Pain – A disease in its own right!!

The world is waking up to an epidemic of persistent pain. We all grow up being told and understand that pain is a symptom of disease.

A schematic of how pain is processed from the stimulus to the brain.
Photo from: http://www.feelingprettyremarkable.com

To start with, it is absolutely right.

Pain serves as a warning signal that we assess / investigate to identify and treat the underlying cause.  This ideology understandably draws no arguments.

The caveat in the above scenario,

“To start with……..”.

The bar chart below depicting the proportion of patients when investigations (blood tests and scans) successfully identify a cause (red shaded area) for the patient’s presenting complaint. Each vertical column representing a particular patient complaint.  Not finding anything of significance or normal /near normal investigation, is a surprisingly common scenario.

A google scholarly article search on “medically unexplained symptoms” confirms a rapidly expanding literature on this aspect. A survey of symptoms that went on to have an identifiable cause in western world general practice unearths sobering patterns.

Let’s look at the “glass half full scenario”. Great! I don’t have cancer, TB, Infection, etc.

Now the “Glass Half empty scenario”. But, I still have the pain!

Only a small proportion of patients with symptoms have an identifiable cause and the others have normal investigations (blood tests and scans). Irrespective of the paradox of the situation, the epicenter of the scenario - the person in pain, begins a merry go round of multiple doctor / hospital visits. A parallel visit to faith healers with bowed down heads or succumbing to internal / social pressure drags you to alternative health systems like Ayurveda / Homeopathy. This journey of seeing multiple specialists spread across a wide geographical area, each providing nuggets of information  (in good faith) creates a concoction of confused understanding about causation, treatment options and prognosis. While each have good intentions for nuggets of information / treatment are absolutely right in a specific context. But the person in pain, it breads is confusion and despair. Into this scenario, add the contribution of quacks and divine healers and you have a path to disaster for that confused individual (don’t forget the plight of near and dear ones). Varied explanations from each is counterproductive in the long run, As is rightly said “ Too many cooks spoil the both”.

Patients' understandable attempts to alleviate their symptoms (including pain) may paradoxically exacerbate them. Let me explain, excessive rest to reduce pain or fatigue is a recipe for ensuring the body loses its endurance / activity tolerance, needless to say counterproductive in the longer term. Even if the source of the pain is cured, the weak easily fatigable body can’t cope with activities of daily living, which is easily interpretable as ongoing illness. Doctors may also contribute to this by failing to address patients' concern or unwittingly increasing fear of disease (such as by excessive investigation). Patient’s views about treatment being focused on medicines, immediate cure, curative surgery, reluctance to engage in physiotherapy and aversion to address frustration / low mood all contribute to a treatment failure. Here we go, Ready for the next specialist consultation ……..

The World is Waking Up
The medical fraternity is slowly waking up to the fact that “Persistent pain  is a medical condition by itself.” So much so that conferences are organized to raise awareness of the issue, as in - “Chronic Pain – A disease in its own right” Second Lilly Pain Masterclass Meeting held at the Royal College of Physicians in London 2012.
The EFIC (European Federation of IASP Chapters) current declaration on pain is that “Pain is as a major health problem, a disease in its own right”. 
An organization called the International Association for the Study of Pain has defined pain as an “unpleasant sensory and emotional experience associated with actual or potential tissue damage or described of in terms of such damage”. Even then there are 500 types of chronic pain and no two patients suffer in a similar fashion. The words emotional experience have great significant in defining pain. The fact that we can’t explain it does not mean it does not exist for that patient.

Current Thinking and Lines of Research
Chronic pain often outlives its original causes, worsens over time, and takes on a puzzling life of its own. There is emerging evidence that over time, untreated pain eventually rewrites the central nervous system, causing pathological changes to the brain and spinal cord, and that these in turn cause greater pain. Sometimes the original problem creates new ones as the patient distorts posture and avoids exercise in an attempt to reduce the pain.  In chronic pain, the protective mechanism of avoidance becomes maladaptive and counterproductive.
Achieving a happy, informed and relaxed patient, as treatment goes along is just as important as any medicine or medical procedure to ease pain / suffering.
The need of the hour is a detailed assessment of this persistent pain and its consequences to assist in formulating an individualized treatment regime with a combination of medicines, physiotherapy, non-surgical treatments and training on improving ability to lead an independent life. The initial challenge in these setting is in unravelling the different counterproductive beliefs of a desperate patient while specific treatments are provided to achieve a happy patient at the end of the journey.
If the above article resonates with your past experience, its time you recognize it, take charge and build your road to recovery.


A helping hand is always available……
#releafpain; #mutagi.paindoc