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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 36  |  Issue : 3  |  Page : 152-155

Knowledge, awareness, and practices of chronic pain among uttarakhand patients


1 Department of Anesthesiology, Era Medical College, Lucknow, Uttar Pradesh, India
2 Department of Anesthesiology, Government Medical College, Haldwani, India
3 Department of Anesthesiology, AIIMS, Rishikesh, Uttarakhand, India

Date of Submission26-Jul-2022
Date of Acceptance16-Sep-2022
Date of Web Publication21-Nov-2022

Correspondence Address:
Dr. Namrata Gupta
Department of Anesthesiology, Government Medical College, Haldwani, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpn.ijpn_79_22

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  Abstract 


Background: Chronic pain is a silent pandemic with a prevalence varying from 15% to 30% globally. Yet there is widespread ignorance among health professionals as well as society. We conducted this institution-based study among chronic pain patients with the aim to know their awareness and knowledge about chronic pain and pain physicians. The gist of this study can help us in future to bridge the gap and create mindfulness among the masses regarding chronic pain. Materials and Methods: Two hundred and seventy-three people with chronic pain were questioned about their knowledge and awareness of chronic pain through a questionnaire comprising eight questions. Results: Out of 273 participants, 84.62% took treatment for chronic pain. Yet only 2% consulted pain physicians. 62.64% and 73.63% had no idea about chronic pain being a disease in itself and pain physicians, respectively. All the illiterate participants were unaware of the presence of pain specialists and 89.47% of them were ignorant of the sound effects of physical activities in treating chronic pain conditions. Conclusion: The majority of the participants were not aware that chronic pain can be a disease in itself and that there are pain physicians who specialize in treating this condition. However, most of them had an idea about the beneficial effects of performing daily physical activities. Furthermore, the level of education had an impact with illiterates having the least insight about the participants. These lacunae can be improved by educating people, creating more awareness, and further encouraging pain services.

Keywords: Awareness, chronic pain, pain clinics, pain physicians


How to cite this article:
Saini KY, Gupta N, Kumar A. Knowledge, awareness, and practices of chronic pain among uttarakhand patients. Indian J Pain 2022;36:152-5

How to cite this URL:
Saini KY, Gupta N, Kumar A. Knowledge, awareness, and practices of chronic pain among uttarakhand patients. Indian J Pain [serial online] 2022 [cited 2022 Dec 7];36:152-5. Available from: https://www.indianjpain.org/text.asp?2022/36/3/152/361631




  Introduction Top


Pain is a global pandemic which is preventable and treatable in most occasions. It is an aversive state which is highly subjective. Chronic pain (>3 months) has been only recently given a separate entity in the International Classification of Disease (ICD) classification and is still an unknown entity among the general population.[1]

It brings out immense social and financial encumber on the sufferer.[2] The prevalence of chronic pain worldwide has been estimated to be around 30%.[3] In 1940, Dr. Bonica was the first to introduce the concept of pain clinics.[4] However, even to date pain continues to be highly undertreated as well as overlooked condition.[5] So far, numerous studies have been designed to study the lack of awareness and knowledge about chronic pain among health-care professionals.[6] However, to our best knowledge, very few studies were specifically designed to study the awareness of patients suffering from chronic pain. We aimed to study the people with the objective to assess awareness of chronic pain and their outlook toward health. This information can be used in future for further advancement of education among the general population and additional improvement in measures to deliver pain services.


  Materials and Methods Top


The present study was undertaken in our tertiary care institute, after getting approval from the institutional review board and ethical committee. We designed a questionnaire with eight questions (in native language) to study the awareness and knowledge about chronic pain which was validated by subject experts [Figure 1]. Written informed consent was included with questionnaire. We selected the family member accompanying the patients coming for preanesthetic checkups. Nine hundred and seventy participants between the age group of 18 and 65 years were questioned over 6 months. Those who had chronic pain conditions (>3 months duration) as enlisted in [Table 1] were further questioned. Two hundred and seventy-three participants were included in the study.
Figure 1: Study questionnaire

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Table 1: Various chronic pain conditions included in the survey

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Demographic data comprising their age, sex, education level, occupation, and locality were noted. The questions included whether they took any treatment for their pain. Those who took treatment were further questioned whom did they approached for the same. We questioned them if they knew that chronic pain is a disease in itself. They were asked whether they knew that there are pain physicians who specialize in treating pain. Furthermore, they were questioned if they performed and knew the role of exercises in treating various pain conditions. The association between knowledge of chronic pain and education was studied in anticipation that it increases with an increasing level of education. This was determined using Chi-square test.


