Agony and ecstasy
If you suffer from chronic pain, help is at hand. Smitha Verma writes that super-speciality pain clinics have come up in the country offering a raft of advanced pain-relief solutions
For 12 years, Shilpa Anand endured pain. Work as a television actress was always gruelling — there were days when she had to face the camera for over 10 hours at a stretch. But what troubled her more was an excruciating headache that came and went. Doctors said she was suffering from migraine, and Anand was prescribed pills. But nothing seemed to help.
"I wanted a permanent solution. So I did some research and came across a pain clinic. And my life changed drastically after a visit there," Anand says. Doctors at the Mumbai-based clinic diagnosed her condition as occipital (a spine nerve) neuralgia. She was given a single-shot occipital nerve block injection. And Anand is now free of pain.
Pain is something that most people undergo — but some dramatically more than others. For long years, they were advised to bear up with pain. But now a new breed of super-specialist pain healers is offering solutions that ease away pain, sometimes in just a few hours.
"Pain specialists come at a level where medicines offer little help and surgery is not an option," says Dr Murlidhar Joshi, director of Joshi's Institute of Pain in Hyderabad. The experts use various techniques, ranging from epidural steroid injections, radio frequency ablations, a procedure under which a tumour or tissue is removed using heat produced from a radio wave, neurolytic blocks (a form of anesthesia) and the use of specialised equipment such as spinal cord stimulators.
The number of pain clinics has grown significantly in recent years. Dr Kailash Kothari, who dealt with Anand's complaint, runs six clinics — called Pain Clinic of India — in Mumbai, besides one in Mauritius and Goa. Daradia: The Pain Clinic in Calcutta is a centre that offers research and training, besides treatment. A few months ago, two government hospitals in Chennai started pain management clinics. Government hospitals in Mumbai and Kerala too have separate pain units. Pain clinics are also entering Tier 2 cities such as Ahmedabad and Lucknow. Delhi and Mumbai boast of 15-20 standalone clinics.
"Pain management as a super-specialty field made inroads into India in 2004. But it is only in the last five years that the specialty has started gaining significance," Dr Kothari explains. "Today the patient size has grown four-fold from the figure in 2004."
According to healthcare experts, chronic pain affects more than a third of the adult population in India. "In our country, 35 per cent of the population suffers from pain at any given point of time," points out Dr D.P. Dureja of the Delhi Pain Management Centre. "Most common complaints are knee pain, back pain and headaches," he says.
Pain that accompanies life-threatening diseases is being dealt with as well. "Increasingly, cancer patients have been coming to us for pain relief," says Dr Neeraj Jain, who heads pain clinics in four hospitals in Delhi. "Morphine can provide relief to a certain extent and over a period of time one has to increase the dosage. Though the laws related to morphine have been eased, the side effects of prolonged usage remain. So we treat the pain with an injection administered directly into the nerve. The relief can last three months to three years," he adds.
It is also, he adds, cost-effective. While treatment using morphine may cost Rs 5,000-10,000 a month, pain management therapies cost Rs 20,000-50,000 for a longer duration of pain relief.
Pain management is a sub-branch of anesthesia and one of the youngest specialities in medicine. Not surprisingly, the field is dominated by anaesthesiologists. "They are the ones who take care of pain in hospitals. They handle injections to be administered directly to the nerves and so are better equipped to treat pain," Dr Joshi explains.
The industry is, indeed, flourishing. Today, the Indian Society for the Study of Pain (ISSP) has around 1,500 members from 25 different specialties. According to consulting firm KPMG, the market has been growing approximately at 16-20 per cent annually. Some market estimates put the size of the pain management market at Rs 200 crore for the standalone centres.
"While it is a challenge to put a figure on the consolidated market size for pain management, estimates suggest that the current market for pain management products and equipment stands at Rs 2,500 crore," says Subir Moitra, director, marketing and communications, KPMG.
The segment is now attracting many new entrants such as Elder Healthcare and Bafna Pharmaceuticals, in different areas of pain management. A leading US-based medical devices provider, DJO Global, recently entered the knee pain management segment of the Indian market. "Rising patient expectations on the quality of life and the increasing non-communicable disease burden are the two key growth drivers of pain management in India.
The relatively low cost of setting up a pain management clinic versus other specialty clinics (such as a dialysis centre or an eye clinic) also makes this proposition more lucrative," Moitra says.
Setting up a pain clinic, depending upon the machines to be installed and the location as well as the city, can cost anything from Rs 30 lakh to Rs 50 lakh. "The returns are higher and faster," Dr Kothari says. Setting up an eye care clinic may cost three times more and takes a longer time to break even.
But pain specialists rue that awareness is still low and the segment isn't given its due. "Often specialists avoid referring patients to us as they would rather mint money doing surgery or prescribing medication for prolonged periods. They can easily guide a patient to us for an interventional procedure," Dr Dureja says.
Agrees Madhu Saini, who was asked to go for a knee replacement surgery. "I still don't understand why no orthopaedic surgeon advised me to go to a pain clinic. It was my friend who urged me to visit a pain clinic," Saini says.
Still, pain management is yet to develop as an organised specialty. ISSP has urged the Union health ministry to recognise pain management as a health problem and as the fifth vital in the medical treatment chart — along with body temperature, blood pressure, pulse rate and respiratory rate, which are the four parameters that doctors first check while diagnosing a disease.
"Pain is a specialised system of treatment and yet it is not a part of our curriculum, unlike in the West. We have been asking the Medical Council of India to make curriculum changes and include pain as a separate speciality," says Dr Ashok Kumar Saxena, secretary of ISSP and professor of anaesthesiology at the University College of Medical Sciences, Delhi.
The experts believe the time has come to look at chronic pain as not just an irritant. Handle it with care, they advise, and you may be able to wipe it out of your life.
• More than a third of India's adult population is affected by pain
• Several techniques are used — epidural steroid injections, radio frequency ablations, neurolytic blocks (a form of anesthesia), to name some
• Pain management therapies cost Rs 20,000-50,000 for longer duration pain relief
• Setting up a pain clinic can cost anything from Rs 30 lakh to Rs 50 lakh