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 Table of Contents  
EDITORIAL
Year : 2015  |  Volume : 29  |  Issue : 2  |  Page : 59-60

Need of Indian protocol in pain management


Daradia: The Pain Clinic, Kolkata, West Bengal, India

Date of Web Publication15-Apr-2015

Correspondence Address:
Dr. R Gurumurthi
Daradia: The Pain Clinic, 92/2A Bidhan Nagar Road, Kolkata - 700 067, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-5333.155166

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How to cite this article:
Gurumurthi R, Das G. Need of Indian protocol in pain management. Indian J Pain 2015;29:59-60

How to cite this URL:
Gurumurthi R, Das G. Need of Indian protocol in pain management. Indian J Pain [serial online] 2015 [cited 2019 Dec 16];29:59-60. Available from: http://www.indianjpain.org/text.asp?2015/29/2/59/155166

Pain medicine is one of the fast developing medical fields in India, especially among the anesthesiologist. Even patients are nowadays becoming more aware of this super specialty. Though multidisciplinary mode of management should be the approach among all specialties, still it is much insisted in pain medicine because it's an younger branch of medicine. [1] Patients with pain are seen often by general physician, orthopedician, neurologist, pain physician and so many specialists. Each has their own way of examining and treating those patients, which may vary with their knowledge and expertise. Added to this, there is no availability of standard protocols for treatment of many disease conditions. At present, we have some recommended protocols for certain diseases like American Society of Interventional Pain Physicians Guidelines for responsible opioid prescribing in chronic noncancer pain and spine intervention procedures, World Institute of Pain guidelines for interventional pain procedures, WHO ladder for cancer pain management, American College of Rheumatology criteria for fibromyalgia and so on. Though these guidelines are based on well controlled randomized trials, they are mostly based on foreign studies and research which may not be applicable for Indian population.

Abundant evidence clearly demonstrates that pain responses are characterized by substantial interindividual variability. In other words, an identical noxious stimulus produces vastly different experiences of pain in different people. In addition to interindividual variability in clinical and experimental pain sensitivity, substantial individual differences in responses to pain treatments exist. For example, in a study of postoperative pain, the median number of morphine boluses required to achieve pain relief (Visual Analog Scale rating <30) was 4, but the number of boluses ranged from 1 to 20 across patients. [2] While variability in pain responses has been studied for decades, [3],[4] interest in individual differences in pain and responses to treatment has increased substantially in recent years, reinvigorated largely by the genomics revolution. However, variability in pain perception and responses to treatment is driven by complex interactions among multiple biopsychosocial factors, including, but certainly not limited to, genetic influences. Socioeconomic variables, such as education and income, are associated with increased risk for pain and poor health status and are likely to contribute to ethnic/racial disparities in pain. [5],[6],[7],[8],[9] In addition to this, neuroendocrine factors may contribute to ethnic/racial group differences in pain perception. Thus genetic, social, economical, geographical, religious, cultural, spiritual factors might have importance influences on pain perception.

While ethnic/racial group differences in clinical and experimental pain responses have received considerable empirical attention, little research has addressed ethnic/racial group differences in responses to pain treatment. An important goal of research on individual differences in responses to pain and its treatment is to develop the ability to generate accurate a priori predictions of a person's response to pain or pain treatment based on assessment of specific characteristics of that individual. For example, if sufficient knowledge were available, we might predict response to a pain medication based on a combination of body size, genetics, sex, ethnicity, and other factors. Of course, before this type of individualized pain medicine can be realized, a substantially better understanding of individual differences in responses to pain and pain treatment will be needed. [10]

Given the current state of the evidence, tailoring pain treatment based on sex, ethnic/racial group, or genetics may not be practical at this time; however, with enhanced understanding of the influences of these and other individual difference variables on pain, individualized treatment could become a reality in the future. Of particular importance will be large-scale studies that provide opportunity for modeling interactions among multiple individual difference factors. More widespread recognition of the importance of individual differences in pain along with additional research to illuminate the nature of mechanisms of these individual differences will ultimately lead to more effective pain diagnosis and treatment. [10]

