Most people who seek medical help complain of some form of pain. Depending on the duration, pain can be classified as acute or chronic. When the duration of pain is more than 3 months or, more than the expected time of healing, it is generally termed chronic pain. Pain, especially if it is chronic, is both a physical and emotional experience and can adversely affect the quality of life. Therefore, the pain physician needs to treat it in its entirety and from a ‘biopsychosocial’ point of view. This requires a holistic and multimodality approach. Chronic pain can also broadly be divided into non-cancer pain or cancer pain. The treatment approach to both also varies.

Pain Management: An overview

Providing relief from pain, whether it is non-cancer pain or cancer pain, is one of the most rewarding and challenging experiences for the pain physician. The various modalities used to treat chronic pain  can be broadly classified as drug and non-drug modalities. Treatment with oral medicines such as analgesics, has its own shortcomings. These include continuation of medications for an indefinite period, side-effects of certain medications that can cause organ damage among other adverse effects. However, for cancer pain, oral medications based on the WHO analgesic ladder can address pain in more than 70% of patients.

Some medications can be injected locally at the site of pain. These include trigger point injections, nerve blocks, joint injections and spinal injections. These interventions are made more targeted and accurate and, therefore, more effective, with the assistance of ultrasound or X-ray. Trigger point injections & nerve blocks are useful to treat pain originating from muscle and nerves respectively. Spinal injections include epidural injections, nerve root injections and facet blocks and these are useful in treating low back pain and sciatica.

Some of the conditions treated by nerve blocks, joint injections & spinal interventions:

• Back pain & sciatica
• Neuralgias
• Frozen shoulder & shoulder pain
• Knee pain
• Cancer pain
• Coccycodynia or Tailbone pain
• Failed back surgery syndrome

Non-drug therapy, can obviate some of the side-effects of medicines. These modalities include dry needling, physical therapy, psychological support, dietary counselling etc. Since pain is a biopsychosocial phenomenon,  a pain management regime which is individualized to the patient, would  yield a favourable outcome. Such a holistic approach would not only decrease pain, but it would also improve the quality of life.