Chronic illnesses: When you need a pain management expert

Most of the time, this pain disappears when healing occurs. But there is pain that persists for days, months, or years despite the patient having healed.

Then there is pain that occurs spontaneously and is difficult to manage. These kinds of pain arise from a dysfunctional nervous system which affects the overall life experience for such pain patients.

To manage this kind of pain, one has to appreciate it is not only an acute disease but a chronic disease.

It is estimated that about 20 percent or more of the population may suffer from chronic pain (pain that carries on for longer than 12 weeks despite medication), and the prevalence can increase depending on different circumstances.

This calls for a multifaceted approach to cover most of the issues these patients suffer in difficult psychological spaces caused by pain.

At what point will my pain require a pain management specialist?

Chronic pain’s impact is insidious; before you know it, you may reach points in your life where complications become permanent, and the resources spent are enormous.

Therefore, you should consult a pain specialist if your pain has lasted for more than 12 weeks.

The difference between acute and chronic pain is that acute pain is determined to have lasted for three months. Beyond the three months, pain is considered to be chronic pain.

How is pain management administered, and are there side effects?

There are several modalities in which pain management can be achieved. Given the subjective and complex nature of pain experience in each person and their significant caregivers, these pain management modalities are usually tailored for an individual pain patient to achieve maximum benefits for the patient.

Pharmacological modalities: They are mainly used to control about 60 to 80 percent of pain conditions.

It can be achieved using tablets, syrups, gels, sprays, and injections.

Patients may experience side effects from the pain medications, ranging from drowsiness, nausea/vomiting, constipation, urine retention, reduced breathing rate, and hyperacidity associated with stomach ulcers.

The medication can be overwhelming to the point the patient just rejects them. In this case, regular and frequent reviews are required to ensure the medication doses are tailored to the patient’s response and satisfaction.

Interventional procedures: These are prescribed where the pain cycle has proved difficult to break using medications or physical therapy.

They can be office-based or operating room-based procedures. They are resorted to depending on the pain intensity, the need to break the pain cycle, and when the pain hinders the rehabilitation programme.

A review immediately after the procedure or a week later is required in which continued pain education and counselling can be provided for the patient.

Complications can range from nerve injury to flare-ups of pain due to a steroid used in most procedures. However, an assessment of the patient who may require these procedures and the clarity needed to understand why the procedure is necessary is provided for the patient.

Non-pharmacological methods: This involves psychological and physical exercises. Although these methods may have no side effects, they may harm a patient if the pain is severe and the patient is being pushed to have physiotherapy or has an injury that has not been adequately diagnosed.

Ultimately, the non-pharmacological methods are preferable for long-term benefits, but if done inadequately, they may also have long-term physical and psychological unwanted effects.

Mitigating these complications is an ongoing process requiring real-time involvement of the medical personnel and patients.

Dr Mwaka is a Consultant Pain Management Specialist at Aga Khan University Hospital, Nairobi.