POWER OVER PAIN
An explosion of new research, treatments and therapies is changing the way pain is understood and managed
Look at the irony of it. I have a broken back, broken knees, I have torn my shoulders six or seven times and I’m playing a superhero.” That’s 38- year- old actor Hrithik Roshan’s way of poking fun at his intimate enemy of 27 years: Constant and relentless pain. “I don’t remember those days when I did not have any pain.” He was just 11, when his knees hurt and a “strange, shooting pain” often hit him like a knife up the spine. At 19, he ended up with a herniated disc, excruciating pain and a long list of can’ts and don’ts. That was also the first time he heard the words: “You should not be an actor.” He proved his doctors wrong. But at 33, when he was put on crutches for six months for arthritis on his right knee, he despaired. “The pain was unbearable. There was hardly any cartilage left. That’s when fear set in and made me imagine the worst.”
His journey captures the story of seven million Indians, who live, work and fight with debilitating pain every year. Modern medicine has conquered many diseases and
halted others, but attitude towards patients in pain— even the terminally ill— has largely remained primitive. Roshan, however, is free of pain now. He happens to be a beneficiary of the new emerging science of pain. After decades of slow progress, an explosion of new research, treatments and therapeutics is changing the way pain is understood and managed. There is new hope in what scientists have learned about how pain works: That it’s not the reality of your injury or illness, pain is how unwell your brain thinks you are.
Is a pain- free future on the horizon? Roshan, for one, certainly thinks so. He has gone through cutting- edge treatments— from functional manual therapy to myofascial tissue massage— that would have been impossible even a few years ago. Now Indian scientists have come up with a new drug that can target cells at the level of molecules and stop the brain from responding ‘ emotionally’ to what it perceives to be damage to the body— or pain. Now waiting for global patent, it is the only reported such pain molecule in the world to have gone through clinical trials.
Pain hit the headlines this year with a vengeance, as Bollywood’s glamorous stars went in and out of hospitals. Amitabh Bachchan blogged in April about his “horrendous pain” that made it difficult for him to “walk, stand, sit or lie down”. Shah Rukh Khan wrote on Facebook in January about pain in his ribs: “Hurts only when I laugh or breathe.” Salman Khan complained of “unbearable pain” in his jaws and cheeks, a recur- ring issue. Roshan went public about his condition after completing 85 days of “non- stop, hardcore action” for his forthcoming science fiction film, Krrish 3: “Hanging from a harness 100 feet off the ground is probably the worst thing for any spine.”
It hasn’t quite made the headlines but the All India Institute of Medical Sciences ( AIIMS) is organising lectures on pain management for MBBS students this year— the first such in India. “For years, chronic pain has been neglected by doctors,” says Dr Sushma Bhatnagar, anaesthesiologist with the cancer centre at AIIMS. “Most treat it as a symptom of other diseases and not as a disorder that should be targeted in itself for relief.” The Medical Council of India recognised it as an MD specialisation in 2011, after global NGO Human Rights Watch revealed in its report the lack of basic knowledge among Indian doctors about pain management.
The God is in biology. Way back in the 1990s, when behavioural neurologist V. S. Ramachandran experimented with mirrors on a patient tortured by “phantom pain” in an amputated arm, it led to the most exciting story in all of pain science: That chronic pain has more to do with the way the brain rewires itself after mining all its data— thoughts, feelings, beliefs, expectations, memories and genetics.
“It was a radical shift in opinion,” says Ramachandran, now the director of Center for Brain and Cognition at University of California, San Diego, US. “We have been urging the new view that something like chronic pain is caused by a shift in equilibrium in