Even in developed nations such as US and UK with well-designed health care policy, lots of studies are done to find out interindividual variation in pain perception and treatment. Indian population who are no more same as those populations in relation to genetic, socioeconomic, cultural etc., cannot be expected to have same type of pain perception and treatment response. Before we think of interindividual variation, we should have broad idea about average pain perception and treatment response in Indian community. As we know India's per capita income (nominal) was $ 1570, (2013) total expenditure on health per capita was $ 157 and total expenditure on health as % of gross domestic product was only 4.1%, [11] which is far low when compared to developed countries, there is always a need of having the most cost effective treatment strategy for Indian population. In India, where health care industry is growing very fast with more doctors getting qualified every year, there is no corresponding growth in standard research articles and publication based on Indian population. Quality and quantity of work done by Indian medical fraternities may be of par excellence, but unfortunately it was not completely reflected on publications and hence that it can be used for further analysis and also in formatting guidelines for future generation.

This is our timely need thing for all those physicians involved in pain management to come up with standard research articles including community based pain care. Not only in publications, it is the responsibility of all medical fraternity society to formulate standard cost effective protocols for clinical diagnosis, investigations and evidence based treatment algorithm. Joint work by different societies such as orthopedician, neurologist, pain physician, rheumatologist, physiotherapist etc., is also needed in framing best protocols. Active participation of almost all pain medicine practitioners should be motivated in getting this protocol done. Few practitioner may be practicing International societies recommendation but would have modified it as per their experience and those practitioners should be motivated in getting adequate evidence and come up with good research paper in Indian pain forum which can be in future as best line of management in Indian population. Let us start by now itself.

 
  References Top

1.
Das G, Gurumoorthi R. Introduction to clinical methods in pain medicine. In: Das G, editor. Clinical Methods in Pain Medicine. New Delhi: CBS Publishers & Distributors; 2014. p. 1-3.  Back to cited text no. 1
    
2.
Aubrun F, Langeron O, Quesnel C, Coriat P, Riou B. Relationships between measurement of pain using visual analog score and morphine requirements during postoperative intravenous morphine titration. Anesthesiology 2003;98:1415-21.  Back to cited text no. 2
    
3.
Chapman WP, Jones CM. Variations in cutaneous and visceral pain sensitivity in normal subjects. J Clin Invest 1944;23:81-91.  Back to cited text no. 3
    
4.
Hardy JD, Wolff HG, Goodell H. Pain Sensation and Reactions. Baltimore: Williams & Wilkins; 1952.  Back to cited text no. 4
    
5.
Bruce B, Fries JF, Murtagh KN. Health status disparities in ethnic minority patients with rheumatoid arthritis: A cross-sectional study. J Rheumatol 2007;34:1475-9.  Back to cited text no. 5
    
6.
Portenoy RK, Ugarte C, Fuller I, Haas G. Population-based survey of pain in the United States: Differences among white, African American, and Hispanic subjects. J Pain 2004;5:317-28.  Back to cited text no. 6
    
7.
Deyo RA, Mirza SK, Martin BI. Back pain prevalence and visit rates: Estimates from U.S. national surveys, 2002. Spine (Phila Pa 1976) 2006;31:2724-7.  Back to cited text no. 7
    
8.
Fuentes M, Hart-Johnson T, Green CR. The association among neighborhood socioeconomic status, race and chronic pain in black and white older adults. J Natl Med Assoc 2007;99:1160-9.  Back to cited text no. 8
    
9.
Volkers AC, Westert GP, Schellevis FG. Health disparities by occupation, modified by education: A cross-sectional population study. BMC Public Health 2007;7:196.  Back to cited text no. 9
    
10.
Roger BF. Individual differences in pain: The roles of gender, ethnicity and genetics. In: Fishman SM, Ballantyne JC, Rathmell JP, editors. Bonica′s Management of Pain. Baltimore: Lippincott Williams & Wilkins; 2010. p. 86-97.  Back to cited text no. 10
    
11.
World Health Organization. Available from: http://www.who.int/countries/ind/en/. [Last cited on 2015 Apr 07].  Back to cited text no. 11
    



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