Carry risk of developing back pain

July 09 - 15, 2007

Nearly four out of five people will have back pain at some time in their life, while pregnant women, smokers and people who do repetitive lifting have increased risk of back pain.

This was stated by Dr. Muhammad Zafar Khan, Consultant in Pain Medicine, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, while talking to PAGE.

'Pain can affect in many ways. It can keep the victim from being active, sleeping well, eating or enjoying family and friends. Pain can also make the victim feel afraid or depressed. When the victims are in pain or uncomfortable, their families and friends may worry about them. Some kinds of Pain may badly affect sleeping pattern, which may lead to multi-faceted effects on the life of victims', he opined. He stated that pain relief is important because it helps prevent the side effects by making the victim feel better. In addition, pain management can speed up the victims recovery after a painful disease, help prevent some complications and help return to daily activities.

''Back pain is one of the most common complaints treated by physicians. Nearly four out of five people will have back pain at some time in their life. Some times, the exact cause of the pain can not be found, but mostly after MRI scans a pin point diagnosis can be made'', Zafar Khan said.

To a query, Zafar stated that back pain could develop in association with a number of causes, including muscle strain, injury to the back, overuse, muscle disorders, pressure on a nerve root, poor posture, and many others. Pregnant women, smokers, and people who do repetitive lifting all have increased risk of back pain. The backach may show as Low back pain, pain in any part of the back, pain may radiate to the buttocks or upper leg(s). The majority of nonspecific back pain is probably caused by muscle strain, which is relieved by taking rest for few days. If sciatica develops, it is a sign that the nerves are being pressed, then one need to see a pain specialist, who will inject drugs to reduce inflammation around the nerves coming out of the spinal cord, he added.

He said that the ligaments keep any joint stable and keep its movements pain free. If the ligament is injured by excessive use, as in sports or after an accident, the joint becomes week and painful. The pain specialist can strengthen the week ligament by injecting the weekend spots of the ligament.

Painful heels of women wearing high heel shoes and the painful shoulder of an enthusiastic cricket bowler are good examples of injured ligaments, he added.

For thousands of years, he said that doctors have been helping to relieve their patients' pain with a variety of medications and treatments. Like other areas of medicine, a new subset of doctors has become specialists in treating pain. They are focused on managing all types of pain - studying what causes it, how the body reacts to it, how different medications decrease or eliminate the pain, and how other treatments can be used to relieve many painful conditions, he said.

Doctors who manage pain are specially trained doctors of medicine with further fellowship degrees. Many techniques used to make surgery and childbirth virtually painless are now being used to relieve other types of pain. In fact, the work pioneered by anesthesiologists that led to these new medications and treatments also has created a new category of medicine called pain medicine, Zafar said.

To a query, he stated that people develop pain for many reasons. If the pain is not controlled by simple analgesics after a week's use then it is the time to see a pain specialist. 'After an injury or an operation, If your pain persists after the healing process should be over, you might have what is called chronic pain. If the current treatment you are receiving stops working or your pain begins to get worse over time, your primary care doctor should suggest that you see a pain medicine doctor', he said.

He further stated that cancer pain is another condition that can be managed by a pain medicine doctor while the patient continues to receive treatment for various types of cancer. The pain can be due to cancer surgery or treatment procedures, including radiation therapy and chemotherapy, or the tumor itself, he added.

Some of the more common pain problems pain medicine doctors manage include: arthritis, back and neck pain, cancer pain, nerve pain, migraine headaches, shingles, phantom limb pain for amputees. The Pain Specialist is an expert in managing any type of acute or chronic pain.

Due to rapid advancement in medicine, a variety of medications and treatments are available for acute, chronic and cancer pain. Patients often will be prescribed medications before receiving other forms of therapy, he said.

To another query, he said that medication alone may not be enough to manage certain kinds of pain. Some medicines are more effective in fighting pain when they are combined with other methods of treatment. In some cases, the patient's pain condition may respond to treatment instead of medication. In fact, for some patients, certain therapies may eventually replace the need for taking any pain medicine, or less of it, over time. Local anesthetics can be injected around nerve roots and into muscles or joints. These medicines reduce swelling, irritation, muscle spasms and abnormal nerve activity that can cause pain. Epidural injections are very useful for sciatic pain, he disclosed.

Often a group of nerves called a plexus or ganglion, that causes pain to a specific organ or body region can be blocked temporarily with local anesthetics. If successful, another solution that numbs the nerves permanently can then be used to achieve a long lasting benefit, he said, adding that transcutaneous electrical nerve stimulation (TENS) is a common form of electrical stimulation used in pain management.

Many patients who are in pain feel the emotional effects of suffering along with the physical aspects of pain. These may include feelings of anger, sadness, hopelessness or despair. In addition, pain can alter one's personality, disrupt sleep, interfere with work and relationships and often have a profound effect on family members. Support and counseling from a psychiatrist or psychologist, combined with a comprehensive pain treatment program, may be needed to help manage the condition of sufferer, he said. He stated that Shaukat Khanum Memorial Cancer Hospital & Research Centre; Lahore is one the first hospitals to offer a comprehensive pain management service.