By Nivesh Khandelwal & Dr. Naveen Talwar

September 4, 2023 (IANSlife) Imagine waking up one day and finding your body full of excruciating pain. The pain is such that you can’t get out of bed, can’t get your children ready for school and can’t even think of going to work. You spend the day in bed but can barely sleep. The next day arrives without any relief. You muster enough courage to reach the doctor’s office – however, she doesn’t have a clear answer as to what’s wrong with you. She hands you a few prescription painkillers and orders a few tests. Meanwhile, every day continues to be a harder struggle – and you continue visiting orthopaedic surgeons, physiotherapists, ayurveda practitioners in the hope of some answer and some respite to what has become a hard truth.

 Different versions of this reality are true for more than 200 million Indians living with musculoskeletal (MSK) chronic pain – much higher than the combined incidence of diabetes and cardiovascular diseases together. Yet, despite its widespread prevalence, chronic pain is often misunderstood, and mistreated. In the absence of the right diagnosis and treatments, an average patient lives with chronic pain for over 7 years. The true magnitude of this hits you when you realise that pain is not just a physical problem. It has a rippling effect on relationships, workplace productivity, and even mental health.

Vignesh, a former marathon runner and a father of two, has lived with chronic back pain for over ten years. He says, “It’s not just the pain, it’s how it starts impacting every aspect of your life. It’s there when I wake up, it’s there when I’m trying to enjoy football with my kids, it’s even there when I sleep”. Meera, a homemaker, echoes this sentiment. Diagnosed with fibromyalgia five years ago, she shares, “It’s like your body is constantly screaming at you. It is demoralizing and can leave you feeling exhausted and isolated. I have been to every possible doctor in the city – after a point it just feels hopeless.”

So, what makes MSK chronic pain different from the different kinds of pains that we experience in our daily lives? Think of it like this: when you hurt yourself, your body sounds an alarm, and you feel a jolt as millions of nerve endings tell your brain something's wrong. Normally, as the injury heals, the alarm stops, and the pain fades. But chronic pain is different. Imagine the alarm getting stuck in the "on" position, ringing long after the injury heals or sometimes without any injury at all. It's like a faulty alarm that turns pain from a passing symptom into a relentless disease.

Yes, chronic pain is complex! For a long time, we believed that pain was solely a biological problem - a function of tissue damage or muscle and bone dysfunction among others. Gradually our understanding expanded to include other physical causes of pain including genetics, and hormones. However, we now know that chronic pain has aspects which go much beyond just the physical causes. There are many more layers which need to be peeled to really understand the subject. 

Our emotions, thoughts and coping mechanisms play a significant role in how we experience pain. There's scientific evidence that feelings of depression, anxiety and hopelessness about recovery can increase the sensitivity of our 'pain alarm', leading to heightened pain. Even the way we manage pain has a role to play here. Often patients are advised to give up things that they love the most to protect themselves from pain – their favourite hobby, their daily exercise, or even going to work. However, delimiting things one enjoys has an adverse impact on mental health, thus exacerbating the feeling of pain.

Many patients tend to withdraw from their friends and family due to excruciating pain. However, when we experience social isolation, our stress hormones go up, increasing our pain levels. On the flip side, positive social interactions can trigger the release of endogenous opiates, our body's natural painkillers, providing significant pain relief.

By understanding these various layers of pain, we've grown to acknowledge the profound depth and complexity of chronic pain, more than just its physical aspect.

Returning to our original story, imagine if Vignesh's doctor only prescribed painkillers without addressing the other aspects of his chronic pain, that wouldn't be very effective, would it? Fortunately, an increasing number of health professionals understand this and are advocating for a more integrated approach to pain management. They're not just treating the symptom; they're treating the person, considering all the complex layers of their experience. This approach is comprehensive, blending traditional, unimodal medical treatments with mental health support, physical therapy, and lifestyle changes. For instance, cognitive-behavioral therapy can help patients understand and manage their thoughts and feelings about pain, while physiotherapy aids in improving mobility and strength. Nutritional advice ensures a balanced diet that supports overall health and can help in reducing pain-causing inflammation. By adopting such a holistic approach, we stand a better chance of offering people like Vignesh and Meera much-desired relief. Nivaan is one such pain management company that aims to bring hope to the millions living with chronic pain, creating a future where their pain is more understood, better accepted and more effectively managed.

(Nivesh Khandelwal, Founder & CEO, Nivaan Care and Dr Naveen Talwar, Medical Director, Nivaan Care)

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