Pain management involves both
drugs and psychotherapies

DUBAI - Pain is one of many abnormal sensations experienced by us, and is the most unpleasant of all, according to Dr Rajshekher Garikapati, Specialist Neurologist, Zulekha Hospital, Dubai.

By (Staff reporter)

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Published: Sat 17 Sep 2011, 11:38 PM

Last updated: Tue 7 Apr 2015, 10:55 AM

“All sensations are felt by us when our conscious brain gets the information from some structure, most notably the skin,” he explained.

“There are pain receptors within the skin layers, and these are connected to nerves which serve only the function of conducting pain sensations. These receptors are activated by noxious physical as well as chemical stimuli.”

Repeated stimulation leads to a decrease in its sensitivity, and stimulation of some other cutaneous receptors and nerves may block conduction through these nerves temporarily, a phenomenon called counter-irritant mechanism, which is utilised in balms applied on the skin surface, said the doctor.

Many different disease states lead to pain; pain receptors and nerves constitute the final pathway for its perception. “The most common of these are inflammatory disorders, for example, diseases in which joint inflammation occurs, called arthritis,” said Dr Garikapati.

“All forms of arthritis inflammation of joints lead to formation of many inflammatory chemicals, which then stimulate pain receptors. Here pain perception serves the role of warning the individual of the disease and its activity.”

He also said that another common mechanism of pain is nerve compression. “This is seen, for example, in disc prolapse (or slipped disc) in which the soft tissue between vertebral bones (called inter-vertebral disc) slips out from its normal position. This may then press on the adjacent nerve root and cause pain in the area of its distribution, and this is called nerve root pain or radicular pain.”

There is a separate group of conditions affecting nerves, in which all these mechanisms have been ruled out; no inflammation, destruction, physical pressure, he said. “Still the nerve is stimulated by something and causes intense and severe pain. Such pains are called Neuralgias; one common example is Trigeminal neuralgia which affects the face on one side.”

Managing chronic pain involves many different strategies including drugs and psychotherapies. “When we look upon the individual suffering from pain and the attendant psychological consequences as a weakling, when we attach a stigma to the problem and its treatment, we add to the burden on society. This attitude leads to abuse of drugs for relieving pain and over-use of weak analgesics which the individual has easy access to,” he explained.

Chronic pain can be properly managed only in a Pain Clinic in which psychiatrists, neurologists, anesthetists, physiotherapists, and psychologists work together as a team to identify and treat painful conditions. But most importantly, society has to realise that pain is a sign that there is sickness which needs to be addressed – whether of body or of mind; one should not be preferred over the other, he added.

Dr Rajshekher Garikapati, Specialist Neurologist, Zulekha Hospital, Dubai

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