Persistent, chronic pain can reduce quality of life: experts

KARACHI:

Whether your pain is chronic or acute or if it stems from psychological rather than physical causes, the sensation of intense discomfort has a direct impact on the quality of your life.

In order to discuss this, a seminar on pain management and its relief as a basic human right was held at the Aga Khan University (AKU) on Tuesday. Chairperson and assistant professor for the department of anaesthesia Dr Gauhar Afshan discussed the scope — differentiating chronic from acute pain. Many doctors worldwide now accept pain as a major healthcare concern.

“Chronic pain is a specific healthcare problem and a disease in its own right,” she said. It can pose a massive burden on about 20 per cent of adults, with numbers rising to affect around 50 per cent of the older population. Pain suffered by those with cancer affects nearly 70 per cent of 10 million cancer patients worldwide.

The WHO defines health as not simply the absence of pain but a state of wellness, she said. Quoting the health body, she added, that people who live with pain are four times more likely to suffer from depression and anxiety.

Dividing chronic pain into two categories, musculoskeletal and cardiovascular, she said, lower back pain is the most prevalent and common work-related injury. According to Afshan, 33 per cent of adults are affected by musculoskeletal pain and 29 per cent of work days are lost due to this reason. Unrelieved pain after surgery or trauma can be held responsible for problems with heart rate, blood pressure and put a person at risk for a number of other diseases.

Managing chronic pain

Consultant anaesthetist Dr Mansoor Ahmed Khan outlined the significantly higher psychological aspect in this type of pain for which medication does not work as efficiently. Chronic pain is described as one that exceeds the expected duration of time and does not seem to be improving through conventional methods. Khan then briefly spoke on other choices for the management of chronic pain which include psychological intervention (cognitive, behavioural, bio feedback, relaxation techniques and hypnosis), physiotherapy (heat therapy and cold therapy), alternative therapy, Reiki and acupuncture.

In comparison, acute pain has a sudden onset, remains for a definite time period and has a discernable cause. However, if left untreated it runs the risk of becoming chronic. Dr Robyna Irshad Khan, a consultant anaesthesiologist, spoke on acute pain management and its causes. “Fractures, burns, cuts, labour pain, dental pain, trauma and pain after surgery (or post-operative pain, POP) are among the most common causes,” she said.

On its therapy, she listed pharmacological agents such as opiods and non-opiods. “While opiods are the mainstay method used for medium to severe pain management, they should never be used without the help of a healthcare provider,” she cautioned. The most intense pain of all, as described by Dr Abdul Monem, an associate professor at AKU, is labour pain. “Its best known method of pain relief is the epidural,” he said. The relief does however come with possible side effects, including failed block, patchy block, breakthrough pains, hypotension, itching, numbness, shivering. There are some myths and misconceptions regarding epidural use as well, Monem said, adding that, there is no definite evidence supporting them. There include running the risk of paralysis, chronic backaches, being forced into a C-section delivery. There is some scientific support, however, for the epidural leading to the need for assisted delivery such as the use of forceps as the mother’s ability or energy to push the baby in the last stages may decrease.

Published in The Express Tribune, May 4^th, 2011.