Pain…It’s the thing we all try to avoid…Be it physical or emotional. From the moment we are born, we instinctively work to fight it off. Chronic pain is no different.
It was the early Greeks and Romans who first advanced the notion that “perception of pain” involves the brain and how it processes messages of discomfort. In the 1800’s scientists discovered opiates including morphine to relieve painful maladies, and in the 1890’s German born, Felix Hoffman discovered aspirin from the bark of willow trees.
Today in the United States, pain affects more individuals than cancer, diabetes, and heart disease combined. In fact, one in four Americans (roughly 25.3 million adults) has suffered with pain long-term. Pain affects every age group, can be chronic, and may accompany a number of diseases or conditions including depression, PTSD (post traumatic stress disorder) and traumatic brain injury.
Pain Management—Many Types of Pain
Pain, caused by actual or perceived injury has evolved in humans to protect us from harm. The sensation of pain guides us to act in certain ways, and to avoid specific behaviors and situations.
Two types of pain exist, acute, and chronic pain.
Acute pain is the nervous system’s immediate, normal response to possible injury or illness. It’s essentially a signal to take care of ourselves, slow down, get treatment, and heal.
Chronic pain is different, however. Pain signals continue to fire in the body’s nervous system for a longer period of time. It often stems from an initial injury, infection, illness, or plain old wear and tear. Sometimes chronic pain cannot be completely resolved. In this case, pain can be managed, sometimes for the rest of one’s life. Back trouble, arthritis, cancer pain, and neurogenic pain (nerve pain or pain to the nervous system) are generally chronic.
Pain can be further described as either nociceptic pain or neuropathic.
Nociceptive pain is felt in response to tissue damage such as a cut or burn. In this case, tiny nerve endings are activated by the injury and send signals to the brain.
Neuropathic pain is caused by problems with the nerves themselves that send messages of pain to the brain. Often this type of pain feels like burning, stabbing, shooting, or aching.
Pain may also be described as somatic pain or achy, throbbing, or dull pain. Arthritis, bone or low back pain is somatic pain. Visceral pain is felt in the trunk of the body and experienced as squeezing, pressure, or cramping pain such as that with appendicitis, or a gallbladder attack.
What conditions can be improved through pain management?
Many chronic pain conditions can be treated including:
- Back and neck pain
- Burning or prickly sensations from an injury
- Herniated discs
- Myofascial pain (soft tissue pain)
- Neuropathy (nerve damage)
- Sacroiliac joint dysfunction (joint problems in legs, groin, back)
- Spasticity (muscle tightness that affects moving or speaking)
- Spinalstenosis (narrowed spinal canal)
- Radiculopathy (nerve compression/inflammation)
- Sciatica (radiating lower back pain)*Chronic pain sufferers often have diminished levels of endorphins in their spinal fluid.
Pain Management Treatment Options
Treatment options for pain may include medication, electrical and brain stimulation, acupuncture, and surgery. Other alternative treatments may include meditation and relaxation therapies, biofeedback, behavior modification, and exercise.
Finding and understanding the causes of chronic pain is key to better treatment and advances in neuroscience.
What is Pain Management?
Every individual experiences pain to a greater or lesser degree, but each of us perceives a particular pain stimulus subjectively. The intensity, location, duration, and any aggravating factors all depend on the receiver of the pain. Treatment of pain through pain management is based on these factors. The structures that cause pain are also considered. These involve a nerve supply, and are susceptible to injury. Stimulation of the structure also causes pain.
Treatment Concept for Pain Management
The majority of treatment interventions for pain are based on the concept that a specific structure within the body contains nerves of sensation that is causing pain. Pain management helps identify the specific source of the problem and helps determine the most optimal treatment.
What Patients Can Expect With Pain Management
Pain Assessment—Medical personnel will assess a patient’s pain using a standardized method such as the WILDA approach. WILDA stands for: Words to describe pain, Intensity, Location, Duration, and Aggravating Factors.
Physical Examination—A physician or other medical personnel will conduct a thorough examination to identify the specific area of pain involved as well as any referred pain.
Further Testing—Blood tests, biopsies, MRI’s, or X-rays may be administered to help determine possible causes of pain.
Treatment Plan—Your physician or other healthcare practitioner will generally outline a specific method of treatment or treatment plan going forward.
Pain Relievers for Pain Management
Pain relievers are medications that work to relieve soreness, arthritis, muscle aches, and headaches. Some types of pain respond better to particular medications. Individuals respond to certain medications more than others as well.
