Long-term pains and how to resolve them
Chronic pains are defined as pain that persists for at least three months. Such pains include lower back pain and migraines. The World Health Organisation estimated one in five (22%) people worldwide live with chronic pain. In Singapore, the number is slightly less than one in ten (9%).
Singapore also ranks among the highest in the world for body and head pain, based on the 2017 GSK Global Pain Index, which surveyed 19,000 adults across 32 countries. About 85% of 500 Singaporeans surveyed reported having experienced such pains, with four in 10 suffering body pain every week.
With the growing ageing population in Singapore, the healthcare system works to cope with its challenges and the rising impact of chronic disease by mobilising general practitioners (GPs). About one in five (19.5%) of the elderly aged 60 and above suffer from chronic pain, according to the Well-being of the Singapore Elderly (WiSE) study published in the Pain Research and Management journal in 2016.
Most patients who suffer from chronic pain are prescribed painkillers such as ibuprofen. However, this method does not address the root cause of the pain, and prolonged use of such medication can cause more harm. Treating chronic pain in Singapore
In Singapore, GPs refer their patients to a specialist if they are unable to treat the condition. Those suffering from knee pains are referred to an orthopaedic surgeon, and incurable frequent and intense headaches are referred to a neurologist. With more sufferers seeking treatment, there has been a rise in patient load. At the Singapore General Hospital (SGH), its team of pain management doctors had to expand from four to approximately 14 anaesthesiologists specialising in pain management.
The hospital uses a combination of treatment - inclusive of medication, minimally-invasive injections, and exercise. Some are also referred for psychological intervention such as cognitive behavioural therapy. SGH’s Dr Tan states that although milder and more moderate forms of pain such as migraines, muscle and body aches can be relieved using over-the-counter medication, multiple scientific publications have shown that psychological interventions can help make a difference in pain management. Alternatively, acupuncture is also said to prove useful in stimulating naturally-occurring pain relievers in the body.
How chronic pain is treated globally
In Australia, chronic pain is treated and approached as an independent condition instead of as a symptom of disease.
GPs consider minimally-invasive procedures, patient education, behavioural, cognitive or physical therapy, as well as family therapy among others if needed. In other parts of the world, millions of people are prescribed antidepressants to relieve the condition. However, they’re being prescribed without sufficient reliable evidence of their effectiveness. The National Institute for Health and Care Excellence (NICE) explains that doctors should advise sufferers to use physical and psychological therapies, rather than resort to analgesics to manage their pain. They also recommend doctors to draw up a care and support plan with patients about how to manage their pain based on its effect on the sufferer's daily life.
“The plan should include interventions that have shown effectiveness in managing chronic primary pain. These include exercise programmes and psychological treatments. Acupuncture is also recommended as an option. Antidepressants amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine, or sertraline can also be used. Sufferers should not be started on commonly used medications such as paracetamol, benzodiazepines, or opioids, which poses risks that include addiction,” said Dr Paul Chrisp, the director of NICE’s centre for guidelines.
Moving away from the conventional way of medicine, Canadian surgeons are using virtual reality to manage patient pain. It involves a patient wearing a VR headset during more minor procedures such as mass removal or hand surgery, and it has shown an improvement in managing patient pain. Health Canada has also authorised three clinical trials that are considering using the VR devices for pain management therapies. In November 2021, the U.S FDA approved the first VR device for medical use with chronic lower back pain in patients 18 years and older.
What should be done to effectively manage chronic pain Pain assessment and diagnosis heavily rely on a patients’ self-report. This combined with limited medical resources and specialists in pain management result in an under-diagnosis and ineffective treatment. A journal published by The Lancet explains that such situations can be improved by regular pain measurement and changes in physician training, by shifting the focus towards relieving pain and not just treating diseases that cause pain.
The study also acknowledges that chronic pain needs to be managed using the biopsychosocial model that involves multimodal and multidisciplinary approaches. Aside from self-management tools such as exercise and lifestyle changes, opioid and non-opioid pharmacological therapies, it should also include psychological therapies and integrative treatments.
