Dr Deepak Ravindran on his book ‘The Pain-Free Mindset’ and longcovid treatment

“The pain we feel is real. It is not in the head,” says Dr Dr Deepak Ravindran who is set to launch his book The Pain-Free Mindset (published by Vermilion) shortly. Presently the Lead for Pain Medicine in Royal Berkshire Hospital, Reading and Berkshire Healthcare Foundation Trust in Reading, UK, Deepak helped develop and lead the Longcovid (Post-COVID) Service for the county of Berkshire.

After he found himself giving 20-30 speeches and talks to general practitioners and allied health care professionals on pain management, Deepak realised the need to pen it all down.

“There is a huge knowledge gap amongst healthcare professionals and the public when it comes to understanding and treating pain because we are going by a 400-year-old medical model which is flawed and outdated, according to the latest advances in neuroscience. My book addresses that failed model and presents a more hopeful way forward,” says this alumnus of Hyderabad Public School and Little Flower Junior College, Hyderabad.

Over an email interview Deepak unravels the many variants of pain, its management and what the book has to offer.

Can you elaborate on the title of the book?

The Mindset is both an acronym and an indication of a need to reframe our way of thinking rather than just believing that it is “all in the mind”. Within social sciences, business, health and well being, we are aware of a concept of growth mindset where we can use the powerful capacity of the brain to rewire itself (neuroplasticity).

The pain that we feel is very real. It is not in the head. However, the pain we often refer to is a complex output rather than just coming from a part of the body.

I want to introduce to the general public this word called nociception, which is the sensation produced by released chemicals when we get injured/hurt physically.

If we learn that there is a difference between nociception and pain then we automatically become aware of so many equally powerful methods to overcome pain with fewer side effects.

One of the biggest mindset shifts that the general public and healthcare fields have to make (and are starting to make) is that pain is an evolutionary mechanism of protection and not a sign of danger.

How is longcovid (post-COVID) treatment different from other viruses?

Longcovid is a very different condition to present known viral diseases. We generally understand that some viral infections can leave people with post-viral fatigue syndrome. Longcovid is thought of being four different kind of problems — there are those who have been in ICU/hospital and been very sick; those with long-standing organ complications, the group with post-viral fatigue and finally, the large group of people with fluctuating symptoms coming from different organ systems that don’t seem to have a satisfactory explanation right now.

Has pain endurance and management been more of a challenge with the pandemic?

In the UK and the US, it has been difficult to see the primary care doctor because of restrictions and lockdown.

In India, things are much better, but the choices are endless and often it is restricted to mainstream options like surgeries because we are told that every pain can be seen on a scan and can be fixed which is unfortunately not true.

During the pandemic, people have been more cautious to go to hospitals and have been looking and reading around other options to self-manage. And the Internet can be a very confusing and worrying place for someone in pain.

This is where my book can make a difference in showing the positive aspects and can aid self-management and support in an evidence-based fashion.

How different is an anaesthetist from a pain doctor? Is pain medicine gaining ground now globally?

In the UK and EU and generally in the US and Australia, most pain docs have a background PG training in anaesthesia and then super specialise in Pain Medicine. The US is more advanced in having other specialities as well as taking up pain medicine.

In India, most pain doctors will have an anaesthesia background. Pain Medicine is an established speciality in most countries. In the UK and Australia, they usually have Royal Colleges, which will have the exams and they are run by faculty so you pass it and become a Faculty Fellow. India has the same level of accreditation, though recognised training schemes are still evolving. There is unfortunately a larger focus on giving injections or interventions as the reimbursement incentives are skewed in that direction. This is unsustainable in the long run, so holistic treatment options and integrated centres of care are the future.

Can you throw light on psychological stress manifesting in physical pain and how it is dealt?

Stress in the acute phase is good but chronic stress (physical or psychological like work pressures, worries related to health, family, anxiety/depression, bullying, isolation) will activate the protection mechanisms and make them hypervigilant. In that situation, even a trivial nociceptive problem can be amplified by the sensitised nervous system as a big pain experience. So if just nociception is there — which happens after acute pain or injury — then medications and interventions (M I) can help but when that is not the case, then understanding how the brain and nervous system works (N), what is the right kind of diet (D), sleep hours (S), specific exercises (E) and mind-body therapies (T), which also include traditional Indian modalities like yoga/meditation/Ayurveda/mindfulness. We also know that harnessing the power of the brain and using neuroplasticity (the ability of the brain and nervous system to be plastic and adapt) can be quite powerful and the right way forward for comprehensive pain control.

What are the challenges faced by a pain management doctor?

The biggest challenge is the lack of a common ecosystem and a similar outlook from all healthcare professionals. The broad theme is that often when a patient gets pain, we always assume that it must be coming from only one structure and then we spend lots of money hinting for that one structure when the issue can be managed from the beginning in a more integrated fashion. By the time, my patients come to see me, it has become more than 1-2 years and they have spent their money or insurance money with no idea of what all they could have done to make it better. By the time they see me, they are desperate or don’t have insurance/money for their care and that anxiety and anger only fuels the pain. I realised that this is a challenge faced by many pain doctors and clinicians hence this book is a way to address that challenge.