Hi, I am Dr. Kedar Tilwe, consultant psychiatrist and I will be talking about pain along with my sister Dr. Amrita Ajay Tilwe, who has done a fellowship in chronic pain management. Pain is one of the clear sign of the stress involved in our body and something needs the focus of our attention. However, sometimes this pain persists despite all medical tests and treatments and takes the form of a chronic situation which seldom seems to respond to any treatment. Dr. Amrita would explain to us how pain works and why it occurs. Hello everyone, this is Dr. Amrita Tilwe. I am anesthesiologist in pain physician. Now, what is pain? Pain is an unpleasant sensory or emotional experience, that is caused due to tissue damage or probable tissue damage. Now pain can be of different types. It can be an acute pain which is in often immediate setting and chronic pain which comes from 3 to 6 months and lasts long. Pain can be felt like a normal dull aching pain to a sharp pain to tingling sensations or just a dull visceral pain. Pain can be of variety of types. But we have to know that we don’t have to live with this kind of pain.
Nowadays we have lots of medicines, procedures, and therapy by which we can avoid this pain. Now, what does pain do? Pain restricts your lifestyle. You can’t experience all the pleasures of your life, you can’t do everything. You get restricted. It might be as simple as a small backache because of a backache you might not able to watch your movie or go to any theatre and watch a play. Just a simple backache might restrict you from your activities or it might be something difficult like trigeminal neuralgia were even washing your face or where even driving might cause such severe pain in your face that you might just give up on everything. You don’t have to live with this pain. You can just be comfortable. And the procedures, the medicines they are simple. Just remember that you don’t have to live with the pain. In here, we take you in, we take a nice detailed history of you so that we understand what type of pain you have. We try to find out what is causing that pain and when we understand what is causing the pain, what type of pain you have, then further we manage.
For example, if you have small muscle pain like you have a muscle pull, then we can have physiotherapy and we can have something like acupuncture, which helps to release the muscle tension. On the other hand, if you are having a backache which is radiating to one side say one of your leg pains or it gives a sharp shooting sensation in the night or intermittently during the day which has restricted your activity, we can give you simple procedure like Transforaminal Epidural Steroid Injection. This will help you to the next extreme is cancer pain. There are cancer survivors who say we are fine with cancers but we don’t want that pain. For such people also we have to tell that you need not suffer through the pain. There are simple blocks like lumbar sympathetic block or celiac plexus block which will help you recover and these things are done at Dr. Tilwe nursing home. The physical causes of pain apart as in psychiatrist, I see many cases in whom the pain doesn’t seem to have a physiological basis or is often experienced in a degree much worse than anticipated or expected.
This is known as a condition of somatic symptom disorder with predominant pain. More often than normal doctors would not be able to explain the cause of why it occurs, why it persists for so long or what to do about it. It is at these times when there seems to be no other help readily available that we can consider the possibility of one of my medicines or therapies helping. It is worth noting that up to 12 percent of people during their lifetime may experience something similar to somatic symptom disorder with predominant pain in which no explanation is possible. It is also worth remembering that more often than no medical basis for this. While the causes can be psychological and in some cases a biological predisposition causing more acute presentation of symptoms. There just seems to be no treatment in sight. So what do we do about these?
Well we have the options of medicines in the form of pharmacotherapy such as antidepressants like SSRIs, tricyclic antidepressant or SNRIs in the form of mood stabilizers which have shown to reduce the amount of pain endured and sometimes in therapy in the form of CBT or other forms of therapy which will help reduce the pain that you have experienced. Remember the idea is to experience your life to the fullest and not the pain. So if for any reason you find yourself in a situation in which the pain persists and physical treatment has not seemed to take full effect then there are other alternatives that can be considered. So to reach out, one of us may be able to help.