Dr Bernard Lee, Senior Consultant Pain Specialist of Singapore Paincare Center explains chronic pain and how minimally-invasive treatments can help reduce the dependency on painkillers.

For Life (FL): What is chronic pain and how prevalent is it in Singapore?

Dr Bernard Lee (Dr Lee): Chronic pain by definition is pain that persists beyond the normal healing time of tissues  and differs from acute pain when it persists for more than three months.

Pain can be called a disease in itself because it is accompanied by biological changes that involve cellular and biochemical processes in the body. Chronic pain can affect the individual’s ability to perform daily functions, including work, thus creating an economic burden.

Available data from 2009 reported that the prevalence of chronic pain among Singaporeans is at 8.7% , with a higher prevalence (14.2%) among individuals from lower socioeconomic communities .

FL: What causes or contributes to chronic pain?

Dr Lee: The cause of chronic pain depends on the location of the pain, lifestyle factors such as sports, which may predispose one to strain and injury and/or exacerbate old injury, type of work, as well as past surgery or injury. The overstraining of muscles and bones can also lead to physical injury at a specific site or the surrounding tissue.

In some patients, pain sensitivity occurs after an injury, causing the nerves to be sensitised with pain signals. This can lead to tension or spasm of soft tissues surrounding or near the location of the injury. In such cases, the patient can remain in pain even after the injury is no longer present, leading to prolonged or chronic pain.

Many factors, including genetics, medical conditions, and a person’s state of mind, can affect how a person feels pain and contribute towards the pain feeling better or worse.

Dr Bernard Lee, Senior Consultant Pain Specialist at the Singapore Paincare Center

Dr Bernard Lee, Senior Consultant Pain Specialist at the Singapore Paincare Center

FL: How can chronic pain be managed?

Dr Lee: Pain is a challenging problem for both the patient and physician. It is multidimensional and complex, and involves emotional, cognitive, affective, behavioural, and sensory components which is why it needs to be tackled using a multidimensional approach.

Locating, understanding, and addressing the root cause of the pain is important to effectively treat the pain, and find long-term solutions to minimise and eliminate the pain that can improve the patient’s quality of life.

Generally, the sooner the cause of pain is identified and treated, the less complex and less expensive treatments tend to be. On the contrary, the longer the pain is present, the harder it is to treat from the pathological perspective, as the way the nerves are wired and sensitised can lead to pain amplification.

The view of pain specialists is that pain can be removed, and pain generators can be eliminated without always subjecting the patient to an invasive surgical procedure. At Singapore Paincare, to effectively diagnose and treat pain, we prescribe and administer minimally-invasive procedures, supplemented with exercise, physical therapy, and medications.

FL: How effective are painkillers for chronic pain?
Dr Lee:
Painkillers work by momentarily inhibiting the early warning system of the body from continuously transmitting pain signals to the brain about the injured or damaged cells or stopping the damaged cells from releasing these chemical signals altogether. They do not address the root cause of the pain.

Non-steroidal anti-inflammatory drugs (NSAIDs) can be used to provide relief from injury-related acute pain such as a sprain, as well as selected chronic pain that is accompanied by chronic inflammatory processes such as in rheumatoid arthritis or osteoarthritis.

The long-term use of painkillers such as NSAIDs or opioids can lead to their misuse and cause unwanted side effects such as heartburn, ulcers, and skin rashes in the case of NSAIDs, as well as urinary retention, cognitive impairment and dependency from the use of opioids. Steroids consumed for longer than three months may cause weight gain, osteoporosis, and muscle atrophy, while adjunctive analgesics such as anti-convulsants or anti-depressants can cause side effects like dry mouth, blurred vision, and nausea.

FL: What are some of the common misconceptions about chronic pain?

Dr Lee: One common misconception is that pain or chronic pain is part and parcel of ageing. Although our bones and tissues naturally degrade with age, pain is not an integral part of ageing. Leading a healthy and active lifestyle, including maintaining an ideal weight according to your height and age, keeping an active lifestyle, and having healthy sleep habits can help minimise pains that occur with natural ageing.

Another misconception is that painkillers can cure pain. They are merely band-aid solutions that suppress our body’s ability to feel or generate pain signals.

It is best to seek advice from pain specialists for persistent and troubling pain conditions. Pain specialists recognise contributing factors and address them with safe pain treatments and rehabilitation. Minimally- invasive treatments such as radio frequency (RF) have been proven effective in treating chronic pain conditions.

Other emerging therapies such as nucleoplasty, neuroplasty, or epidurolysis have been shown effective in treating chronic pain. Cognitive behavioural therapy (CBT) manages pain using breathing exercises, stretching, and viewing pain positively which helps reduce patients’ reliance on medications and enabling them to return to their usual activities and work.