Incidence of Chronic Pain in India
I lived in Australia for 4 years before I decided to return to India 10 years ago. I have noticed a difference in how pain is perceived in both countries which led me to this question. Can India afford pain?
The neuroimmune-based Explain Pain approach is a huge game changer in the treatment and management of pain. In May this year the Explain Pain revolution hit India with the first Explain Pain and Graded Motor Imagery course held in Mumbai. Participants were physiotherapists, with professional experience in diverse socio-economic areas of the city.
We exchanged notes and realized that we all see a lot of chronic pain patients where the pain lasts more than 3 months. We do not see too many cases of frank CRPS though. We have come across a number of patients misdiagnosed as fibromyalgia, because their doctors were unable to detect the cause of their symptoms during the investigations. Some did not receive the right professional help and responded better on being accurately assessed and given appropriate treatment. We see cases of Complex Regional Pain Syndrome post Colles’ fracture. However, we know that the incidence has gone down due to better management and early intervention by qualified professionals. We observed that as physiotherapists, we don’t see too many “chronic pain sufferer” cases and agreed on a few probable causes.
- Economic development has led to increased awareness around physiotherapy in our country but it is restricted to the metropolitan cities. People, including health professionals in small towns and villages are neither aware of our profession nor of modern pain treatment strategies. More importantly they do not have the time or money to spend on therapy. Getting a prescription and taking a few tablets is a lot cheaper than spending on regular therapy. Besides, time required for therapy is time lost at work and feeding the family is more important than pain. Unless the pain is incapacitating and affecting daily activities including work, people are not motivated to do much about it.
- A large number of people living in rural areas tend to rely on miracle curers for treatment based on certain traditional, spiritual and religious beliefs. They are known to get their horoscope and vastu (science of architecture as per the traditional Hindu system) checked for faults and look for solutions to change their destiny which also includes pain.
- The sheer lack of awareness that physiotherapists can help also influences the treatment of pain to a great extent. Not only patients but even treating physicians, orthopaedics and pain specialists are unaware that physiotherapists can do much for the “so called fibromyalgia” cases. Patients like these end up taking drugs endlessly or being referred to a psychiatrist.
- Physiotherapy in India is essentially an out-of-pocket expense because insurance covers it only for the first 2 months post surgery. Thus those spending on therapy are ones who want to get better faster. However, those who can afford therapy and have their work and daily needs taken care of, are also the ones that are more prone to chronic pain because they can afford it.The medical fraternity in India is still not aware of how a physiotherapist can help chronic pain. I am often told by doctors not to bother about certain patients because they have fibromyalgia. An orthopaedic surgeon once told me that CPRS is a self-limiting disease which is resolved in 2 years. He was not aware of any therapy or treatment that could help and thus recommended leaving patients on their own.
- Many consider the occurrence of pain to be a natural process as you age. A physiotherapist working as a community medicine specialist in a Mumbai slum shared her experience about elderly women having incontinence. Besides the higher incidence of incontinence, as expected, the intriguing bit was the women’s belief that incontinence is as normal as any other ageing change in the body. This could be a notion they may have inherited from older generations or might simply be a coping mechanism to shield themselves from difficult circumstances. The same logic applies for pain in people from different cultures, backgrounds and belief systems.
- India’s joint family system provides social support which helps people cope with pain. At times this has been unfavourable when the family dismisses a person’s pain. However, this social system is rapidly transforming with nuclear families becoming the norm.
Let’s Talk Pain
I was keen to teach the NOI courses in India because the methods and techniques developed within them make patients an important part of their own recovery which is cheap, effective and empowering in many ways. After wrapping up NOI India’s inaugural course I was curious to find out the participants’ views on the subject of pain in India, how best we could deal with it and which cases of chronic pain were more widely seen in India.
We agreed that knee pain ranks highest in terms of chronic pain followed by lower back and neck pain. Hand pain is not too common but foot-related problems are on the rise due to an increase in the number of runners these days. With the knee cases, patients often complain “I have a gap” which is actually a good thing. This metaphor is very different to the “bone on bone” metaphor I came across in Australia. I am happy that this discussion has now begun because there is a lot more to it.
It would help a great deal if fellow Indians and Asians contributed to this conversation with their observations. The goal is to build a collection of metaphors and pain stories used in developing countries. We need to find the reason behind the difference in our pain population when compared to that of developed countries and if this difference will continue to exist in the future.
Will we catch up with the pain epidemic as we are developing faster? Is it only a matter of time that we will be in a position to afford pain?
– Prakkash Sharoff, Instructor for NOI India