Pain and Palliative Medicine
Any pain causes unpleasant physical and emotional experience for the sufferer. Although the symptom is as old as human mankind, research is constantly evolving to find newer, novel therapies to treat it.
What makes “pain treatments” so perplexing? The answer to it is that pain can present in various forms. It could be pain due to a fever, a small cut or a burn. These are examples of “acute pain” that lasts for short duration and responds to simple therapies like medications.
Some pains can have no obvious injury. Examples include a “slipped disc” or “osteoarthritis of knee” or persistent pain despite a successful surgery (post-surgical neuropathic pains) or persistent pain after an attack of herpes (post-herpetic neuralgia). These are examples of “chronic pains.” Chronic pains are those pains that last more than 3-6 months and have no actual reason for being so persistent. It happens due to an exaggerated or abnormal response of the nervous system to painful stimuli. Chronic pains are sometimes difficult to treat. It may require interventions, medications, physiotherapy, occupational therapy, life-style management etc. All these options aim to relieve chronic pains thereby improving the functionality and quality of life of patients affected by it.
Pain is also a very common symptom of long-standing organ diseases like cancer, end-stage diseases of heart/lungs/liver/kidneys, degenerative diseases like neuro-muscular dystrophy etc. In these conditions pain may co-exist with other symptoms like fatigue, breathlessness, loss of appetite, bed sores, ascites, disability etc. Many of these long-standing diseases, at times, reach a stage where the medical or surgical options start to become less effective because of various factors. The treating clinician may communicate that the disease has reached a stage where “cure” options are less. In such a scenario, the family is left to “care” for their loved ones. For the patient, it will be a life to live with various physical and psychological symptoms. Their social and spiritual circumstances also change.
“Palliative Care” is a care-based approach that attempts to reduce chronic suffering. The World Health Organization (W.H.O) has stated that “Palliative Care” is an approach that improves the quality of life of patients and that of their families who are facing challenges associated with life-threatening illness, whether physical, psychological, social or spiritual.
Palliative Care encompasses “terminal care” when the course of the disease goes downhill. During this phase, there could be complex changes in the body and mind of the patient, but they are not left alone to cope with their distress. They are provided with safe treatment that addresses their symptoms and helps maintain their dignity and individuality. Palliative care seeks to keep the patient who is in the terminal phase of life, symptom-free and comfortable to the best possible extent. Terminal care also includes care for patients’ loved ones by giving them emotional support especially while taking tough decisions in these situations.
Why Rangadore Memorial Hospital?
Rangadore Memorial Hospital is a philanthropic institution providing quality health care at affordable cost. The Department of Chronic Pain and Palliative Care was started six months ago. In India, only 2% of the population needing Palliative Care have access to it.
Historically, the philosophy of Palliative Care has existed in the thinking behind the “dammasalas” and “punyasalas” that were built during the reign of King Ashoka. Keeping in alignment with tradition and the global need of humanity today, the Rangadore Memorial Hospital is proud to be one of the access points to the pain and palliative services as a valuable add-on to integrative oncological services it already offers.
Treatment and Procedures
- OPD consult for chronic pain conditions
- OPD consult for Palliative care
- Counselling for patients with terminal conditions/families facilitating shared decision making
- Interventions for chronic pain like disc pains, musculoskeletal pains, nerve pains, joint pains
- Interventions for Palliative Care including terminal care
- Home care services for terminally ill
b) Customised treatment & procedures:
2) Collaboration with physiotherapy or physiatry
3) Counselling for life style management, shared decision-making during cancer care or other prolonged end-stage diseases
4) Nerve blocks: trigeminal neuralgias, post herpetic neuralgias, post-surgical neuropathic pains
5) Radio-frequency nerve pulsing or ablations: for recalcitrant nerve pains based on indications
6) Epidurals: neck- thorax-back pains
7) Infusions of analgesic medications: acute pain scenarios
8) Dry Needling: musculoskeletal pains
9) Joint injections: painful joints of degenerative diseases like osteoarthritis, arthritis
(The above interventions are performed under C arm or USG guidance)
Dr. Renuka Pai
MBBS, Diploma in Anaesthesia, Fellow in Chronic Pain, Fellow in Palliative Care, World Headache Society Cert. in (Headache)
“My 84-year-old father was diagnosed with advanced lung cancer. His prognosis was bad. My father decided against chemo or surgery. He felt he had lived his life to the full and if he was to die due to natural circumstances, he would welcome it! But...his only concern was pain and breathlessness- he did not want to suffer either. In the second visit to the Dept of Palliative Medicine, RMH, my father accompanied me to understand how Palliative Care would benefit him. He was happy with the explanation that Dr Renuka, the Palliative Care physician gave him. He was re-assured about the care of his symptoms which was treated with medications. Dr Renuka was very particular about my father's emotional health. She also counseled the family members who had their own queries and concerns. My father's condition progressed rapidly and eventually, he passed on peacefully. We were assured of support through-out. Palliative Care is the best option when there is no hope for cure because even after the patient's death, family has the satisfaction that their loved one lived comfortably being loved and cared for. I’m very happy that I got the best palliative care from RMH. I feel so content even after my father's demise because, I am convinced I had the best opportunity to take care of him with the best treatment”.
Purnima, patient’s daughter