Role of Anaesthesiologist in Chronic Pain Management
Dr. Vrishali Ankalwar
Associate Professor,
Dept. of Anesthesiology
GMCH, Nagpur
Introduction
Since the demonstration of painless surgery on by W. T. G morton on 16 October 1846, journey of pain-free world was started…
Over the period, Anaesthesiology is defined as the practice of medicine dedicated to the pain relief and total care of surgical patients and Anesthesiologist is defined as physician who focus on perioperative care of surgical patients and pain relief. Since last century, Anaesthesiologist is continuously expanding his horizons, formerly restricted to operating room, to include perioperative medicine. The later encompasses treatment of acute pain, postoperative pain intensive care, in addition to chronic pain medicine, sleep medicine and palliative care and thus rendering services to various fields of Medicine…
Anaesthesiologist, perioperative physician is master of management of perioperative pain and applies his knowledge experiences and expertise skilfully using pharmacological methods which included use medications like opioid and interventions like central neuraxial blockade, peripheral nerve blocks ect…for management of acute pain in perioperative period. This indepth expertise in pain management makes anaesthesiologist a leader of chronic pain management task.
History
No wonder, pain medicine was born in the cradle of anaesthesiology as pain management is the priorities since the beginning of speciality…
It is not by accident that the International Association for the Study of Pain IASP was created by Dr. John Bonica, an American anesthesiologist.1 In the United States, the idea of establishing pain management as a specialty emerged as early as 1989, and in 1990. The American Board of Anaesthesiologists suggested the creation of the certification in pain to the American Board of Medical Specialties. The first residency program in Pain Management was approved only in 1992. Later, in 2002, it was renamed Pain Medicine.2
Interventional pain management have been developing new techniques by John Bonica since 1960. Use of interventional and regional nerve blocks lead to establishment of cancer pain management and palliative care.
Merits Of Taking Up Pain Medicine As A Career
As pain medicine covers patients suffering from chronic and cancer pain, a pain physician can cater to a large proportion of population. An anaesthesiologist who chooses pain medicine as a career has an opportunity to perform interventional pain procedures. The pain physicians are trained and have enough skill and knowledge to carry out such procedures. The pain relief given to the suffering patient is very rewarding and satisfying. Patients in pain are in need of a sympathetic clinician who will support their perseverance, hope and trust, and pain physicians by doing so, gain the patients’ gratitude and blessings. Moreover, pain medicine practice is financially rewarding after initial few years of practice.
Examples of conditions of chronic pain treated by Anaesthesiologist
- Epidural block – Low backache with radiculopathy, postherpetic neuralgia, Phantom limb, cancer pain
- Stellate Ganglion block – CRPS, Lymphedema, Reynaud’s disease
- Lumbar Sympathetic block – Burgers Disease, Phantom Limb
- Coeliac Plexus block – Chronic pancreatitis, Hepatocellular carcinoma
- Spinal cord stimulator- Chronic abdominal and back pain
- Intrathecal Drug Delivery Devices – cancer pain
Conclusion:
We anaesthesiologist are best physician to work in pain clinic, because in pain management is part of our competence. If we don’t want to do it, somebody else will…
References:
- Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al The revised International Association for the Study of Pain definition of pain: Concepts, challenges, and compromises Pain. 2020; 161:1976–82
- Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, et al Chronic pain as a symptom or a disease: The IASP classification of chronic pain for the International Classification of Diseases (ICD-11) Pain. 2019; 160:19–2
- Singla V, Batra YK. Recognition of pain as a specialty in India Indian J Pain. 2016; 30:80–82
