01 November 2010
By Sumitra Deb Roy
Mumbai, India
One in five Indians with chronic pain finds little or no relief from it despite medication, suggest studies that prompted the Indian Society for Study of Pain (ISSP) to come up with its first set of pain management protocols in the country. The doctors’ body had released the protocols last week, using which medical experts can understand and manage pain accordingly.
The idea of coming up with a structured set of guidelines, say experts of ISSP, is to acknowledge the fact that pain has moved on to become a disease itself rather than a symptom of an ailment. Their observation that most patients of pain in the country are either ‘under–treated’ or ‘over–treated,’ has prompted them to come up with norms on treating back pain. Soon, they plan to follow it with protocols to deal with six–eight most common pain syndromes like headache, knee pain to trauma and cancer pain.
President of ISSP and professor of anesthesiology at Tata Memorial Hospital Dr Parmanand Jain said there was an urgent need to put an end to the abuse of pain–killers. "Abuse of pain–killers is rampant and their over–the–counter usage by patients is overwhelming. That has contributed to a good 20% of pain incidences moving on to become chronic from acute or mild stage," he said. The protocols, Jain says, will help doctors follow a proper path of investigation or diagnosis before prescribing right and effective medicines.
The ISSP, on its part, has been lobbying for pain to be considered the fifth vital sign after BP, pulse, temperature and respiration. Many big private hospitals in the city have already started the practice though it is yet to become a medical norm. For instance, Tata Hospital maintains a ‘pain score’ where patients are asked to measure the intensity of their suffering every four hours and treatment is offered accordingly.
Besides, the ISSP has observed that given the lack of effective painkillers like morphine, doctors are forced to recommend less efficacious drugs for ailments like cancer. Pain specialists feel a major handicap is limited availability of morphine and strict narcotic laws guarding their usage. Data suggests that morphine consumption per head in the country is as low 0.6mg as opposed to the world’s average of 5.93mg or US figures of 76mg. "We have appealed to the narcotics control bureau to increase the distribution of morphine," added Jain.
Pain specialist of Jaslok Hospital Dr Preeti Joshi also agreed that drugs like morphine can go a long way in relieving chronic pain. "The irrational use of these drugs can be checked by strict protocols and allowing a fixed set of doctors to prescribe them," she said. "There have been studies to show that not all patients on morphine go on to become addicts," she added.
According to many pain experts, clear norms would save rigorous, expensive diagnosis and even surgeries in many cases. There is also a need to have more pain clinics. At present, Mumbai has just about 10–12 clinics. Jain also added that pain management should be included in MBBS and MD curriculums. "The notion that curing an ailment will cure the pain may not hold good for all cases. So better education is needed for evaluation," he added.
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