Pain is as old as the saga of humans. Even the mighty king Ramesses II of the Land of the Pharaohs and Nile River is said to have suffered from arthritis.
A multitude of Sri Lankans, old and middle aged and even young suffer from all types of pain. Here is a question and answer session with Dr.Harindu Wijesinghe, who has specialized in the sphere of pain management at Concord Hospital in Sydney, Australia and is today a Consultant in Rheumatology , Rehabilitation and Sports Medicine.
Q: What is meant by pain management, Is it elimination of pain or reduction of pain or control of pain?
 Pain occurs due to many causes |
A: Pain management can mean either complete removal of pain or when this is not possible control of pain thus enabling the patient to live a better life.
Q: How is this achieved?
A: Pain occurs due to many causes. The first step in pain management is to reduce or manage the patient's pain. In modern pain management this is achieved by using a variety of different treatment methods which are used together. These include drugs, injections, physiotherapy, massage and other methods.
Another important thing in pain management is to find the cause of the pain. If the cause is found we can completely remove the pain and prevent it from recurring. So what we mean by pain management is controlling or removing the pain by using a number of different methods.
moreQ: Is pain a disease?
A: Pain is not a disease; it is our body telling us that there is something wrong within our body which needs attention. A good example of this is if you pull one of your fingers back you will feel pain. This is your body telling you that there is something wrong with your finger, once you let go this pain will go away. This is the same with all types of pain once the cause is found and corrected the pain will also reduce or disappear.
Q:How does pain occur?
A: We have specialized nerve endings in our body when these get irritated our mind perceives this as a feeling of distress, suffering, or agony. Pain has a protective function; acting as a warning sign and preventing further injury. However, even mild pain can have a detrimental effect on performance and severe pain will limit movement. And sometimes pain lasts longer than the initial insult and becomes a chronic pain; this type of pain is difficult to treat and may need management in a specialized center.
Q: What are the areas in the body most afflicted by pain?
A: Pain can affect any part in the body. Pain affecting the chest, stomach or head may be due to a serious cause such as a heart attack and demands immediate medical attention. The main causes of chronic pain that we see are due to back, neck , knee , shoulder and hand pain. Pains due to problems in these areas are the commonest cause of pain worldwide.
Q: What were the treatments used then and by whom?
A: Many herbs that are used today have been around since ancient times. They have been used for easing the pain. Some of these herbs are even used in modern day medicines. In Egypt there were often bone injuries like broken bones and fractures, arthritis as well as joint inflammation which in fact was the disease suffered by Ramesses II. Other diseases included the Tuberculois of the spine and age-related chronic arthritis. They used various herbs treatment and even surgeries like amputation for these ailments. So pain and remedies for pain has been there for a long ime.
If it existed in ancient and medieval Lanka have you any idea by what names they were called ? What the local/Ayurvedic remedies were?
As western medical practitioners of Sri Lankan origin we are proud to say that the earliest records of dedicated hospitals were in Mihintale in Sri Lanka where evidence of dedicated medicinal treatment facilities for patients are found. So there were most probably ancient remedies for pain then.
Q: Is pain increased due to modern life styles?
A: Modern life style as well as increased life expectancy of people has in a way increased pain in people. One of the main reasons of pain is wear and tear of joints and cartilages which occurs with aging. As we all know people now live longer and because of this the elderly population is increasing and this leads to increased number of patients with pain.
Due to a more sedentary lifestyle with less physical activity people have weak muscle and they are also more overweight and this leads to joint pains. Also occupationally jobs which lead to long hour of sitting such as computer related work also lead to pain in neck, back and hand. Another very important factor is stress which appears to increase this dilemma of pain among people. Pain occurs to day even among young due to changed life styles.
Q: How is pain connected to obesity?
A: When your weight increases you put more weight on your joints such as the knees, hips and lower back which are the main weight bearing joints. This puts more stress on the bones ,cartilages , ligaments and muscles of these joints. This increased stress leads to small damages in theses tissues which manifest as pain.
Q: Is there a disparity between the genders as regards pain victims?
A: Researchers have found that females are subject to more pain because they have a different set of hormones and because of the hormone fluctuations only particular to females. Thus a variety of chronic and painful conditions, for example are more common in women and these include migraines, rheumatoid arthritis, irritable bowel syndrome, and fibromyalgia.
Q: Why do the old and the aged get more afflicted with pain?
A: As you age your bones, cartilages and other tissues age with you. During your life time you will accumulate small tears and breaks in these tissues which will increase as you grow older. This with the combination of increased weight as you age leads to more pain in the elderly. Unfortunately pain in the elderly sometimes is not detected and is mistaken by others as depression, anxiety, sleep disruption, appetite disturbance and limitations in the performance of daily activities. Thus pain in the elderly has to be assessed and treated properly.
Q: Is there a complete cure for pain diseases?
A: Complete cure depends on the cause of the disease. Some types of pain can be completely cured. However sometimes pain can't be cured and in these situations we have many different treatment methods including some very new methods to control these pains.
Q: Knee pain seems to be the most common. What are the most common forms of medication for these?
A: Knee pain is treated with tablets to relive the pain along with physiotherapy methods. As always the cause for the knee pain must be assessed as there many different causes for knee pain. If there is a correctable cause we will use methods to correct the underlying disease.
The commonest cause for knee pain is wear and tear of cartilage in the knee which we call knee osteoarthritis. This is treated by using a combination of drugs, physical therapy methods, strengthening exercises, posture corrections' and advice on weight reduction. In our treatment along with all these methods we place a very special emphasis on explaining the disease and the treatment process to the patient which helps relieve the anxiety of the patient.
Q:What is the role of injections in treatment?
A: Injections given into the joint are effective and help reduce pain, however they should be given by someone with experience in this process as if given incorrectly there can be complications. We use a combination of steroids and local anesthetics for the injections which can be given to nearly any painful joint in the body. Given properly they can be repeated without causing any further damage to the joints.
Q: What is the role of operations?
A: Operations are usually done when all methods of pain control have failed. However the choice of doing an operation for pain is the patient's choice and different patients select the operation for various reasons while other patents prefer not to undergo surgeries.
