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What is chronic pain?

Pain is your body’s normal reaction to an injury, infection, or illness in the body. With proper treatment when the condition starts healing, the pain usually disappears. But for some, the pain may continue for 3 to 6 months. This debilitating long term pain is called chronic pain and may end up in a condition called syndrome or CPS. According to statistics, 1 out of 5 people suffer from chronic pain. Battling chronic pain is physically and mentally exhausting and takes a psychological toll on the sufferer causing symptoms of anxiety, depression, insomnia, and suicidal thoughts in extreme cases.

Many people cannot function normally and their lifestyle changes from normal to one with dependency. Everyday activities can become difficult and many times treatments are hard to find. A combination of medication, physiotherapy, counseling, and relaxation techniques can help to manage and relieve pain to an extent. Alternative therapies like acupuncture, dry needling, muscle/ trigger release may also give additional relief to some.

While we are aware of chronic pain conditions like migraine, back pain, neck pain, arthritis, there are many pain conditions that exist but are not very well known. Also because many of these pain conditions are a feeling and cannot be physically seen, some sufferers may look normal from the outside as their condition is invisible. Being aware of these conditions helps us be sensitive and empathetic with the people suffering from them and helps us understand them better.

Fibromyalgia

A neuromusculoskeletal pain condition, fibromyalgia is a problem with central pain processing in the brain, where there may be an increased sensitivity or perception of pain. fibromyalgia is difficult to manage as each patient experiences a different set of symptoms. As there are no tests for the condition, it leads to delayed or missed diagnosis. It is usually confirmed by eliminating other pain conditions and autoimmune disorders. Symptoms include widespread body pain, irregular sleep patterns, tingling and numbness in the hands and feet, restless leg syndrome (RLS), heightened sensitivity to touch, cold or heat, “fibro-fog” or poor memory, tenderness in trigger points, fatigue, and stiff joints and muscles.

Endometriosis

Endometriosis occurs when the tissue similar to the lining of the uterus grows in other places in the body outside of the womb. Unbearable abdominal pain, heavy periods, and infertility are some of the symptoms. Treatment options include pain relievers, hormones, and surgery. In endometriosis, the pain may be so intense that they are called killer cramps. It worsens with age. It causes pelvic and belly pain, back and leg pain, migraines, bowel issues, and painful sex.

Lupus

A long-term autoimmune disease where the body’s immune system becomes hyperactive and attacks normal, healthy tissue, Lupus is called “disease of 1,000 faces”. Joint and muscle pain or myalgia is often the first sign of lupus. Other symptoms include inflammation, swelling, and damage to the joints, skin, kidneys, blood, heart, and lungs.

Multiple Sclerosis (MS)

Multiple sclerosis is a disease where the immune system eats away at the protective covering of nerves resulting in nerve damage. Multiple sclerosis may cause vision loss, pain, fatigue, and impaired coordination. The symptoms may not be felt by Some people while others can have severe, chronic symptoms that never go away. The pain caused by MS is musculoskeletal, paroxysmal, or chronic neurogenic. Pain syndromes include headache, continuous burning pain in the extremities, back pain, painful tonic spasms (cramping, pulling pain).

Ankolysing Spondilitis

Ankylosing spondylitis is an inflammatory disease where some of the small bones in your spine (vertebrae) to fuse, making the spine less flexible. This results in a hunched back for some and makes the back, rib cage, and neck stiff and painful along with painful chest, hips, shoulders, and feet. It is at times accompanied by inflammation in the bowel and eyes. There is no cure for ankylosing spondylitis,

Complex Regional Pain Syndrome (CRPS)

CRPS is a rare chronic neurological condition and is a.k.a. suicide disease (due to the level of pain). It is a form of chronic pain that usually affects an arm or a leg which develops after an injury, a surgery, a stroke, or a heart attack and can spread from its source to elsewhere in your body, such as the opposite limb. Pain, swelling, redness, noticeable changes in temperature, and hypersensitivity are the initial symptoms.

Irritable Bowel Syndrome (IBS)

Result of an overly sensitive colon or immune system which causes extreme belly pains or cramps in the lower half of the belly, which get worse after meals and feel better after a bowel movement. This can be because of slowed or spastic movements of the colon, causing painful cramping, abnormal serotonin levels in the colon, affecting motility and bowel movements, a mild celiac disease that damages the intestines, can cause IBS symptoms. Other symptoms include bloating and gas, constipation, or diarrhea.

Osteoarthritis

When the cartilage between the ends of bones in joints gradually deteriorates and wears down completely, it results in osteoarthritis. The bone can rub on bone and hence it is also known as a “wear and tear” disease. osteoarthritis affects the entire joint and causes changes in the bone. It deteriorates the connective tissues that hold the joint together and attach muscle to bone. Since it causes inflammation of the joint lining, Osteoarthritis is a degenerative disease that worsens over time, resulting in chronic pain.

Rheumatoid Arthritis

Rheumatoid arthritis is a chronic inflammatory autoimmune disorder that can affect not just your joints but can damage other body systems like the skin, eyes, lungs, heart, and blood vessels. It occurs when your immune system attacks your own body’s tissues. Rheumatoid arthritis causes a painful swelling on the lining of the joints and eventually results in bone erosion and joint deformity. The resulting inflammation can damage other parts of the body as well.