  Results Top


The study comprised 273 participants who had complaints of chronic pain. [Table 2] shows the distribution of the participants according to their age, gender, and education. Of the participants who complained of chronic pain, 59.34% were females, whereas 40.66% were males. 20.88% of the participants had no formal education.
Table 2: Distribution of participants according to demographic data

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[Table 3] shows the awareness of the participants regarding their pain condition. 84.62% of the participants had taken some form of treatment. Out of the respondents who took treatment only 2% consulted pain physicians. The majority (24.1%) simply consumed over-the-counter medications. The remainder received treatment from orthopedicians (19.78%), neurologists (8.79%), physiotherapists (7.69%), and Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy practitioners (7.69%) among others [Figure 2].
Figure 2: Response to the question “Whom did you consulted for the treatment?”

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Table 3: Distribution of participants according to their “awareness” of pain

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The majority of respondents (62.64% and 73.63%) were unaware of chronic pain being a disease in itself and pain physicians, respectively. However, 56.04% acknowledged the good effects of practicing various physical activities on their chronic pain conditions. And that 54.95% of participants actually performed exercises at least once a day [Table 3].

We compared the knowledge about pain among different levels of education [Table 4]. And found that 68.42%, 63.16%, and 53.33% of illiterate, educated up to 12th standard and graduates did not know that chronic pain in itself is a disease.
Table 4: Distribution of participant's awareness according to their education level

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All the illiterate participants were unaware of the presence of pain specialists. Furthermore, 89.47% of them were ignorant of the sound effects of physical activities in treating chronic pain conditions.

We found significant association (P < 0.001) between the level of education and awareness of pain physicians as well as the effect of daily physical activity on chronic pain.


  Discussion Top


Chronic pain in itself can be a disease or a disabling state and has been recently included in ICD-11.[1],[7] The people, in general, are unaware that even though the primary disease needs to be attended to but the pain generating from it can be more distressing and can even affect the prognosis of the disease itself. Persistent pain negatively impacts the quality of life. It also has serious effects on the mental health of patients. It is well proven in numerous studies that chronic pain is associated with anger, depression, poor self-esteem, anxiety, and even suicidal ideation.[8],[9] Apart from affecting physical and psychological functioning, chronic pain can be a severe hurdle in social development and is economically draining.[8] Chronic pain is thus a burden to society.

Therefore, chronic pain needs to be treated in very comprehensive manner. And here comes the pivotal role of dedicated pain physicians and pain clinics. Pain clinics offer more specialized and focused approach toward pain management.[10] Pain specialists not only provide treatment by addressing pharmacological and psychological aspects but also perform specific interventions. They offer a holistic approach toward pain management.

Nearly, 84% of the study population took treatment for their chronic pain condition, and even though 26.37% of respondents were aware of the existence of pain physicians only 2% consulted pain physicians. Saxena et al. came to a similar conclusion where they found 4.8% referrals to pain specialists.[3] This clearly points out to lack of professional pain specialists, unawareness, and/or unwillingness of health-care professionals toward adequate referrals to practicing physicians.[6],[11] The awareness of pain clinics will automatically increase among the general population once they get referred to pain physicians. Thus by increasing public awareness regarding pain clinics, we can reduce the overall suffering of patients as well as society.

The practice of consumption of over-the-counter medication is associated with increased risk of side effects, drug abuse, and overdose toxicity.[10],[12] Over-the-counter analgesics can suppress their pain for a limited period but the underlying clinical condition is not addressed. Furthermore, the majority of over-the-counter drugs comprise nonsteroid anti-inflammatory drugs which can lead to gastrointestinal ulceration, bleeding, and even nephropathies when consumed in heavy doses and for prolonged periods. 24.1% of people in our study preferred to take over-the-counter medications from a nearby chemist shop. This is definitely an unhealthy practice, especially in chronic pain sufferers as lifetime consumption of analgesic dose is much higher in them. Furthermore, under dosage is not beneficial either as it will not resolve their suffering. Educational campaigns regarding safe analgesic practices are the need of the hour. Recent advances in pain medicine and advent of various interventions, nerve blocks, radiofrequency ablation, and neuromodulation have opened numerous gates to treat chronic pain. However, all are subject to awareness of the masses and referrals by primary physicians.

