Dr. Vorawat Eawsinphanit, Rehabilitation Specialist is going to tell us about pain management and the goal to make patients able to return to their normal life happily. Sukhumvit Hospital is aiming to use various methods by medical team, nurses, occupational therapist, and physical therapists together with equipment to ensure treatment efficiency and make sure that our patients will be able to return closest to their normal life no matter what kind of pain they have been through (either muscles or malignant tumor)
Quality of life assessment before the treatment
Patient’s quality of life will be assessed. They will be asked about what they used to do before the pain, what their daily life was like, hobbies, the needs to use any part of the body more often than others and so on. This information not only helps with pain management planning, but also let us know their capacity which will be our goal to enable them to do everything they used to do before the pain as much as possible.
Pain Management by Sukhumvit Hospital
Pain management here is categorized into 3 main groups according to the severity i.e. mild, moderate, and severe because each group needs different method.
- Mild pain. Medication might not be needed. Patients might be asked to change their lifestyle, do some stretching exercise with a physical therapy device. They can get better.
- Moderate pain. Medication might be used together with a physical therapy device. Injection might be administered to fasten the healing process and reduce the pain as quick as possible.
- Severe pain. We are trying our best to disturb this group of patients as least as possible. Special injection technique will be used, major operation will be avoided if not necessary.
For all 3 groups, the treatment normally starts with non-medicine methods. Some physical behavior will be adjusted first. If medication or injection are administered it is only to control the pain as quick as possible.
If the pain is bone or joint related, equipment is available here to manage such pain. For example, we have muscle ultrasound machine to identify the problematic spot. Injection will be administered right to that spot to reduce the pain. The medicine we are using is different from others. We try our best to avoid steroid. Steroid can reduce the pain very quickly but it causes other problems to the muscle afterwards i.e. thinner ligament. In a long term it will cause changes physically. We are using the technique called Prolotherapy. High glucose, or PRP (Platelet Rich-Plasma Therapy), which is the use of platelet rich plasma to help with the recovery and repair the damaged part of the muscle. If the pain is too severe to be treated by oral medicine or injection such as pain caused by Herniated Nucleus Pulposus which will not respond to any treatment.
If it is malignant tumor related pain, our specialists are here to take care of this patient group. Our state-of-the-art equipment is ready to help the patients out with their pain. Pain reduction will be performed efficiently and there might be no need of major operation. The pain itself is bad already, let alone the major operation that would cause so much more pain. Cancer related pain is so much it is almost unbearable and sometimes the tumor in question is located in a difficult to access area which causes a greater pain.
Some patients suffer Night Pain i.e. the pain occurs only at night which results in sleeping difficulty. This leads to insufficient rest and the body has hard time recovering causing both physical and mental discomfort, worse quality of life, and negative emotional status. Here is what we do: the pain management team will be handling the exact nerve that causes the pain and relieve the patient from the pain as soon as possible. Pain medication will be used the least because pain medication is comprised of morphine and it gives side effects.
We have been trying our best to make sure the pain is under control and pain management is efficiency because this is the key to achieve pain management goal and better quality of life afterwards. Apart from pain management, we also assess other aspects to see what activities the patients can do just like before and when the patients feel better, our occupational therapists will help them out with further treatment.
Pain is what makes us feel both physically and mentally uncomfortable and it must be managed. The limitation includes the identification of exact area and get to the point. In case that there is a disease that cannot be completely got rid of such as certain type of cancer that the operation cannot be done, we will do everything to make sure that the patient is able to live with it the best we can.
It is not quite difficult to find out the cause of mild and moderate pain and manage it directly. However, in some serious cases which the pain is caused by a serious disease or one that the operation is not a treatment method because the cause is located on a difficult area such as adjacent to blood vessels and treatment methods are limited. In these cases where the disease itself is not cured, pain will be controlled to make the patient feel better and live their daily life. For example, cancers like pancreatic cancer or lung cancer are quite difficult to perform operations. These are diseases that cause a great pain i.e. lying on the sides, lying still, or even breathing are already painful. The patient’s quality of life is worse, and our job is to control this pain.
Duration of pain management
Duration depends on the diseases. Generally, it takes 1 – 2 weeks but could be longer in more severe cases. When the patients start to feel better, more activities will be gradually assigned to them aiming to give them a better quality of life. Their muscles will be readied and their physical capacity will be increased so by the time the pain is totally cured, their organs can be functioning just like normal.
Treatment and Rehabilitation
Pain makes patients unable to do certain activities causing them to feel unhappy. Some enjoy jogging, exercising, marathon running, and all of a sudden, their ankles or elbows hurt and the pain won’t go away. They cannot do what they want to do. Here we do not tell the patients to stop doing, we encourage them to get back to those activities as quick as possible. For cancer patients, the pain is extremely severe that even a slight movement is a problem. If we reduce it to the point that they can move their body freely and do daily activities without pain, this is what we call a better quality of life.
For patients who suffer chronic pain from cancer, they are likely not to need much just be able to handle their daily activities such as washing face, showing, toothbrushing which they are happy already as long as they don’t have to undergo the operation. In cases of backpain or Herniated Nucleus Pulposus patients, if the patients do not get better after physical therapy sessions, injections will be administered to the nerves. Needles might be placed into the herniated disc in question to melt it. this is the procedure that can control the pain in an effective manner without major operation. In cases of frozen shoulder, open surgery or endoscopic surgery might be needed to make the shoulder move normally again. Ultrasound machine is used to check the joint area and the injection device is used to administer the medicine to stretch the membrane around such area. After the injection the patient is likely to move freely right away. This helps shorten the physical therapy sessions which previously could take up to months.
We recommend that you discuss your pain problem at “Pain Management Center” here at our Rahabilitation Center of Sukumvit Hospital. Our medical team is ready for early consultation and suggest the most suitable treatment if only physical therapy or with injection. For chronic cases, we will be giving you suggestion what to do next, ablation is needed or not, or only the injection is enough. Our medical team, nurses, multidisciplinary team, and staffs are working together closely with the equipment to make sure that the treatment and rehabilitation program will enable the patients to return to their normal life with better quality.