Myths & Facts in Pain Management
Dr. Sunita Lawange
There are various myths which have been incorporated in the chronic pain patients’ mind through various media, relatives etc. They not only make them suffer but also play an important role in changing their mind-set towards certain treatment modalities.
Myth-1: Pain-killers like ibuprofen, diclofenac etc are the only medicines for pain.
Fact: Many a times pain killers like NSAIDS are prescribed for every kind of pain, as they are the most commonly prescribed over counter medicines. NSAIDs or pain killers must be avoided & can be used only for some specific types of pain. Most of the time in chronic pain, sensitization develops and pain-killers have a limited role. More ever they must not be taken for chronic use, because of the side effects they carry along with them. Paracetamol, opioids and co-analgesics like antidepressant and anticonvulsants have got a better & have very minimum side effects.
Myth-2: If a patient is taking opioid, addiction develops.
Fact: Addiction characterized by compulsive medicine seeking and use, despite of harmful consequences. However dependence is characterized by the need of a medicine by the person to function normally and abruptly stopping the medicine leads to withdrawal symptoms. Opioids forms a part of treatment for chronic pain. If is its prescribed for a short duration the risk of development of addiction is minimal. Also in some opioids like tramadol, fentanyl etc. addiction is very rare.
Myth-3: When pain can’t be diagnosed by different modern imaging like MRI, it must be psychological.
Fact: Image can show us the structural abnormalities. But some structural abnormalities may not produce pain and in some kinds of pain no structural abnormalities are observed. WHO states that pain more than three months is a disease itself. Thus most chronic pain can’t be diagnosed by MRI. If pain persists for a longer time, affective components manifest in the form of the anxiety, depression, sadness, mood disorder, disturbed sleep, irritability, decreased concentration, loss of appetite etc.
Myth-4: Pain medications should be taken only when pain is severe and unbearable.
Fact: We should start taking the pain medicine (but not the common pain-killers like diclofenac or ibuprofen) even when pain is mild. We should not wait till it become moderate to severe. Once it is moderate to severe, it is difficult to control. Some pain medications like co-analgesic Duloxetine are slow and effective only after 1-2 weeks.
Myth-5: Investigations like X-rays MRI are mandatory to diagnose chronic pain
Fact: Detailed history helps more in diagnosis of chronic pain than MRI, CT Scan or other costly investigations. Detailed history & clinical examination is all that is required to arrive to a clinical diagnosis. For example in case of facet joint and sacroiliac joint arthropathy a diagnostic block with a local anaesthetic is required to diagnose them as a source of pain generators rather than the costly investigations like MRI or CT scan. Investigations should be there to support clinical diagnosis, an asymptomatic disc prolapse patient seen in MRI need no treatment.