Tell us your experience if you are suffering from a debilitating chronic pain condition.

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The coronavirus pandemic has brought the world to an abrupt halt. It has muddled people with unresolved questions that have left them with a vague picture of COVID 19 in terms of its many causes and effects. The one section that seems to be especially ambiguous in these trying times is the ‘pregnant women’. Pregnancy is a phase where a woman can feel multiple emotions. With Coronavirus coming into the picture, a lot of to-be-mothers are left daunted with uncertainties and fairly so! But here is a thing-Optimism is the opium for all those hullabaloos popping up in the mind. In these times of open-ended possibilities, we talked to a Dr. Manisha Singh (MBBS, DGO, DNB – Obstetrics & Gynecology) at Fortis Hospital, to converge and make sense of all that is disjunct with respect to ‘Coronavirus and Pregnancy’.

Precautions! What to do?

Coronavirus is a subject that is still being widely studied by the researchers. This in itself makes it obvious that it is in the best interest of all people, especially pregnant women to stay indoors and maintain isolation because there may not be an immediate and sure shot solution for COVID 19 infected pregnant women. “When pregnant women get even normal fever, it is always recommended to get a detailed consultation.”, says Dr. Manisha Singh, a senior gynecologist at Fortis hospital. Coronavirus has been spreading all over the world like wildfire. In these times, it is imperative to follow the guidelines provided by the World Health Organisations because everyone irrespective of their existing physical conditions is indiscriminately susceptible to the Coronavirus. “So far we have not dealt with a pregnant woman with COVID 19 but with all that is going on, if a woman gets a high temperature, she must without much ado consult a doctor.” However, WHO on their FAQ section does not mention pregnant women in the high-risk category. In addition, Dr. Singh says that pregnant women should keep in mind to be very honest about their partner’s travel history to the doctors besides keeping general precautions.

Can the Coronavirus be transmitted from mother to baby?

With scant availability of data, the recommendations coming in from various reports across the world are contradictory. Dr. Manisha says that while studies are still evolving, so far it does not precisely indicate that newborns can contract the virus from their mothers. However, she continues, it is a good idea to isolate the baby from the mother as soon as they are born. Her advice aligns with a number of worldwide reports including China and the US. According to the WHO, so far no sample of the virus has been found in amniotic fluid or breast milk. It is still a matter of contention if the COVID 19 can be passed on to the babies from the mothers.

Can pregnant women with Coronavirus breastfeed?

The World Health Organisation says, ‘YES’. Since the virus sample has so far not been found in breast milk, women depending on their wish may/may not opt to breastfeed. Dr. Manisha reiterates that coronavirus is still an open-ended subject and we can never be sure what we learn about it tomorrow so it is important for mothers to be mindful at all times. WHO gives a nod to breastfeeding on conditions such as utmost care for respiratory hygiene, washing hands before and after touching the baby and regularly cleaning the surface that may have come in contact with the infected mother.

In addition, if the mothers feel too weak to be able to breastfeed, they can resort to ‘expressing milk’, ‘Relactation’ and ‘Donor milk’ as alternate options.

Delivery of the baby- C-Section or Normal

In the case of confirmed or suspected COVID-19 cases, WHO advises that normal delivery is the best way to go about it. However, the Caesarean section should be considered only if medically necessary or justified. Moreover, the report also states that the “mode of birth should be individualized and based on women’s preferences alongside obstetric indication.”

Has the COVID 19 lockdown affected pregnant women’s visits and timely consultations?

Dr. Manisha says, “We have definitely limited the patient’s visits to the hospital but we are available for them 24*7 over the call. We keep a tab on their health by constantly staying in touch. However, if there ever arises a need to see a doctor even for a mild fever, we are always around and hospitals are always open.” It is advisable to take adequate precautions while visiting a hospital such as masks, sanitizers, etc.

The psychological effect of coronavirus lockdown on pregnant women

The coronavirus lockdown phase is quite a testing time for everyone in general. Therefore it is quite understandable that pregnancy, which is already an emotionally charged phase in a woman’s life may in a lot of ways affect their mental space. Dr. Manisha suggests that during these times of emotional turmoil, women should always keep in touch with their closest confidante and share everything without any fear of judgment. It is important to talk to someone and feel free to be able to speak up. Most importantly, talk to the doctors, they are always listening and they can always be trusted. A wise person once said, “No question is a silly question, especially during pregnancy.” In addition, physical exercises like walking and yoga coupled with a few minutes of meditation every day can release all that oxytocin and make one feel happier and refreshed.

In conclusion, pregnancy is a beautiful time in the lives of all women and no matter what the circumstances are, it can always be made special with people who matter. Love flavored with some excitement and covered by precautions can surely help one get through this phase of pregnancy with ease. On an optimistic note, while you square up to official WHO guidelines, don’t forget to stop and embrace each moment that is going to bring you a lifetime of joy, happiness and uncontained aspirations for the future.