Pain products come in many different forms and consist of both over-the-counter, and prescription products for pain relief. Over-the-counter (OTC) pain relievers fall into one of two categories, either acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs). Aspirin, naproxen (Aleve), and ibuprofen (Advil, Motrin) are OTC NSAIDs. Many of these are also sold by prescription at higher doses. Most NSAIDS are well tolerated, but can cause permanent kidney damage if taken in large doses for chronic pain relief.
Opioids are the most powerful pain relievers, are very effective, and require a doctor’s prescription. They are only used to treat symptoms and may mask the root cause of a medical condition or injury. Opioids can be highly addictive and must be closely monitored by a physician. Opioids are inexpensive, provide immediate relief and can play an effective role in an ongoing treatment plan.
Side Effects of Pain Relievers
Side effects of acetaminophen may include:
Side effects of Nonsteroidal anti-inflammatory drugs NSAID’s (such as Advil, Aleve, and Motrin) may include:
Increased risk for heart attack or stroke
Side effects of Opioids may include:
Dizziness, lightheadedness, or feeling faint.
Nausea or vomiting
Topical Preparations for Pain Relievers
Topical analgesics are delivered as liquids, gels, powders, creams, semisolids, emulsions, patches, foams, or aerosols to be applied on or around a specific site. Buprenorphine and fentanyl are two of the most popular analgesics for pain although effects are primarily central. NSAID’s are meant to minimize inflammation, as well as the cascading effects caused by inflammation to an injured area of the body. NSAIDs are delivered as gels, creams, or sprays, to penetrate skin, fat tissue, and muscles.
NSAID’s are widely used for both chronic and acute musculoskeletal conditions. These are popular due to their ability to provide relief without cognitive impairment to the user.
Electrical and Brain Stimulation for Pain Management
Electricity is used to help reduce pain, improve circulation, repair tissues, strengthen muscles, and promote new bone growth.
A transcutaneous electrical nerve stimulation, or TENS unit, helps manage pain with small electrodes placed on the skin where pain is located. Electrical stimulation is then applied.
Side effects include:
Damage to Open Wounds
Treatment with Deep Brain Stimulation (DBS)
DBS has been used since 1970 for nociceptive pain. Treatment is used for severe cases of chronic pain only and may lift feelings of depression and anxiety associated with pain.
Side effects may include:
Natural Approaches to Pain Management
In addition to pain relief through targeted medications, natural pain management may also be beneficial.
What types of natural treatment options are available for pain management?
The following therapies may offer pain relief:
Acupuncture—Needles placed under the skin in pain centers/meridians
Spinal manipulation—Chiropractic care
Massage therapy—Specific massage of deep tissue and muscles/muscle groups
Relaxation techniques—Meditation and relaxation through deep breathing techniques
Tai chi and Qi Gong—Relaxed body movement/energy concentration
Natural pain solutions benefit individuals by offering varying levels of relief without dangerous or damaging side effects. Other than possible mild inflammation at insertion sites (acupuncture) or temporary swelling from skeletal manipulation, alternative therapies are well tolerated by most individuals. Complementary approaches to treatment allow patients to take an active role in their own pain management. Many health insurance companies now offer coverage for acupuncture, chiropractic care, and massage.
While millions of individuals suffer with chronic pain lasting weeks, months, sometimes even years, many options for pain management are available. Finding the right treatment or combination of therapies that’s right for your individual situation is the most important thing you can do to manage chronic pain.
1Bittar, R G, et al. “Deep brain stimulation for pain relief: a meta-Analysis.” Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia., U.S. National Library of Medicine, June 2005, www.ncbi.nlm.nih.gov/pubmed/15993077.
2“Chronic Pain Information Page.” National Institute of Neurological Disorders and Stroke, U.S. Department of Health and Human Services, www.ninds.nih.gov/Disorders/All-Disorders/Chronic-Pain-Information-Page.
3“Chronic Pain: In Depth.” National Center for Complementary and Integrative Health, U.S. Department of Health and Human Services, 24 Jan. 2017, nccih.nih.gov/health/pain/chronic.htm.
4Fink, Regina. “Pain assessment: the cornerstone to optimal pain management.” Proceedings (Baylor University. Medical Center), Baylor Health Care System, July 2000, www.ncbi.nlm.nih.gov/pmc/articles/PMC1317046/.
5Jorge, Liliana L, et al. “Topical preparations for pain relief: efficacy and patient adherence.” Journal of Pain Research, Dove Medical Press, 2011, www.ncbi.nlm.nih.gov/pmc/articles/PMC3048583/.
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