INTRODUCTION
One of the revolutionary disciplines emerging in the field of medicine in India in recent times is Pain Medicine, though developed countries like the United States have put a special impetus on its practice and recognized it as a separate specialty since the last century. This shows the lack of awareness of this specialty in our country not only among patients but also among the medical fraternity. This huge lag in the awareness of pain management facilities calls for special endeavors involving dedicated awareness programs via educational handouts, social media, TV, press release, and public exhibitions. Separate continuing medical education programs and conferences should be promoted among the medical community specially dedicated for the cause.
A major part of pain management lies in palliation of the incurable conditions like cancer, which is emerging as a major cause of morbidity in the present scenario of increased life expectancy due to advanced medical facilities. Medical science has found ways to cure cancer or at least prolong its course, but the patients who go through the cycles of treatment only know the pain they have to go through to put up with their situation. The unbearable pain, however, makes life worse. And little do the patients know that there is an escapade from the situation in pain medicine. Even doctors, when encounter such situations, leave the patients with prescriptions of mild analgesics like paracetamol, not realizing that they are in fact making their patients life worse with the ignorance of their enormous pain. Pain clinic is an answer to the problem, providing palliative care to patients with such incurable conditions. Palliative medicine in itself is emerging as a branch of medicine with contributions from different specialties like oncologists, anesthesiologists, oncosurgeons, and physicians.
However, the facilities and resources available are scarce. Morphine, the alkaloid product of the opium poppy plant, Papaver somniferum, which is the gold standard for pain relief as per the World Health Organization, is available in very selected hospitals and institutions for prescription to the terminally ill patients with cancer and acquired immunodeficiency syndrome. Opioids are the necessity of the hour in such demanding situations, but restrictions as per the Indian laws on its cultivation and marketing make it difficult to avail even when medically indicated as a part of pain medication. It is a matter of major concern as well, because morphine use needs careful medical supervision since on one end of the spectrum its excessive use edges on physiological addiction. Opioids, thus, as the double edged sword they are, need to be prescribed with an educated and dedicated intellect of a pain physician.1
Pain physicians of today are competent to treat the entire range of pain encountered in the delivery of quality health care, whether it is due to a discrete cause like cancer pain and postoperative pain to primary pain problems like musculoskeletal pain, neuropathic pain, urogenital pain, headaches, etc. Thus, pain medicine is not only restricted to the use of drugs like opioids, but various other drugs like nonsteroidal anti-inflammatory drugs, antidepressants, and antipsychotics are also prescribed for their analgesic potential in various doses. Besides, interventional modalities have emerged as a revolution in this field as a beautiful result of advanced modern technology shaking hands with medicine, giving birth to “Interventional pain management,” the side of pain medicine that still needs to be unveiled on a large scale in our country. This covers a wide spectrum of pain procedures ranging from radiofrequency ablation, thermal and pulsed, to the implantation of spinal cord stimulators, peripheral nerve stimulators, and intrathecal pumps, exploiting the various applications of neuromodulation. The expertise required for these procedures based on the intricate study of etiology of pain and its pathway requires its acknowledgment as a discrete discipline. The American Medical association recognizes pain medicine, incorporating interventional pain management, as a discrete specialty in the field of medicine.1,2
Therefore, the present day pain physician has various weapons in their armory and apart from medical management, interventional pain management procedures can be resorted to not only to help in the diagnosis but also to provide long-term pain relief for the patient.
With the growing life expectancy that medical science and technology are gifting mankind, the quality of life becomes an important factor to be taken care of. Chronic pain becomes an ailment which not only handicaps the person physically and mentally, but is also a handicap for the family and society, making it a global health problem. In such a grim scenario, pain medicine is the specialty of medicine emerging to treat the suffering in Tithonus' boon of immortality, making the concept of chronic pain management and "Pain Clinic" the need of the hour.