Back pain? New norms to ease it
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- Published 17.10.10
New Delhi, Oct. 16: An association of doctors has pencilled India’s first formal guidelines for pain diagnosis and treatment amid concern that Indian patients are either under-treated or over-treated for acute and chronic pain.
The Indian Society for the Study of Pain (ISSP) will release its pain management protocols for low back pain next week, to be followed later by protocols for other conditions, from headaches and neck and joint pain to pain related to cancer or trauma.
Limited surveys suggest that one in five patients in India with chronic pain do not find relief despite being under medical treatment, specialists in the ISSP said.
“We believe there is under-treatment, over-treatment, direct over-the-counter purchase of medicines by patients, and erratic treatment,” said Parmanand Jain, ISSP president and professor of anaesthesia at the Tata Memorial Hospital, Mumbai. “We’re hoping these pain management algorithms will improve this situation.”
The protocols, developed primarily for the medical community, will provide a well- defined sequence of diagnostic investigations and the line of treatment for specific conditions associated with acute or chronic pain.
Pain specialists are hoping the protocols will also help keep patients away from diagnostic procedures such as magnetic resonance imaging (MRI) scans, and even surgery, when they are not required.
Patients with low back pain are usually given mild painkillers and advised rest. If the pain doesn’t go away or gets worse and MRI scans show degenerative changes in the vertebral discs, it doesn’t mean surgery is required.
“Three out of four persons without any back pain may also show changes in MRI scans. So, the changes (in those with pain) may not be causing the pain at all,” said K. Jawahar Choudhury, senior pain management consultant at Apollo Hospital, Delhi.
As for over-treatment, many pain specialists believe the long-term abuse of painkillers is contributing significantly to the country’s burden of kidney disease.
But ISSP members concede that doctors in India are sometimes compelled to prescribe inappropriate treatment to cancer patients because morphine, a key pain-killer, isn’t easily available. The drug is distributed only through licensed clinics.
“We’ve been telling the narcotics control bureau to expand the distribution of morphine,” said Geeta Joshi, anaesthesiology professor at the Regional Cancer Centre, Ahmedabad. India’s per head consumption of morphine is 0.6mg, whereas the world and US figures are 5.93mg and 76mg, respectively.