FEATURE

Pain-man’s greatest enemy.

Pain has been man’s greatest enemy from time immemorial and shall be so for all times to come. Pain is also the best method the body can convey that all is not well with the owner to urge him/her to take some remedial action. The physiology of pain is still not fully understood although from time to time people discover something new to evolve a drug treatment method. Pain killers, as they are called, are the real killers. Aspirin, the first pain killer to the latest complicated pain killers that the greedy drug industry has researched are making a big business, but are the leading killers in the adverse drug reactions (ADR) list. Some of them had to be withdrawn from the market as they led to heart attacks and heart failure even up to five years after their administration!

The dark side of pain killer research is that the most powerful pain killer, morphia, has recently been shown to act through its placebo effect ONLY! (Sc. Transl. Med 2011; 3:70) After this elaborate study from four universities was published I had a new thought on pain management. Why not we use the body’s capacity to contain pain as a tool in treatment? I thought seriously about making use of exercise as a mode of pain treatment. Conventional thinking in medicine was (is) that any bodily injury or disease needs complete rest for good recovery. This myth was blown off by one of my former teachers, Professor Bernard Lown, who invented the first chair treatment for heart attack patients in 1952. Up until then heart attack patients were put to bed permanently, mostly to meet their maker in heaven sooner than later through deep vein thrombosis!

This did not attract as much curiosity as the then American President Eisenhower’s heart attack three years into his first presidency. His two cardiologists, the fathers of modern American Cardiology-Sam Levine and Paul Dudley White, took courage in both of their able hands and asked him to be mobilised soon to not only run the remaining part of his presidency, but to contest for the second term as he was very popular. Eisenhower ran a hectic campaign and won the second term to complete it successfully. Early mobilisation became a reality since then. People started thinking that mobility soon after a major heart attack is one of the ways to keep people healthy and fit. I still remember the early days of heart valve replacement surgery. I was working for Malcolm Towers, a great cardiologist who was the left hand of one of the fathers of British cardiology, Paul Wood along with Evan Bedford. Our surgeon was Miss Mary Sheppard; a lion of a surgeon, tall and well-built she could out beat any man. This chain smoking thoracic surgeon was a dare devil. When she replaces one, two or, even, three valves patients remained in the ICU for eight to ten days and then only mobilised. A new young, dynamic, short built, Egyptian, Magdi Yacoub joined us as a second consultant surgeon by then from the National Heart Hospital where he was senior registrar to Mr. Donald Ross.Magdi’s valve replacement patients were mobilised on the second day even when they were in the ICU and they did much better.Miss. Sheppard stopped doing valve surgery conceding that Magdi did a better job, a magnanimity rarely seen among greedy doctors today. All these convinced me that work is good and rest is not that good for recovery.

I had a major car accident 40 years ago when I had 18 stitches on my scalp and a big bandage. I came home the same night and did not take even a single pain killer that were prescribed telling my mind that after allpain can be controlled by the mind. That did the trick. The role of the mind in controlling pain is now well understood. Mind being not in the brain helps much more in relieving pain.

I used to have a nagging pain in my left deltoid and triceps (shoulder) as I use them once a day to cut open a tender coconut for its water for breakfast. I had to pin the coconut down with my left hand to chop off its front portion with the right hand. Conventional methods, drugless of course, did not help. One day I gave my left shoulder a lot of work, like carrying large beds upstairs and also carrying my loaded suitcases in the left hand.My triceps and deltoid have been free from pain since then. Aches and pains are a sign of life in old age and doctors and patients together drug them so much that some elderly people are on two-three PAIN KILLERS on an average!I advise them to exercise to the best of their ability to get rid of the pain instead of resting and eating the killer pain medicines. Results have been very encouraging.

I travel a bit and each time after a long a hectic travel by plane, car etc. I get pains almost everywhere. When I get back I go for a long walk despite the fact I would have been fagged out completely.The real joy and josh that one gets after this mild exercise is something to be really enjoyed rather than learnt from others.Now I have made walking exercise a must after a hard day’s work and exhaustionto feel fit again. The exhilaration after bad day’s exhaustion is something one must enjoy to get convinced.

The other menace of pain is the misuse and abuse of pain killers. A researcher, Krishna Rao, told me that in a small village, Gogi (Gogi Thanda) village, Post Kamalapur in Gulbarga District of North Karnataka where he had done a survey for Fluorosis he found 300 tablets of Declofanac were sold daily in a small beeda-beedi shop in that village in addition to many prescription pain killers doctors there give. His health survey showed many kidney, liver, and heart diseases in that village.If this were the situation in a small remote village, what would be the pain killer load and consequent ADR load on the people and our medical system? 

Doctors were useful to treat pain in the past, present and will be useful to treat them in the future as well. We should innovate treatments for pain and suffering. Drugless treatments will not only be inexpensive; they will be healthy as they do not have the added menace of ADR.

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