relief with routine medicines. This should be under the behest of specialists and should be done with psychotherapy.
- Nerve stimulation or nerve blocks are required in some cases.
- For others, Acupuncture or other Alternative therapy is best suited. Massage and physiotherapy does wonders in many.
- Life style changes. These are extremely beneficial and need to be supervised:
- Stress management. Relaxation techniques and yoga does wonders and should be taught at appropriate centres.
- Physical activity as per age and medical condition.
- Diet, balanced, with supplements for seniors.
- Adequate sleep. This is needed to break the sleep- pain cycle.
- Others. Music, dance, gardening are some of the mind engrossing activities. A person loses pain in such activities.
- Family support is of utmost importance. Yes, the healthy members of the family have to do additional chores and it is not an easy task if the pain extends from months to years. But without their support, it is unlikely that the patient will improve.
- Laughter group. Laughing loud releases natural pain killers in the body. In a group, it helps bonding and connectivity with others, relieving anxiety which accompany Chronic Pain.
The incidence of Chronic Pain will keep increasing in most countries (less Africa) as their population transits to 'middle age'. The population of senior citizens will also increase by leaps and bounds with better medical facilities. This will result in explosive rise of persons with Chronic Pain.
ROLE OF GOVERNMENT
The government needs to give thought and plan many more pain clinics to reach the vulnerable population. That is, the rural areas and the urban slums. More doctors from all streams of medicine (modern medicine, ayurveda, homeopathy and Unani/ siddha) need to be trained in Pain relief, especially in the geriatric population. In US alone, $100 billion loss in economy is reported due to absenteeism/ lost jobs because of this malady. The medical services can be improved at half it cost.
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