Chronic pain after healing needs specialist care, say doctors

A 42-year-old homemaker from Mysuru continued to experience severe burning pain, swelling, stiffness and skin discolouration months after her fractured wrist had healed. Repeated tests confirmed the bone had mended, yet she could neither cook nor bear the touch of clothing on her hand. She was later referred to pain specialists and diagnosed with Complex Regional Pain Syndrome (CRPS), a condition in which the nervous system keeps producing pain signals long after the original injury has healed. With specialised pain management, she gradually regained function and independence.

Specialists say such cases underline the need to treat chronic pain as a condition in its own right, one that may call for focused medical care rather than endurance.

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 the pain clinic was set up in June 2023. Run by the Department of Anaesthesia, Critical Care and Pain Medicine, the clinic has also seen over 4,000 patients in its outpatient department.

With September observed as Pain Awareness month, the Karnataka Chapter of the Indian Society for Study of Pain (ISSP) has begun a public campaign asking people not to treat chronic pain as an unavoidable part of life but to seek specialised help when it outlasts the normal healing period.

Satish Kumar M.N., associate professor in the Department of Anaesthesia and Pain Medicine at BMCRI and treasurer of the state ISSP chapter, said the team, led by department head Nethra S.S., had carried out over 1,200 advanced pain intervention procedures and attended to more than 4,000 outpatients. The clinical team includes associate professor Nethra H.N., assistant professor Harshavardhan H.S., Satish Kumar and Dr. Nethra, and handles cancer pain, neuropathic pain, musculoskeletal disorders, spine-related pain, knee and shoulder pain, trigeminal neuralgia and other chronic pain conditions.

Apart from 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 allowed BMCRI to offer procedures that were earlier available largely in corporate hospitals.

Sadasivan S. Iyer, consultant and lead for Pain Medicine at Manipal Hospital, Old Airport Road, and vice-president of the Karnataka ISSP chapter, said a common misconception was that patients should simply learn to live with chronic pain. Many patients are told to 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 acts 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 keep transmitting pain signals even after tissues have healed. Normal scans therefore do not necessarily mean the pain is imaginary, and abnormalities on imaging do not always explain how severe the symptoms are.

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.

Murali T.S., consultant and lead for Pain Medicine at Apollo Hospitals, Bengaluru, and president of the Karnataka ISSP chapter, said the goal is not merely to lower a patient's pain score but to help them sleep better, return to work, carry out daily activities and regain independence. Pain relief, he said, is ultimately about restoring quality of life.

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 seeking evaluation if pain lasts more than three months, keeps returning, interferes with sleep or daily activities, persists despite treatment of the original illness, or comes with burning, shooting or electric shock-like sensations.