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New Norms to Ease Back Pain

An association of doctors has pencilled India’s first formal guidelines for pain diagnosis and treatment amid concern that Indian patients are either under-treated or over-treated for acute and chronic pain.

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The Indian Society for the Study of Pain (ISSP) will release its pain management protocols for low back pain next week, to be followed later by protocols for other conditions, from headaches and neck and joint pain to pain related to cancer or trauma.

Limited surveys suggest that one in five patients in India with chronic pain do not find relief despite being under medical treatment, specialists in the ISSP said.

“We believe there is under-treatment, over-treatment, direct over-the-counter purchase of medicines by patients, and erratic treatment,” said Parmanand Jain, ISSP president and professor of anaesthesia at the Tata Memorial Hospital, Mumbai. “We’re hoping these pain management algorithms will improve this situation.”

The protocols, developed primarily for the medical community, will provide a well- defined sequence of diagnostic investigations and the line of treatment for specific conditions associated with acute or chronic pain.

Pain specialists are hoping the protocols will also help keep patients away from diagnostic procedures such as magnetic resonance imaging (MRI) scans, and even surgery, when they are not required.

Patients with low back pain are usually given mild painkillers and advised rest. If the pain doesn’t go away or gets worse and MRI scans show degenerative changes in the vertebral discs, it doesn’t mean surgery is required.

“Three out of four persons without any back pain may also show changes in MRI scans. So, the changes (in those with pain) may not be causing the pain at all,” said K. Jawahar Choudhury, senior pain management consultant at Apollo Hospital, Delhi.

As for over-treatment, many pain specialists believe the long-term abuse of painkillers is contributing significantly to the country’s burden of kidney disease.

But ISSP members concede that doctors in India are sometimes compelled to prescribe inappropriate treatment to cancer patients because morphine, a key pain-killer, isn’t easily available. The drug is distributed only through licensed clinics.

“We’ve been telling the narcotics control bureau to expand the distribution of morphine,” said Geeta Joshi, anaesthesiology professor at the Regional Cancer Centre, Ahmedabad. India’s per head consumption of morphine is 0.6mg, whereas the world and US figures are 5.93mg and 76mg, respectively.

: The Telegraph ( Kolkata, India)

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Website on Pancreatic Cancer

It’s one of the most fatal cancers, yet little is known about it. What’s worse, more and more people are being diagnosed with pancreatic cancer in recent years. The numbers may be small — 1-2 new cases per 100,000 people every year — but it’s enough to send alarm bells ringing. As it’s also a silent killer, few are aware of it till it’s late.

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However, the recent launch of a website on the disease could address this problem. Medical experts say there’s a definite rise in numbers, but unlike the west, there are no surveys to cite exact figures.

“If we look at individual hospitals, then there is an increase in the number of patients. In the last 15-20 years, these have grown five to 10-fold in my hospital itself,” says Dr Sudeep Gupta, assistant professor and oncologist, Tata Memorial Hospital, Mumbai. National Cancer Registries are the other source of information. There are various reasons for the rise in pancreatic cancer cases. Some feel lifestyle changes and diet have resulted in an increase in all types of diseases. In that respect, pancreatic cancer is no exception. Others feel that more cases are coming to light as more people are reporting the disease.

Pancreatic cancer is a silent killer seldom detected in the first stage. The pancreas lies behind the lower part of the stomach. The symptoms — stomach pain, loss of appetite, jaundice — may not even manifest themselves till the disease has advanced. But once it happens, it’s almost fatal. In the US, pancreatic cancer is the fourth leading cause of cancer-related deaths. Unlike certain cancers such as lung or breast, researchers have still not been able to pinpoint the exact reason for pancreatic cancer. “We can only guess that diet, smoking, alcohol consumption and obesity could be the reasons behind the disease,” says Dr Shyam Aggarwal, senior consultant, oncology, Sir Ganga Ram Hospital, Delhi.

Surgery is usually the best treatment. “But in most cases, it’s ruled out as the disease is already in an advanced stage,” says Dr Malay Nandy, senior consultant, oncology medical, Fortis Healthcare, Delhi. Chemotherapy and radiotherapy are the other options. However, 80% cases are likely to relapse post surgery and after that, survival is a matter of six months only. Experts say only 10% survive after five years of treatment.

The surgery is complicated and involves the Whipple’s procedure, wherein the pancreas are removed. Unfortunately, India has very few oncologists with the expertise to perform this complicated surgery. As so little is known about this disease, the recent launch of a website, , touted as the first comprehensive one in Asia on pancreatic and peri ampullary cancers, is welcome. The interactive website will give patients access to the latest research on the disease and to specialists who will answer queries. “It will help patients get information from the best in the field. What makes it more relevant is that it will be totally in an Indian context,” informs Aggarwal.

Sources: The Times Of India

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