The need for special attention in case of “pain intervention” through homoeopathic treatment in the present era.

Authors:

1. Dr. Abhijit Dutta. Postgraduate Trainee, Dept. of Organon of Medicine, National Institute of Homoeopathy, Kolkata (Govt. of India) Email: drabhijitdutta1@gmail.com

2. Dr. Sanjukta Mondal.Postgraduate Trainee, Dept. of Homoeopathic Materia Medica, Mahesh Bhattacharyya Homoeopathic Medical College& Hospital, Howrah (Govt. of West Bengal) Email: m.sanjukta@yahoo.com

Abstract:
Pain is considered to be one of the most distressful symptom due to excessive irritability of nerve. Although this is not a separate disease entity, yet a separate class of symptoms which signifies some underlying disease conditions. Pain is exclusively a subjective sensation having a broad variety and description. There are infinite pain cases which requires special medical attention. Pain medicine refers to the super specialty in conventional system of medicine, which exclusively deals with such pain cases.  According to Homoeopathic concept, disease is nothing but a set of symptoms and in order to cure the person that totality of symptoms should be removed from the person. Pain is one the important symptoms which has to be given special emphasis in order to provide solace to the patient. There are innumerable medicines in homoeopathic Materia Medica which may have significant role in managing several types of pain but needs to be thoroughly evaluated so that they can be applied rationally. In this context, a separate and special emphasis should be given to the pain spectrum with an exhaustive clinical testing, separate clinical setup, special evaluation and thorough sincere monitoring of cases.

Introduction:
Pain is basically a protective mechanism of the nature and it actually gives warning to the sufferer to withdraw the distressing stimulus. Most of the pain resolves by removing such noxious stimuli.¹ The distress that arises by the pain are lack of attention in work, reduced mental flexibility, inability in information processing, anxiety, depression, fear, anger etc.² It is one of the major causes which may drastically reduce the patient’s quality of life.³

Pain may be broadly classified into acute and chronic. Acute pain is much easier to manage by conventional system of medicine but chronic pain is less likely to be.⁴

There are so many medical conditions in which managing pain is a challenge to the practitioners, like pain in cancer, chronic post-operative pain, advanced osteo-arthritic pain, trigeminal neuralgia, various psychogenic pains, breakthrough pain in different conditions etc.⁵ In most of the cases the underlying pathology is very difficult or impossible to remove and thus pain management becomes necessary. Although those challenges are encountered by various specialty and super- specialties but most of the cases appears to be refractory to the medications. That’s why a separate super- specialty called pain medicine has been evolved in medical province.⁶

Pain is an enormous problem globally. Estimates suggest that 20% of adults suffer from pain globally and 10% are newly diagnosed with chronic pain each year.⁷

A study shows a prevalence of pain in patients visiting PHC in central India is 29.63% and the prevalence of chronic pain amongst these patients was 19.23%. It was predominant in females and age group of 21-60 years. Prevalence of chronic back pain was highest (24.84%), followed by body pain (22.98%), Knee (16.77%), Chest (13.97%), Upper limb (10.87%). Other pains had prevalence of less than 10%.⁸

International Association for study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”⁹

Types of Pain: There are basically 2 types of pain acute (persisting less than 3months) and Chronic (persisting more than 3-6months). But another classification may be according to the type of pain like throbbing, neuralgic, neuropathic, breakthrough pain etc.⁴

Homoeopathic Point of View:
In homoeopathy, totality of symptoms is the foremost important thing in any case.¹⁰ But in the fast moving time special modulation is needed for keen understanding of any disease because it is almost impossible for a single physician to know and tackle all cases and perceive the nature and prognosis of the illness. Conventional therapy has so many limitations in pain management where homoeopathy can contribute a lot. So it’s time that a special emphasis may be given in such pain cases irrespective of the fact that absolute cure is possible or not. 

For the treatment of any disease the anamnesis is needed in each and every case, but in these cases a special reference must be given to the character of pain in terms of:

1. Location
2. Sensation 
3. Modality
4. Extension
5. Nature and intensity
6. Associated symptoms and 
7. Underlying pathological or psychological conditions.

Whereby it is known to us that in Materia Medica there are innumerous medicine and symptoms regarding pain and if we can use it rationally then it must bring some fruitful result in favor of the suffering mankind. But a thorough and extreme special behavior is to be projected towards understanding and managing cases.^11,12

Discussion and Conclusion:
There are so many intractable cases where removal of pathology, in order to remove pain, is infeasible. According to the Homoeopathic Philosophy those cases needs palliation with the most similar remedy. For this totality of symptoms is the only way to treat and for making the totality, a thorough and in-depth understanding of the nature and intensity of the disease is obligatory which is not possible in a general clinical set-up; rather to say a special setup and emphasis should be created in the light of pure and classical homoeopathy to know the complaint related to the man and to treat them rationally. So it is high time that we think about such specialties where homoeopathy integrated with other relevant therapy can do much and pain medicine is one among them for making a broader aspect of the system and to help the suffering humanity.

References:

1. Katz J, Rosenbloom BN, Fashler S. Chronic Pain, Psychopathology, and DSM-5 Somatic Symptom Disorder. Can J Psychiatry. 2015;60(4):160-7.
2. Wong AY, Karppinen J, Samartzis D. Low back pain in older adults: risk factors, management options and future directions. Scoliosis Spinal Disord. 2017;12:14. Published 2017 Apr 18. doi:10.1186/s13013-017-0121-3
3. Dueñas M, Ojeda B, Salazar A, Mico JA, Failde I. A review of chronic pain impact on patients, their social environment and the health care system. J Pain Res. 2016;9:457-67. Published 2016 Jun 28. doi:10.2147/JPR.S105892
4. Yarnitsky D. Conditioned pain modulation (the diffuse noxious inhibitory control-like effect): its relevance for acute and chronic pain states. Current Opinion in Anesthesiology. 2010 Oct 1;23(5):611-5.
5. Garg R, Joshi S, Mishra S, Bhatnagar S. Evidence based practice of chronic pain. Indian J Palliat Care. 2012;18(3):155-61.
6. Dureja GP. Handbook of Pain Medicine-E-Book. Elsevier Health Sciences; 2013 Nov 28.
7. Fayaz A, Croft P, Langford RM, Donaldson LJ, Jones GT. Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies. BMJ open. 2016 Jun 1;6(6):e010364.
8. Deshpande AN. Prevalence of chronic pain based on primary health center data from a city in central India. Indian J Pain 2018;32:81-5.
9. Treede RD. The International Association for the Study of Pain definition of pain: as valid in 2018 as in 1979, but in need of regularly updated footnotes. Pain Rep. 2018;3(2):e643. Published 2018 Mar 5. doi:10.1097/PR9.0000000000000643
10. O’relly, Wenda Brewster(2010). Organon of The Medical Art by Samuel Hahnemann. BJAIN Publishers.2010; ISBN: 978-81-319-0922-5
11. Clark, John Henry; A Dictionary of Practical Materia Medica(2010); B JAIN Publishers (P) Ltd. ISBN 978-81-319-0261-5
12. Boericke, William; Pocket Manual of Homoeopathiic Materia Medica & Repertory(2011); B JAIN Publishers (P) Ltd. ISBN 978-81-319-0128-1