COMMON MYTHS ABOUT PAIN TREATMENT

WHO has included PAIN as fifth vital sign of health in 2001 but still Pain is the most undertreated symptom. Pain treatment is not just about popping analgesics, it may require a whole lot modalities. In the era of advanved medical science, living with one's pain is no more needed. Patient don't treat their pain because of under awareness & myths.

Myth-1: Pain medications should be taken only when pain is severe and unbearable. Fact: We should start taking the pain medicine (but not the common pain-killers like diclofenac or ibuprofen) even when pain is mild. We should not wait till it become moderate to severe. Once it is moderate to severe, it is difficult to control.

Myth-2: Sinusitis & headache together is common & it is most common cause of headache. Fact: Recurrent sinusitis may cause headache, but it is rare cause of headache. Commonest cause of headache is tension type headache and commonest cause of moderate to severe headache that brings a patient to a doctor is migraine. Sinusitis & headache may be seen together but sinusitis is not the cause of headache in most situations.

Myth-3: Local application of NSAID(analgesics) is safer and don't have any systemic side effects in arthritis. Fact: Topical application of NSAID also will be absorbed systemically and can cause gastritis and renal damage. It had been believed that when NSAID is applied topically it will act only on that site and is not be absorbed systemically thus no side effects. It has been proved that analgesic action due to topical NSAID is very minimal and mostly action is due to placebo effect or its counter irritant effect. It will be absorbed systemically and will cause gastritis and renal damage, though less intense than oral or systemic NSAID. It can also cause local skin damage and reaction.

Myth-4 : Patient with shoulder pain or back pain with high serum uric acid should be treated for gouty arthritis. Fact: Shoulder and spine are very rarely involved in gouty arthritis and just elevated serum uric acid without clinical features need not to be treated. Approximately 25% of the population has a history of elevated serum uric acid, but only a minority of patients with hyperuricemia develops gout. Thus, an abnormally high serum uric acid level does not always indicate or predict gout. Asymptomatic hyperuricemia generally should not be treated. Renal function should be monitored in these individuals.

Myth-5: Spondylosis is the most common cause of the low back pain. Fact- Sponylosisis a not a clinical but radiologic terminology and it merely indicates degenerative change in any part of the spine. It does not constitute a specific diagnosis. The most common cause of low back pain in young and middle aged population is disc degeneration and in elderly age group it is facet joint arthropathy.

Myth-6: Investigations like X-rays MRI are mandatory to diagnose chronic pain. Fact: Detailed history helps more in diagnosis of chronic pain than MRI, CT Scan or other costly investigations. Detailed history & clinical examination is all that is required to arrive to a clinical diagnosis. For example in case of facet joint and sacroiliac joint arthropathy, a local anaesthetic is required to diagnose them as a source of pain generators rather than the costly investigations like MRI or CT scan. Investigations should be there to support clinical diagnosis, an asymptomatic disc prolapse patient seen in MRI needs no treatment.

Myth-7: Lying down on a hard surface is helpful and is indicated until the patient is fully recovered from back pain. Fact: Sleeping on hard surface produces more back pain. It may also cause disturbance in sleep which is again harmful. Mattress should not be too soft. Patient should be allowed to continue with bed that is comfortable.

For any query regarding pain contact :

Dr. Sachin Mittal (MBBS, DA) Ph.: 9013518119. Clinic : 109, Om Plaza, Sector-15, Vasundhara, Gzb. E-mail: painclinic2010@gmail.com or see page-10