New Ways to Relieve Pain

Pam H. had always enjoyed hiking, kayaking and skiing. But beginning in her late 50s, she noticed her left knee was starting to bother her, and soon the osteoarthritis made it too uncomfortable to enjoy the activities she loved. By the time she reached her 70s, it was painful just to walk or drive. She decided to have knee replacement surgery, which had helped many of her friends. Unfortunately, the new knee wound up hurting even more, because it was discovered that Pam was allergic to at least one of the metals it contained. Doctors told her replacing the knee again wasn’t an option and she would just have to live with the pain.

A study published in the Indian Journal of Palliative Care­ estimates that about 19 per cent of the Indian population—around 200 million people—­experience chronic pain. Of these, more than over 30 per cent said the pain interfered with their day-to-day living. Aching backs and knees, neck and shoulder pain, headaches, sore feet and arthritic hands are a daily part of life for many.

“Low back pain is one of the most common conditions we treat,” says Benjamin A. Howie, MD, a pain management specialist and assistant professor of anesthesiology practicing at Columbia University Irving Medical Center in New York City. He estimates that once people reach their 60s, nearly half will suffer from some degree of back pain.

By the time patients consult a pain specialist, they’ve usually tried to manage the pain on their own with rest, heat, ice and over-the-counter medications such as ibuprofen or acetaminophen. And they’ve probably been to see their primary care provider. But many are still hurting.

Pain management is a relatively recent medical specialty. For years, the most powerful and effective drugs in the specialty’s arsenal were opioid medications such as morphine, oxycodone, hydrocodone and fentanyl. But we know these drugs have fuelled an epidemic of addiction that the World Health Organization estimates killed more than 4,80,000 people globally in 2019. Most doctors are now reluctant to prescribe them (though these medications still have an important role in easing pain from cancer and surgery, as well as pain that is not helped by other methods). And most patients are reluctant to take them. Does that mean we’re destined to keep hurting?

Not at all. The options for pain relief are growing at an impressively rapid rate. “The field is exploding,” says Dr. Howie. “People are living longer and don’t want to accept chronic pain or immobility. And we can drastically improve their quality of life.”

Here are a few of the newer drugs and procedures that pain specialists can offer.

Injections

Targeted injections with steroid drugs or hyaluronic acid gel can help relieve pain in knees and other joints, while epidural injections (into the space around the spinal cord) can help mini­mize sciatic pain in the lower back and down the leg.

Alternatives to OpioidsNew drugs aim to alleviate severe pain without the risk of addiction, and without unpleasant opioid side effects like nausea, vomiting and constipation. One example: The FDA recently ap­­proved suzetrigine, a new drug that works by blocking signals in peripheral nerves outside the brain and spinal cord, stopping pain signals from reaching the central nervous system so they are never perceived.

Nerve Blocks and Ablations

Injecting nerves with anaesthetics to block pain signals can provide temporary relief. For longer-lasting results, doctors can damage or destroy the ­portions of the nerves that are res­ponsible for localized pain. The most common of these procedures is radio­frequency ablation (RFA). After determining which nerve areas are responsible for the pain, the doctor inserts a long needle into each, delivering heat to deaden it.

This is the option that was recommended to Pam H. Her pain specialist used RFA to destroy the problematic areas of three of the four main nerves that allow the knee to feel and move properly. A few weeks after the ablation, Pam was relieved that her knee felt numb. When the effect wears off, generally in six months to two years (nerves can regenerate), the procedure can be repeated.

And this is just a sampling. Other techniques for easing pain include: spinal cord stimulators to help with chronic leg or back pain related to ­spinal disease vertebral spacers that can help with back and related pinched-nerve pain bone cement to help with pain from fractures peripheral nerve stimulator implants to help with localized pain intrathecal drug pumps, which are implanted to deliver small doses of drugs around the spine.Some of these options are so specialized that even primary care providers may not know about them.

“There are still a lot of providers who send patients to us just for opioids, not aware of all these things we can do,” says Dr. Howie. He recalls one case that stands out. “There was a woman in her 30s who came to see me for horrible neck pain and chronic headaches,” he recalls. She had seen at least 15 medical providers over 10 years, and they tried every medication under the sun to help. I did diagnostic neck point injections [a procedure to identify which nerves are responsible for pain by injecting them with local anaesthetic]. Within 15 minutes of getting the injections, her headaches were gone. I remember she was so happy and relieved that she started crying.”

—with inputs by Ishani Nandi