Pain management has several methods to reduce, prevent, or stop pain-related sensations. These include the use of medicines, psychological methods, and physical methods such as ice and physical therapy.
Pain acts as an alert for potential or less or severe damage to the body. The interpretation for damage is quite broad; pain may arise from injury as well as disease. Pain that acts as an alert is called productive pain. After the signal is received and interpreted, further pain offers no real benefit.
Pain also contains a negative impact on a person’s quality of life and impedes recovery from illness or damage.
Unrelieved pain may become a syndrome in its own right and cause a downward spiral in the health and outlook of a person. Managing pain properly makes an easier recovery, prevents additional health complications, and improves the quality of life of a person.
For many years it was believed that newborns do not feel pain the way older children and adults do. As of the early 2000s, there has been a better understanding of the problems that arise from pain, even in childhood.
Here is a quick review of pain definitions and mechanisms that may be useful before considering pain management.
What is pain?
According to the international association that is involved in the study of Pain, “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage.”
In other words, pain is a procedure in which the peripheral nervous system (PNS) warns the central nervous system (CNS) of injury or potential damage to the body. The Central Nervous System comprises the brain and spinal cord, and the PNS is composed of the nerves that stem from and lead into the CNS. The Peripheral Nervous System includes all nerves throughout the body except the brain and spinal cord.
Once the brain receives and processes the pain message and coordinates an appropriate response, the pain has served its purpose. The body uses natural pain killers, known as endorphins, that are meant to reduce further pain messages from the same source. However, these natural pain killers may not be enough to dampen a continuing pain message.
What are the different types of Pain?
Pain is further divided into two categories: chronic pain and acute pain.
Acute pain may begin suddenly and is often feeling sharp. It is slightly similar to the body’s warning system signaling that something is wrong. Most times, acute pain may resolve quickly, although by definition it may last three to six months. Patterns of recovery from acute pain are usually to be expected and helps in developing a treatment plan. Pain specialists know the importance of controlling acute pain to prevent it from becoming chronic.
Causes of acute pain include:
- Broken bones (spinal vertebral fracture)
- Burns or cuts
- Certain diseases
- Dental work
- Labor and childbirth
- Soft tissue injury, such as whiplash
- Surgical pain (postoperative pain)
Chronic pain is lasting longer than 6 months, it is persistent and may be severe. The treatment of chronic pain is difficult. A multi-disciplinary approach, involving several experts who offer treatment separately or simultaneously, has become a parameter of care. Such specialists include anesthesiologists and physiatrists.
Chronic pain affects people emotionally as well as physically. Physical symptoms of chronic pain include loss of mobility, muscle tension, lack of energy, and appetite. The emotional effects of this pain can be similarly destructive and include depression, anger, and anxiety.
Causes of chronic pain can include:
- Arthritis (osteoarthritis)
- Degenerative disc disease and other spinal disorders
- Nerve dysfunction (with or without nerve damage)
- Soft tissue injuries, such as trauma such as a fall or motor vehicle accident
- Unresolved disease or injury (psychogenic pain)
Many kinds of pain can be described under acute or chronic. Some include:
Myofascial pain- Painful trigger points that develop in a muscle or a group of muscles are responsible for this type of pain. Myofascial pain may cause “referred pain” because when you press a trigger point, the pain may be felt elsewhere. This pain may be chronic and described as burning, aching, nagging, or stabbing.
Psychogenic pain looks like a real physical pain caused by a psychological problem. This pain is caused by the patient’s emotional or mental issues.
Radicular pain, or radiculitis, is caused by inflamed or compressed nerve roots. For example, an inflamed nerve root present in the neck may radiate pain into the arm or hand. Other associated terms are “lumbar radiculitis” or “cervical radiculitis”. The meaning of these terms is that the pain originates from a cervical (neck) or lumbar (low back) spinal nerve. Sciatica is a general term that describes pain that descends into the leg.
