Pain can come in various forms – mild, moderate and severe. The World Health Organization defines pain as “an unpleasant sensory and emotional experience associated with, actual or potential tissue damage.” 

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While a simple pain in the head or body ache could be treated with an analgesic, and some tissue pains could be relieved with hot or cold packs, massage or even exercise, there are other forms of pain that are tricker and more challenging to treat.    

Doctors categorise pain as acute or chronic. There are many people who experience pain: apart from those who have had a trauma, which could be temporary, there are the elderly, as well as persons with cancers and other disease, who need relief.  

So what is pain? Pain is an experience transmitted through a nerve to the brain. Chronic pain is any pain that lasts more than three months. Chronic pain is when the brain continues to receive signals from the affected nerve.

Chronic pain can be extremely challenging to treat, says Anand Murugesan, a pain management specialist at Apollo Hospital, Chennai. People with chronic pain may require the support of a multidisciplinary team. Chronic pain is associated with cancers as well as with the wear and tear of tissues. Such pain is alleviated using targeted treatment of the region, he says.  

A person could become anxious, depressed and sometimes even have suicidal thoughts as a consequence of suffering excruciating pain constantly.  Mallika Tiruvadanan, a palliative care expert who heads the Lakshmi Pain and Palliative Care Clinic in Chennai, says that while for simple body aches medicines are not prescribed and patients are instead advised to consider hot fomentation or meditation, for those on medication any increase in dosage has to be done only after careful consideration.

Sometimes, she says, patients with severe, debilitating pain, have pleaded with doctors to end their suffering. Doctors say the most advanced pain relief options are considered only when all other available conventional methods have been exhausted.

Advanced options  

For those with excruciating pain that makes regular day-to-day activities difficult, advanced pain relief options are explored. There are invasive treatments such as radiofrequency ablation, stimulator implants and neuromodulations -- considered the last option -- they point out.

One option is blocking the experience of pain -- which is transmitted through a nerve to the brain -- and thereby relieving the patient of pain. The treatment modality is generally to numb the experience of pain – this could be through oral medications or injections. Advanced therapies include blocking the nerve directly either through scarring or stimulating the nerve. Radiofrequency ablation involves the use of advanced imaging modalities to help doctors reach the affected nerves, and the nerve is then scarred, thus preventing it from sending signals to the brain. The patient then experiences pain relief. Such efforts help, for instance, when a spinal surgery has not provided relief. Radiofrequency ablation helps in such cases to strengthen the vertebral body and alleviate the pain, Mr. Anand says.  

For some time now, doctors have also been using another technique - neuromodulation – where the nerve is stimulated instead of damaging it. When the nerve is stimulated it is hyper polarised, and thus pain signals are filtered out. As a result, the brain does not receive the pain signal and the patient experiences relief. 

Pain specialists such as Mr. Anand believe this method could be the way forward for chronic cancer-induced and non-cancer induced pain, such as diabetic peripheral neuropathy.

Senior consultant spine surgeon at Apollo Hospital K. Appaji Krishnan, who has been involved in neuromodulation therapy explains the case of a recent patient seen at the hospital. The patient had exhausted every method, but was still suffering, following a surgery to remove a testicular tumour. At the hospital this patient was reviewed by a psychiatrist and an interdisciplinary team evaluated him. They decided that a stimulator would relieve him. “We found out that we wanted to do the procedure but the machine that is used for dorsal root ganglion (a cluster of neurons in a dorsal root of a spinal nerve) was not available in the country,” he explains. 

The hospital then improvised with the existing equipment. “We found out that there was spinal cord stimulator,” he says. The surgeons implanted a spine stimulator and introduced an electrode into the affected nerve. The stimulator released small doses of electrical energy to the dorsal root ganglion that the brain perceived as an impulse, but not as pain. This gave the patient relief.

What happens in the government sector?

The six-year-old Department of Pain Medicine at the Tamil Nadu Government Multi-Super Specialty Hospital is a specialised centre in the government sector that provides pain relief, says G. K. Kumar, pain specialist, and head of the department of anaesthesia and pain medicine. “We have treated more than 10,000 patients on outpatient basis and more than 1,500 specialised pain treatment procedures/interventions have been done, to date,” he says.  

“All pain relief treatment facilities are provided free of cost under the Chief Minister’s Comprehensive Insurance Scheme,” says the hospital’s director and dean R. Mani. The physician in the department was trained in reputed institutions, bringing advanced treatment options involving current advances and cutting-edge technology to poor patients, Dr. Mani explains.

However more such efforts are needed, primarily in the public sector, and also in the private sector, to help the thousands who suffer but find it difficult to get relief, say experts.