Most commonly used definition of chronic pain is the international association for the study of pain IASP definition. They define pain as “an unpleasant experience”, sensory and emotional associated with, or resembling that associated with, actual or potential tissue damage. Chronicity is defined by arbitrary duration more than 3 months. In fact, successful management of pain stems around understanding this definition by clinicians and equally by patients and their surrounding circles. Pain is largely an experience, individual one in fact, hence what compromises one’s quality of life or functioning is specific to that person and wouldn’t necessarily do the same to another patient hence all management plans should be individualised to patients’ needs and this is what Dr Alkholany offers his patients.
2. What is bio-psycho-social nature of chronic pain?
Pain is a multidimensional problem. There might be a biomedical element to pain; damage, wear, and tear…etc but what governs magnitude of pain and its impact on quality of life and daily functioning is usually not solely the biomedical dimension, but rather any psychologic or social dimensions that could be there in the background and without addressing them no successful management could be achieved.
3. Who is a Pain physician?
A pain physician is a trained doctor, originally trained as an Anaesthetist hence has the skills and knowledge to do injections and prescribe pain killers. He/she opts for focused training in pain medicine as a subspeciality to gain better understanding about different pain phenomena and how to manage them.
4. Are Morphine like medications effective for the management of chronic pain?
Morphine and similar medications are largely most effective pain killers invented by humanity. While they are effective in managing acute pain; after having surgery or sustaining a fracture for example, but evidence proved them ineffective as long-term treatment for chronic pain. The reason is built in in their pharmacology and interaction with human body, since the body develops tolerance to them after short period of time when patients need to increase the dose further to get same effect till, they end up on big doses of highly addictive medications not helping with pain and causing long list of problems at the same time. Most of us will be aware about the so-called opioid crisis especially in North America and to some degree in Europe secondary to the ill-informed previous liberal use of Morphine like medications for chronic non cancer pain. That said opioids might be effective in specific selected cases and in cancer pain management as well.
5. Why do we develop pain?
Pain is part of our nature as human beings and its protective in its acute form; if you step on a nail or break a bone, you hurt to alert your system about the problem, healing happens, and pain goes away. Some patients are unfortunate and will have their pain carrying on from the healing point onwards to become chronic for various physiologic reasons and some are even more unfortunate to have an impact secondary to that on their functioning and quality of life. As a scientific fact long, standing pain is difficult to treat due to a phenomena called neuroplasticity that happens in the nervous system with long term stimulating signals, as simple as what happens when you study for an exam and store information that you won’t forget easily. This is why when it comes to the impact of pain on quality of life and functioning, we step back and have a helicopter look on the multidimensional nature of long standing pain being a biomedical but also psychologic and social disorder and it’s not uncommon to find the answer in those areas more than biomedical reasons for long standing pain and addressing them with the help of members of the pain team; pain psychologist and physiotherapist is what helps achieve success with management.
6. What to expect from my Pain doctor?
Your pain doctor will work out a plan of management based on your assessment and will employ medications and/or injections to help ease your pain parallel to a rehabilitative program under care of physiotherapy and sometimes might need input from pain psychology if you seem to have obvious stressors or abnormal thinking and behaviour around your pain condition holding you back from being able to respond to treatment and to regain your quality of life and functioning.