Somatic pain occurs due to bodily injury or other event affecting the pain receptors in the ligaments, muscles, skin, bones, or joints. This pain may be chronic and sometimes cancer may be an accomplice of this pain.
Visceral pain is caused by internal organs that are damaged or injured.
How to manage pain?
Considering the different causes and types of pain, as well as its intensity and nature, management of pain may require an interdisciplinary approach.
The components of this approach contain treating the underlying cause of pain, nonpharmacological and pharmacological therapies, and some invasive (surgical) procedures.
However, there are no guarantees of immediate relief from pain from these procedures.
Pain-relieving drugs, generally known as analgesics, include Nonsteroidal Anti-inflammatory Drugs (NSAIDs), acetaminophen, narcotics, antidepressants, anticonvulsants, and others. These drugs can also be used as a subsidiary to other drug therapies, which might require a doctor’s prescription.
NSAIDs include ibuprofen, aspirin, naproxen sodium (Aleve), and ketoprofen (Orudis KT). These drugs are used to treat pain and work by blocking the production of pain-raising neurotransmitters, such as prostaglandins.
Narcotics may be ineffective in some forms of chronic pain, especially since changes in the spinal cord may alter the usual pain signaling pathways.
Other medicines are used to treat specific types of pain or specific pain syndromes, such as corticosteroids are very effective against pain caused by swelling and inflammation, and sumatriptan (Imitrex) was evolved to treat migraine headaches.
Drug administration depends on the drug type and the required specific dose. Some drugs are not absorbed very well as they are needed from the stomach and must be injected or governed by intravenously. Injections and intravenous administration can also be used when high doses are needed or if an individual is nauseous.
Non Pharmacological options
Pain treatment options that do not require drugs are often used as adjuncts to, rather than replacements for, drug therapy. A benefit of non-drug therapies is that an individual can take a more active stance to get rid of the pain. Relaxation techniques, like yoga and meditation, are used to reduce muscle tension and stress. Tension and stress may also be reduced through biofeedback, in which one can consciously attempt to modify blood pressure, skin temperature, muscle tension, and heart rate.
Participating in sports activities and exercising can also help to control pain levels.
Through physical therapy, one can learn beneficial exercises to reduce stress, and staying fit by strengthening muscles. Regular exercise has been directly linked to the production of the body’s natural pain killers known as endorphins.
Three types of invasive procedures may be used to manage or treat pain known as anatomic, augmentative, and ablative. These procedures involve certain guidelines and surgery that should be followed before carrying out an effective procedure. First, the reason for the pain must be identified. After that surgery should be done only if noninvasive strategies are ineffective. Third, psychological issues should be addressed if any. At last, We have a reasonable expectation of success.
Anatomic procedures involve repairing the injury or removing the cause of pain.
Augmentative procedures include direct application of drugs or electrical stimulation to the nerves that are transmitting the pain signals.
Ablative procedures are characterized by severing a nerve and dissociating it from the spinal cord.
- Due to toxicity over the long term, some medications can only be used for acute pain or as assistants in chronic pain management.
- Nonpharmacological therapies may carry some or no risk. However, it is advised that individuals recovering from severe injury should consult with their healthcare providers before making use of adjunct therapies.
- A traditional fear about narcotics use is the risk of pushing for addiction. As narcotic use continues over time, the body becomes habitual to the drug and adjusts normal functions to adapt its presence.
- Newborns feel pain, but they can not express it in the same manner as young adults or older children. Studies indicate that the majority of guardians do not know how to recognize the signs of newborn babies’ pain, and specialists fail to teach parents what to look for.
- In some cases, narcotic analgesics are required to control childhood pain. These drugs are safe when used according to prescription and should not be withheld for fear of addiction.
- Parents must learn to recognize and treat pain promptly because exposure to chronic pain by babies can lead to life-long changes in their pain response.
Over-the-counter pain killers may be toxic. Parents must read the directions carefully and follow them exactly as mentioned on the label. For liquids, it is necessary to use the proper measuring devices, like a medicinal teaspoon or measuring dropper.