Pain management should be introduced in medical curriculum across the country, said Mary Korula, head of the department of anaesthesia and acute pain services, at Christian Medical College here. She is also the patron for the TN Chapter of Indian Society of Study of Pain.
Speaking to Express, she said post-operative pain services should be made mandatory to incorporate pain scoring as the fifth vital sign along with BP, pulse rate, etc, in all hospitals, in accordance with the declaration made at the World Pain Congress in 2011, which stated that access to pain management is a fundamental human right that must be recognised.
Mary said less than 30 per cent of patients in India received pain relief after surgeries and emerging evidences revealed that poorly controlled acute post-operative pain was the cause of chronic pain development. “In Western countries, where pain relief or analgesia is demanded as a routine after surgery, in India, we are still trying to convince patients that surgery would be associated with pain that has to be accepted.” Is this correct?” she wondered.
Public awareness is the main issue and pain education is mandatory for all clinicians, she asserted. The focus should be on providing effective pain relief, monitoring degree of pain, handling of infusion pumps and patient-controlled drug regimes that could improve the patient-nurse-doctor relationship, she added. “The perception that pain is natural and inevitable accompaniment of disease and severe pain is an acceptable consequence to surgery has to change,” she said adding that pain should be assessed like other vital parameters.
Quoting studies, Mary said lack of pain management services could prolong recovery or precipitate complications that add to the cost for the patient. Every system in the human body get affected by acute pain. Labour pain sometimes disturbs the baby in the womb. “Pain, although difficult to describe, the inability to communicate by the patients did not negate the need for appropriate pain relief treatment,” she argued. Pain is subjective and can involve the whole family. Advances in knowledge of molecular mechanisms of pain, brain imaging and genetic counselling have led to development of multi-modal analgesia and new drugs to treat pain that could be tailor-made for the patient’s need, minimising side-effects, while providing relief.
The acute pain services was introduced in CMC in 2007 with an integrated approach to treat patients undergoing surgeries. Nursing superintendent Dr Jayarani, said pain score has been included in the patient record as an assessment tool. The nursing college attached to the CMC had already introduced pain management in nursing courses and nurses had been trained to assess pain and provide treatment accordingly.
The hospital is in the process of preparing manuals on pain management to educate patients, hospitals and the public.