Pain that persists after healing needs specialised care, say experts

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At Victoria Hospital, attached to the Bangalore Medical College and Research Institute, more than 1,200 patients have undergone specialised pain-relieving procedures since its pain clinic was established in June 2023. | Photo Credit: FILE PHOTO

Months after a fractured wrist had healed, a 42-year-old homemaker from Mysuru was still unable to cook or even tolerate the touch of clothing on her hand. Despite repeated investigations confirming that the fracture had healed, she continued to have severe burning pain, swelling, stiffness and changes in skin colour.

She was eventually referred to pain specialists and diagnosed with Complex Regional Pain Syndrome (CRPS), in which the nervous system continues to generate pain long after the original injury has healed. With specialised pain management, she gradually regained function and independence.

Pain specialists say such cases highlight the need to recognise chronic pain as a condition that may require specialised care.

At Victoria Hospital, attached to the Bangalore Medical College and Research Institute (BMCRI), more than 1,200 patients have undergone specialised pain-relieving procedures since its pain clinic was established in June 2023. The clinic, run by the Department of Anaesthesia, Critical Care and Pain Medicine, has also provided outpatient consultation to over 4,000 patients.

As September is observed as Pain Awareness month, the Karnataka Chapter of the Indian Society for Study of Pain (ISSP) has launched a public awareness campaign urging people not to accept chronic pain as an unavoidable part of life, but to seek specialised care when it persists beyond the normal healing period.

“Our team led by our head of the department Nethra S.S. has performed over 1,200 advanced pain intervention procedures and has seen over 4,000 patients in the outpatient department,” said Satish Kumar M.N., associate professor, Department of Anaesthesia and Pain Medicine, BMCRI, and treasurer of the Karnataka Chapter of the ISSP.

The clinical team, comprising associate professor Nethra H.N., assistant professor Harshavardhan H.S., Satish Kumar and Dr. Nethra, treats patients with cancer pain, neuropathic pain, musculoskeletal disorders, spine-related pain, knee and shoulder pain, trigeminal neuralgia and other chronic pain conditions.

Besides image-guided nerve blocks and joint injections, the clinic performs advanced procedures such as radiofrequency ablation, which interrupts pain signals from affected nerves.

Dr. Kumar said the acquisition of a radiofrequency ablation machine had enabled the BMCRI to offer procedures that were previously available largely in corporate hospitals.

Sadasivan S. Iyer, consultant and lead, Pain Medicine, Manipal Hospital, Old Airport Road, and vice-president of the Karnataka Chapter of the ISSP, said a common misconception was that patients should simply learn to live with chronic pain.

“Many patients are told to simply live with pain because investigations do not reveal an obvious cause. But persistent pain can itself be a medical condition requiring specialised evaluation and treatment,” he said.

While acute pain serves as the body’s warning signal after an injury or illness, pain lasting beyond three months can become a condition in itself, he said. The nervous system can continue to transmit pain signals even after tissues have healed. Therefore, normal scans do not necessarily mean that the pain is imaginary, while abnormalities on imaging do not always explain the severity of symptoms.

Pain medicine is not limited to prescribing stronger painkillers. Depending on the condition, treatment may include medication optimisation, physical rehabilitation, psychological support, lifestyle modification and minimally invasive, image-guided procedures such as nerve blocks, epidural injections and radiofrequency ablation.

“The goal is not simply to reduce a patient’s pain score. It is to help them sleep better, return to work, perform daily activities and regain independence. Pain relief is ultimately about restoring quality of life,” said Murali T.S., consultant and lead, Pain Medicine, Apollo Hospitals, Bengaluru, and president of the Karnataka Chapter of the ISSP.

According to the ISSP, millions of Indians live with persistent back and neck pain, sciatica, diabetic neuropathy, post-herpetic neuralgia, trigeminal neuralgia, cancer pain and pain that continues after surgery.

Specialists advise people to seek evaluation if pain lasts for more than three months, repeatedly returns, interferes with sleep or daily activities, persists despite treatment of the original illness, or is accompanied by burning, shooting or electric shock-like sensations.

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