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Wednesday, September 25, 2013

'Doctor, do you feel Pain?'

By Femi Ogunyemi (Dr)
Last week a patient called me in distress. “My Doctor”, he yelled over the Lagos traffic. “I need to see you. I’m begging you; you must get rid of this pain TODAY!” “How long have you had the pain?” I asked. “Two years now….” he said. I got out my magic wand, and waited for him. Pain can be quite an irritating aspect of life. Its magnitude or severity doesn’t always correlate with a level of tissue damage. It may be severe yet have no significant underlying body tissue damage. It may be minor and barely noticeable yet associated with serious tissue damage.

Even something as devastating as a heart attack may sometimes, uncommonly, be painless.
To make matters more interesting, for the Pain Doctor at least, each human being perceives and reports pain from different thresholds and tolerances.
Acute and chronic pain are very different conditions.Acute pain is short lasting pain that goes away when the tissue damage heals.

Acute pain includes the pain of surgery, childbirth, fracture, toothache, abscess, and many others. If my distressed caller had acute pain, I would confidently use my magic wand to “get rid” of it. Poorly treated acute pain becomes chronic after about 3 to 4 months. Chronic pain is a rather different entity.  The receptors that pick up the pain sensations have become very, very sensitive; the nerves that carry the pain messages to the brain have become more active; the central nervous system that processes the pain messages begins to adapt itself to the pain input.

The sufferer then becomes prone to depression. Their sleep becomes disturbed. Work and play becomes difficult. Over time, family and work relationships begin to suffer. Who wants to hear constant complaints of pain ….?
Separation, divorce, job dismissal may be eventual outcomes in severe cases of chronic pain.
Pain management, with relatively
few practitioners 30 years ago, has become recognized as a true specialist field in the last decade.
The Pain Doctor has much more than medications in his arsenal of treatment.
He (or she) partners with physiotherapists, psychologists, nutritionists, among others to care for the pain sufferer.

In addition, complementary and alternative medicine (CAM) is increasingly being used by patients, especially those with back and neck pain, arthritis, headaches and fibromyalgia.
CAM is generally not considered part of conventional medicine.
There are two types: natural products (like glucosamine, chondroitin, herbs) and mind/body medicine ( like acupuncture, tai chi, guided imagery, hypnotherapy, yoga, spinal manipulation, massage and relaxation). Evidence continues to grow from more studies supporting some benefits of CAM.

Chronic pain treatment
remains very challenging because what works for one person may not work for another, and vice versa.
The Pain Doctor’s objective is always to relieve pain so the patient may FUNCTION.
If, during this process, we “get rid” of the pain, that is an added bonus.
I had urgent business today at the British High Commission.
The Consular Section provided prompt, courteous and professional resolution of an emergent situation.
At the end of my visit, the young lady who had attended to me asked:
“Sir, do you, yourself, feel pain?”

I looked puzzled as I gathered my papers and the ETD she had just given me. “No, Sir,” she said. “I mean, as a Pain Doctor, do you feel pain yourself?” I smiled and nodded.
“Yes,” I said. “I feel pain when I see a 4 year old girl, arm in plaster, waiting 5 hours to see a specialist for 10 minutes in the Casualty of a Nigerian Teaching hospital; I feel pain when I see a woman die because dialysis was not widely available and, when found, not affordable; I feel pain when I see an old retiree dying of cancer, with no strong opioid pain medicines to give him comfort.
How do I “get rid” of these pains?” I wondered aloud. She had no reply.

•Dr. Femi Ogunyemi, FRCA, FWACS, is a member of the British Pain Society, American Pain Society, the North American Neuromodulation Society and the Aerospace Medical Association. He is a Diplomate of the American Academy of Pain Management and a Fellow in Pain Medicine from Emory University.

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