Dr Mary Abraham

This, in turn, can further aggravate the perception of pain, as pain impulses are more easily propagated to the brain in such patients, thus forming a vicious cycle of pain and psychological distress. Conversely, when an individual suffers from a significant psychological problem that creates strong emotional distress, then even in the absence of any physical cause, the person may experience pain. This pain, caused by immense emotional distress, is termed as somatisation disorder. In either situation, regardless of whether the pain is physical or psychological, the person inflicted with pain, and his/her family feel the impact. "Pain is a biopsychosocial phenomenon, which means that social reasons can not only perpetuate pain, but also directly or indirectly affect pain behaviour. Lack of familial and social support, loss of prestige, giving up of roles, being displaced from an important position in the family, loss of job and fear of unemployment, financial concerns and fear of dependency are all significant stressors. These can have a compounding effect on pain behaviour", the authors explain.

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What we get wrong about pain

"The biggest myth surrounding pain is that certain types of pain — such as the pain that follows surgery and cancer treatments — have to be endured and cannot be relieved. This is not true. Several types of pain can be relieved with the help of medication and techniques. Even physiological pain, such as the pain a mother experiences during labour, can be relieved to facilitate comfortable and smooth childbirth," the authors explain. A large part of patients' reluctance to treat pain stems from another prevalent misconception that all pain-relieving medicines are harmful.

Dr Vandana Prakash

"While it is true that some analgesics can harm the body, especially the kidney, liver and the gut when taken for longer durations, there are many which, when given in appropriate doses, cause little or no side effects," the authors explain, emphasising on the fact that untreated pain can affect the sufferer adversely, not only in terms of their physical health, but also their functionality and their quality of life. "There's also a widespread fear of narcotic or opioid drugs, such as morphine, which are believed to be addictive, despite the fact that in certain conditions, including advanced cancer, nearly 75 to 90 per cent of patients experience severe pain that can only be relieved with strong analgesics such as morphine," the authors add.

The use of these medicines must not be withheld, they add, explaining that addiction is influenced by genetic, psychosocial and environmental factors, which have to be ruled out before starting the drug. When administered in appropriate amounts, they will not lead to addiction. The authors stress the importance of caregivers understanding that the sufferer is not "faking" the pain, especially in the case of mental pain. Emotional distress is real and the pain experienced is actually felt. "There is a crying need for a major attitudinal shift where the caregivers understand that the one inflicted by pain needs emotional, physical and social support. Instead of looking down on sufferers, caregivers must encourage them and provide the necessary psychological support to enable them to recover," both authors remind us.

How can you help?

In many cases, healthcare professionals are entirely focussed on treating the underlying disease causing pain. It is important to adopt a holistic approach that treats the person rather than the disease. This approach is termed as total pain management.

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