The benefits of exercise and physical activity in chronic pain conditions have been proven in various studies.[13] Yoga postures, meditation, and exercises are all known to reduce pain by releasing neurotransmitters and thereby uplifting mood and altering pain perception.[14] This was an encouraging finding of our study as almost 50% of the respondents were practicing yoga/exercises and were aware of the benefits.

Illiteracy is widespread in developing countries. The majority of illiterate respondents enrolled in our study were not aware of chronic pain, pain physicians, and the role of exercises in relieving chronic pain. Education thus plays an important role in the overall pain improvement as well as in the betterment of coping skills. Easy to comprehend pictorial depictions and banners should be used by pain physicians to reach out to the masses. Social media awareness and campaigns by medical institutes can create a better understanding of chronic pain in all sections of society.[15] Pamphlets/videos of exercises for various chronic pain conditions can be used to increase awareness among the general population. Organizing discussion forums and seminars will also bridge the gap.


  Conclusion Top


Our study presented an insight that most people who are suffering from chronic pain were not aware that they can be treated more holistically by dedicated pain physicians. The study also threw light on the malpractice of consuming over-the-counter medications by many people suffering from chronic pain. Although it was good to know that many people were practicing daily exercises and were aware of its beneficial effects on chronic pain. The fact that illiteracy is associated with the awareness of pain and related elements, we can further improve the scenario by educating people, creating more awareness, and further encouraging pain services.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, et al. A classification of chronic pain for ICD-11. Pain 2015;156:1003-7.  Back to cited text no. 1
    
2.
Dueñas M, Ojeda B, Salazar A, Mico JA, Failde I. A review of chronic pain impact on patients, their social environment and the health care system. J Pain Res 2016;9:457-67.  Back to cited text no. 2
    
3.
Saxena AK, Jain PN, Bhatnagar S. The prevalence of chronic pain among adults in India. Indian J Palliat Care 2018;24:472-7.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Parris WC, Johnson BW Jr. The history of pain medicine. In: Benzon TH, editor. Practical Management of Pain. 5th ed., Vol. 1. Philadelphia: Elsevier Publications; 2014. p. 3-12.  Back to cited text no. 4
    
5.
Ung A, Salamonson Y, Hu W, Gallego G. Assessing knowledge, perceptions and attitudes to pain management among medical and nursing students: A review of the literature. Br J Pain 2016;10:8-21.  Back to cited text no. 5
    
6.
Deshpande AN, Sahni AV. Awareness, attitude, and knowledge about “pain clinics” among general practitioners in Nagpur City. Indian J Pain 2017;31:152-6.  Back to cited text no. 6
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7.
Siddall P. Is chronic pain a disease? Pain Med 2013;14:1289-90.  Back to cited text no. 7
    
8.
Korula M. Psychosocial aspects of pain management. Indian J Anaesth 2008;52:777.  Back to cited text no. 8
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9.
Vadivelu N, Kai AM, Kodumudi G, Babayan K, Fontes M, Burg MM. Pain and psychology – A reciprocal relationship. Ochsner J 2017;17:173-80.  Back to cited text no. 9
    
10.
Singla V, Batra YK. Recognition of pain as a specialty in India. Indian J Pain 2016;30:80-2.  Back to cited text no. 10
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Billa G, Gabhane M, Biswas S. Practice of pain management by Indian healthcare practitioners: Results of a paper based questionnaire survey. Pain Res Treat 2015;2015:891092.  Back to cited text no. 11
    
12.
Abbott FV, Fraser MI. Use and abuse of over-the-counter analgesic agents. J Psychiatry Neurosci 1998;23:13-34.  Back to cited text no. 12
    
13.
Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: An overview of Cochrane reviews. Cochrane Database Syst Rev 2017;4.  Back to cited text no. 13
    
14.
Yang S, Chang MC. Chronic pain: Structural and functional changes in brain structures and associated negative affective states. Int J Mol Sci 2019;20:3130.  Back to cited text no. 14
    
15.
Shaygan M, Jaberi A, Firozian R, Yazdani Z, Zarifsanaiey N. Effect of a multimedia training programme for pain management on pain intensity and depression in patients with non-specific chronic back pain. Invest Educ Enferm 2022;40:e13.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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