Ways To Manage Chronic Pain Without Surgery ; These days, people are not conscious and responsive towards therapies used for chronic pain management. As Dr.Vivek Loomba, Senior Consultant Pain Physician, Indian Spinal Injuries Centre in Vasant Kunj, New-Delhi, says, “There are numerous patients suffering from complex conditions such as disc prolapse, chronic arthritis, severe migraine, sciatica or knee pain. These patients are not aware of the remedies for pain management and often take the help of painkillers or surgeries as the ultimate option for pain management.”
In an exclusive conversation with TheHealthSite.com, Dr. Loomba sheds light on the different types of chronic pain and the various ways (both non-surgical and surgical) to manage chronic pain.
Types of chronic pain
According to Dr. Loomba, the chief categories of chronic pain include:
Nociceptive pain: It includes pain caused due to deep tissue damage as seen in severe burns, accidental sprains or bruises.
Inflammatory pain: Pain associated with autoimmune disorders or infections.
Neuropathic pain: It is further classified as peripheral neuropathic pain (e.g. diabetic neuropathy or as seen in ‘post- herpetic neuralgia’) or central neuropathic pain. (E.g. as seen in cases of ‘cerebral vascular accident sequel’).
Musculoskeletal pain: It includes pain in the muscles of our body, and may lead to back pain or myofascial pain.
Osteoporotic pain: Resultant from osteoporosis, commonly seen in the elderly with weak bones.
Psychogenic pain: It mostly occurs due to psychological concerns such as abdominal pain or recurrent headaches (as a result of behavioral changes, emotional or psychological factors).
Mechanical pain: Pain caused due to vertebral fractures or due to disc displacement may be included in categories of mechanical pain.
Cancer Pain: This includes pain in cancer patients, resulting from the tumor itself or from the metastasis of the primary tumor
Treatment of chronic pain
Dr. Loomba points out that treatment for chronic pain can be a bit tough as different patients may showcase different levels of pain and the same therapy may not be applicable on everyone. Stressing the importance of understanding the real cause of your pain, he says, “Without a proper diagnosis, the sufferers of chronic pain may be referred from one doctor to the other without getting permanent relief.”
“While treating chronic pain, your doctor will conduct a thorough research on your medical as well as psychological records, the chief mechanism of your injury, details of your work and tasks, the history of your pain, records of your pain management by previous doctors, history of substance usage and other related factors which may impact on your overall treatment results. Your pain management expert may also ask you to get medical tests such an MRI scan or an X-ray, as per your injury or physical condition. It has also been seen that patients with severe chronic pain, suffering from years often try to commit suicide. In such cases, psychological intervention is also required.”
Dr. Loomba further says, “The arena of pain management has shown rapid progress in the past decades. Multimodal pain management therapies include the usage of multiple pharmacological courses of analgesics which cater various receptors and the involved pain mechanism. The main aim of this technique is a reduction of the side-effects using improved analgesics.”
Other advanced methods that are utilized for chronic pain administrationwithout involving surgery are as follows:
Using Pain Relievers: The over-the-counter prescriptions such as acetaminophen are used as the first line of treatment for mild to moderate pain. NSAIDS or Non-steroidal anti-inflammatory drugs as ibuprofen and are used for treating pain associated with arthritis, muscular strains and repeated headaches. They are effective as they provide relief from chronic pain associated with a sudden trauma or a surgical process. In addition, weaker opioids as ultracet and other stronger opioids as morphine are used if patients continue to have persistent pain. These drugs are very useful in managing refractory pain, like cancer pain.
Using Transdermal skin patches: It is a simple comfortable medicine patch that is applied on your skin and the embedded drug gets absorbed at the application site over a short span of time. They are used to transmit a range of medication into the patients body as buprenorphine, fentanyl, nicotine or clonidine.
Nerve blocks: They are methods which help in managing or preventing various categories of pain. Under ultrasound or X-ray guidance, anti-inflammatory medications are injected adjacent to a nerve, and they help in relieving the pain transmitted by that particular nerve.
Ablation of the affected nerves: In this process, a tiny part of your nervous tissue is destroyed by using a minor electric current stimulus, and that results in interrupting the pain pathway. This method has consistently proven to provide good pain relief in refractory chronic pain patients.
Epidural injections: It is basically the injection of a strong anti-inflammatory medication straightaway into the potential space (epidural space) outside your spinal cord. This helps in relieving pain radiating down your upper or lower limbs.
Spinal Cord Stimulators: These devices help in pain management, and work like a pacemaker for the heart. It involves leads which are inserted underneath your skin and they use vibratory signals that help in masking the pain sensations. It is often referred to as neuro-stimulation and is an active method for handling chronic pain in your legs or other body parts, which may be an underlying cause of numbness or unusual discomfort.
Intrathecal pain pumps: In this process, a tiny catheter is placed in your back region using a motor-powered pump. It helps in supplying a decent dosage of powerful analgesics like fentanyl. Intrathecal pain pumps have been successfully employed in cancer sufferers who cannot be given an oral dose of medicines.
Chronic pain management involves various parameters in the treatment process as:
- Medication management
- Physiotherapy and exercise
- Advanced therapies such as nerve blocks, radiofrequency ablation technique.
- Using an implant as using a pain pump or a spinal cord stimulator.
When surgery is required to manage chronic pain?
Dr. Loomba says: Surgery is the last option as a vast majority of patients benefit from various conventional and non-surgical procedures. Surgery is generally reserved for patients who start developing muscle weakness or wasting but it also depends on the category of the pain and its severity along with other factors.
According to recent researches, it has been found that chronic pain can be a hindrance as it readily affects your way of living and can hamper your daily schedule. It is essential that patients with a history of chronic pain should take the help of their health expert rather than managing the pain on their own. Consistent health checkups can definitely prevent chronic pain by identifying the symptoms of health disorders. Thus, if a member of your family is undergoing chronic pain, consult a pain specialist as soon as possible. Your physician will conduct a thorough assessment of the severity of your condition and prescribe the accurate medicines or a treatment plan for dealing with your pain.