When my aunt's breast cancer spread to her bones, the doctors simply sent her home after the mandatory chemotherapy. They said there was no treatment for her condition. For them, it was a gone case. For her, the painful saga had only begun. But with advances in medicine it is no longer necessary to suffer the agony. Though there are not many pain relief centres in the city with the exception of the Morbai Naraindas Budhrani Cancer Research Institute, in Koregaon Park and the Meenakshi Pain Relief Centre at Chinchwad and the Cipla Foundation at Warje, at least these are places where one can get relief.

Take for example Rohit (name changed). An 18-year-old college student who one fine day discovered he had bone metastasis. The pain had literally incapacitated him. Till he sought the help of Dr Yeshwant Nankar, he was bedridden.

With the help of nerve blocks, Rohit not only was able to attend college, but also appear for his HSC exam and pass. Unfortunately, he died a month after his results. But, it is heartening for his family to know that he did not die an invalid and the death was without pain.

The relief centres work to treat just pain. But, pain involves an entire gamut of specialities. At Morbai Institute, the pain is treated not just by the onco surgeon who primarily treats the patient. There is a radiologist, a nuclear medicine consultant and an anaesthetist who work in tandem. The reasons are many. ``First of all," says Dr Nankar, a consultant in pain management, ``we must understand that pain is of two types, acute and chronic. When there is pain, it means there is something wrong with the body. All doctors treat acute pains that are short-lived like labour pains, pains due to appendicitis, fractures and so on.

``Generally it is the chronic pains that require specialised treatment. Pains from cancer, sciatica, spondylitis, migraines, trigeminal neuralgia and such like conditions.'' Treatment of pain is basically of two types, invasive and non-invasive. "When a patient presents his case to us, we have to decide what line of treatment we should use," says Dr Chaitanyanand Koppikar, onco-surgeon at Morbai. ``First would be to find the organic cause and then decide what's best for the person.''

Non-invasive techniques would involve administration of simple analgesics, radiation, oral morphine to the more sophisticated nuclear medicines that act directly on the affected sites. "Though a person maybe diagnosed as terminal, there are some cancers that can go on for two, three or even five years. But that does not mean the patient should suffer till he dies, " says Dr Dhar.

Says Dr Sameer Sonar, nuclear medicine consultant at Morbai, ``Last year we had a 64-year-old man who came to the hospital on a stretcher because of the prostrate gland cancer that had spread to the bone. With just one oral dose of P32, a radioactive isotope that goes directly to the affected site, he was mobile in a matter of three weeks. The effects of this medicine lasts up to six months. This person was so relieved by P32 that he would even walk to the market and feel no pain till he eventually died a year and a half later.''

The other drug which works well is Strontium 89, but the cost is prohibitive. At Rs 40,000 for a single dose, it is beyond the reach of the common man. Morphine is one of the most common drugs used to relieve pain. Though it is associated with addictions, this is a myth according to Dr Anuradha Sowani, palliative care specialist at Cipla, ``Morphine can never be addictive when it is used in the correct dose and to treat pain, because the pain sites soak up all the morphine and nothing is left to cause addiction.''

In the last two years of its existence, Cipla has treated over 600 terminal cancer patients, most of them with morphine, successfully.

``Our aim is to give these patients a good quality of life. Just because death is imminent, does not mean that it has to be painful, humiliating or incapacitating.''

For long, the common man has associated radiation therapy with the treatment of cancer. But Dr K R Hegde of Morbai reveals," Cancers that affect the bone are very painful. In such patients, they actually experience microscopic fractures. With radiation we relieve the pain."

Side effects include nausea and vomitting and bone marrow depression, but these are easily treatable and a small price to pay, considering the fact that patients can become mobile and free of pain.''

Though cancer patients do make up for most of the people treated at pain relief centres, these techniques can be applied to other problems as well. Says Dr Nankar, "At my clinic at Chinchwad, 40 per cent patients have cancer and the rest suffer from spondylitis, vascular pain, post-herpetic neuralgia, migraines and labour pains.''

The problems are treated differently. Besides radiation, morphine and nuclear medications, a centre may make use of invasive techniques like nerve blocks and anaesthesia. Says Nankar ``This technique involves the use of neurolytic drugs that block the nerves in the affected area. In vascular disease, for example, we use certain drugs that block the nerves in the limbs. This helps in relieving pain. Statistics show that for every 15 patients, this treatment works well for 13. ``For painless deliveries and surgeries involving the abdomen, the epidural anaesthesia works well.'' Focussing on pain involves a lot more than just downing an aspirin. But what these doctors aim for while relieving the pain is that the sufferer is able to live life on his own terms and not become a pawn to waste away in the disease.