Interventional pain management
PAIN is inevitable. We all know what it feels like.
It can come in many forms – from a sudden fall, a throbbing headache or worse, a constant pain due to a chronic condition such as arthritis.
Though unpleasant, pain is the body’s way of alerting us to what’s happening in our body.
But imagine having to live with pain for days, months or even longer. This will, no doubt, take a toll on both our physical and emotional health as the discomforts of chronic pain interfere with our daily life.
According to Dr Chen Chee Kean, an anaesthesiologist who also practises interventional pain treatment, chronic pain is very common, affecting one in every five people in the general population. This is because chronic pain increases with age.
With the advancement in medicine and healthcare services, lifespans have also increased – 73 years for men and 77 years women on average ( based on statistics from the Department of Statistics Malaysia).
“Elderly people will become a significant portion in the general population. Thus, chronic pain due to the degenerative process of aging is getting more common,” he noted.
Pain sufferers are often prescribed oral medication as a relief.
Dr Chen said while these medications were effective, their pain-relieving effects only lasted hours to days, adding: “As the pain suffered by patients is usually long standing, they will have to depend on daily intakes of these medications.”
While modern medications are relatively safe in relieving acute pain, he cautioned prolonged consumption would give rise to some serious generalised ( systemic) side effects and complications such as gastric ulcer disease, heart and kidney failure.
“That’s the reason oral medication should be taken at the lowest possible dose and in the shortest duration. When one fails to achieve satisfactory pain relief with maximum dosage of oral medication, the next step is always surgery.”
Most elderly patients suffer pain from degenerative causes – the origin of the pain could be from the neck, back, hip, knee or other parts of body. Using medications to control this form of chronic pain is either causing more problems by damaging other organs such as kidney and stomach, or not helping to relieve pain at all by using a safe but weak pain medication such as paracetamol. The most effective way to treat pain due to degenerative causes is probably surgery where old and damaged joints or discs are replaced by metal implants – as in knee and hip replacement and spine surgeries. Dr Chen Chee Kean, anaesthesiologist
Queries from patients In his practice, Dr Chen has often received queries from patients such as – “Can you offer some other treatment to stop the pain other than prescribing medicine? His kidney is already not so good. Is there anything you can give my father as the doctor says he is not fit for operation, and as his painkillers are not doing any good to his pain, are there any other means of helping him?”
He said it wasn’t very difficult to understand the dilemma faced by elderly patients and their families.
“Most elderly patients suffer pain from degenerative causes – the origin of the pain could be from the neck, back, hip, knee or other parts of body.
“Using medications to control this form of chronic pain is either causing more problems by damaging other organs such as kidney and stomach, or not helping to relieve pain at all by using a safe but weak pain medication such as paracetamol.
“The most effective way to treat pain due to degenerative causes is probably surgery where old and damaged joints or discs are replaced by metal implants – as in knee and hip replacement and spine surgeries.”
Dr Chen pointed out that not every elderly patient was fit for surgery as he or she may be having some other medical conditions such as a previous stroke, heart failure, kidney disease and others which may increase both surgical and anaesthetic risks.
However, he said with recent medical advancement, there was an alternative to conventional treatment of pain – via interventional pain management.
“Interventional pain management is a branch of pain medicine relatively new in our country. It’s a form of treatment to relieve pain with minimally invasive procedures and is targeted to the source of pain without causing many general side effects and damages to surrounding structures.
“Usually carried out as a daycare procedure, it involves injection of local anaesthetics, using radiofrequency technique or laser technology, onto the source of pain like the nerve responsible of transmitting pain signals to the brain or the structure. For instance, a prolapsed disc causing nerve compression will be treated with interventional pain treatment.
“For most of the interventional pain techniques, local anaesthetic is injected around the skin before treating the source of pain and some patients may be given some sedation to reduce discomfort and anxiety during the procedure,” said Dr Chen, who is also a consultant anaesthesiologist at Kuching Specialist Hospital ( KPJ Kuching). Restoring functions He added that the main purpose of chronic pain management was to restore the functions of patients, both physical and mentally.
“We want patients to be able to return to society and become less dependent upon others for their daily activities.”
He suggested that after the interventional pain procedure, certain exercise, physiotherapy and lifestyle modification would help prevent the recurrence of pain.
“The duration of pain relief after the procedure will depend on the severity of patients’ condition. If similar pain recurs after a time, another procedure can be done as it’s very safe.”
Those with chronic pain conditions, including headache, face pain, neck pain, back pain, joint ( knee/ hip) pain, nerve pain, after- surgery pain and cancer pain, will benefit from interventional pain treatment.
Dr Chen cautioned it should not be used to treat pain due to infection, trauma, cancer, inflammation disease and caudal equina syndrome ( severe nerve compression).
On the side effects of pain intervention treatment, he assured the procedure was very safe when performed by a trained doctor in the operation room under the guidance of imaging tools such as x- ray or ultrasound.
However, he pointed out that there were common side effects related to interventional pain treatment, including infection, bleeding, numbness, injury to surrounding tissues and allergic to local anaesthetic or steroid injection.
“These side effects depend on which technique is used and on which area of the body,” he said.