Your first memory of pain may have been of you falling badly during a football game or stubbing your toe while running through the house. Whether you listened or not, that pain tried to make you take a break from your fun.
Pain is a highly unpleasant sensation that occurs as a result of signals traveling through your nerves to the brain. Pain can also be a protective mechanism; it points out tissue damage or foreign bodies and prevents further harm. However, pain also comes with age and certain lifelong conditions, such as arthritis. In such cases, it prevents you from enjoying the simple pleasures of life, such as taking a stroll.
In this article, we look at the various pain management options, taking into consideration that pain management should be holistic, and attend to the patient’s physical, mental and psychological needs.
- Acute pain: acute pain is sudden in its onset. It can immediately be linked to its cause, for example, an injury or a burn. Acute pain resolves when the injury heals. This kind of pain lasts no longer than 3 months. Acute pain is usually described as sharp or stinging.
- Chronic Pain: chronic pain results from tissue injury, just like acute pain. However, chronic pain remains long after the injury itself is healed. Chronic pain lasts longer than 3 months. Chronic pain may be dull, throbbing, pounding, tingling, pulsing or squeezing. Some other kinds of pain include:
- Nociceptive Pain: this is pain caused by external stimuli like cutting yourself, biting your tongue or getting hit.
- Neuropathic Pain: it is caused by damage to nerves. It may be shooting or tingling.
- Cancer Pain: this is pain caused by tumors pressing on nerves and organs. Cancer pain may also be caused by cancer treatment.
Medications are the mainstay of pain medication, and there a vast array of pain relief medications available. Nonetheless, pharmacological pain management must be tactical and stepwise. The best drug option for pain management depends on the class of pain, which may be mild, moderate or severe pain, and how well a patient tolerates the drug.
Acetaminophen, popularly known as Paracetamol, Panadol or Tylenol is perhaps the most widely used medication for mild pain. Despite its popularity, its exact mechanism of action is yet to be uncovered. It is majorly used for its antipyretic activity and mild analgesic action. The standard dose for acetaminophen is 1000 mg three or four times a day. Acetaminophen has less side effects when compared to NSAIDS and opioids. Because it has no activity at COX1 receptors, it does not produce the GI effects seen with NSAIDs.
Non-Steroidal Anti Inflammatory Drugs like Aspirin, Ibuprofen, Diclofenac, Piroxicam, Meloxicam are a class of medications that elicit pain relief by blocking or antagonizing prostaglandins. They are some of the main medications used for pain relief. Prostaglandins are the chemical messengers responsible for pain sensation. As such, good prostaglandin control equals better pain management.
Opioids such as Codeine, Morphine, Tramadol and their derivatives are potent analgesic medications used only for severe pain and cancer pain. Opioids can cross the blood-brain barrier, thus they are centrally acting. While this makes them highly effective for pain management, it leads to many opioid side effects such as addiction, dependence and tolerance.
Opioids act by binding to opioid receptors in the brain and spinal cord, cutting off pain sensation before it is transmitted through the neurons. However, opioids are also known to give a sense of euphoria, even when used for therapeutic purposes. This class of medication does not have a maximum dose or a ‘ceiling’. The higher the dose, the better the pain relief. This opens a window for addiction, tolerance and dependence to set in.
Adjuvant drugs are an inclusion to pain therapy which ought to make analgesics more effective, or work concurrently to cause pain relief. Examples of adjuvants used are antidepressants, anticonvulsants, corticosteroids, local anesthetics and bisphosphonates.
Medications are often the first option in pain management because they are easy to use, commercially available and their effects can be felt within minutes. However, each analgesic has its own side effect. Here are a few side effects you may witness when using analgesics.
Acetaminophen: side effects are rare but include liver toxicity and skin rashes. NSAIDs: headaches, drowsiness, stomach ulcers, indigestion, anemia due to internal bleeding. They also increase the risk of heart attack, angina, hemorrhagic stroke and other cardiovascular diseases. Opioids: sedation, constipation, respiratory depression, dizziness, nausea and vomiting. Adjuvants: corticosteroids may cause increased appetite and weight gain, antidepressants and anticonvulsants may cause confusion, lightheadedness, nausea and muscle weakness.
Non-pharmacological pain treatment involves procedures and techniques aimed at reducing or relieving pain without the use of drugs. Non-pharmacological management of pain encourages the brain to ignore pain signaling by drawing its attention to other more pleasant signals.
Acupuncture is a traditional method of pain treatment. This method involves careful insertion of thin needles into the skin. According to recent research, acupuncture stimulates endogenous opiates such as endorphins and enkephalin, and encourages corticosteroid production. These endogenous agents then go on to relieve pain naturally.
The effectiveness of massage therapy for pain treatment hinges on the fact that pain and touch are transmitted through a complementary set of neurons. Thus, while the neurons for touch are stimulated, those for pain are inhibited. In massage therapy, this is called “closing the pain gate”. Massages also relieve tension in muscles stiffened by pain. It is a great alternative treatment for pain in the lower back, shoulders and limbs.
Although pain is real, it is not solely a physical occurrence. Certain feelings and behaviors worsen our perception of pain, even if the magnitude of the pain remains the same. Cognitive Behavioral Therapy aims to help patients manage their pain better by developing positive thoughts and building healthy habits. CBT may not change your pain levels, but it can reduce how affected you are by that pain.
How do you treat pain without medication? The first step may be to recognize and acknowledge that pain.
Meditation is a great option for pain treatment because it requires no assistance, and you don’t need to leave the comfort of your home. Meditation focuses your awareness on the present. It allows you to properly categorize your pain, seeing it for what it really is. Spending a few quiet minutes can reduce anxiety, stimulate endorphin release and increase one's pain tolerance.
Other non-pharmacological pain treatment options include yoga, relaxation techniques, exercise and nutrition.
Interventional management for pain refers to treatment options that temporarily prevent you from feeling pain by blocking pain receptors. This option is only used in patients who show no improvement with other pain management methods, and whose pain greatly reduces their quality of life. Interventions may also involve surgical implants that release pain relieving medications at intervals. Interventional management for pain can be grouped into:
Nerve blocks are used to cut off sensation at a problematic nerve. Epidural injections are a kind of nerve block. During pregnancy, some women ask to be given an epidural injection so that they feel less pain during labor. Epidural injections refer to nerve blocks in the space outside the spine.
Nerve blocking may be partial or complete. In a partial nerve block, the patient will retain sensation. Complete nerve block on the other hand causes total numbness. Most nerve blocks are temporary, but a surgical nerve block is irreversible. This option is only used where all other options fail, not just because it is permanent, but also because it may lead to more pain, called deafferentation pain.
Infusing analgesics may be preferable when a patient is unable to swallow, or when analgesia is required over a long period. Infusions are also a great way to maximize opioid use. Because the drug is administered directly to affected nerves, the patient requires a lower dose than they would have used orally. Thus, we see less side effects.
An epidural infusion may last as long as six months.
Joint injections are specifically used for arthritis treatment, but they may also be used for serious injuries. The injections are used to directly treat inflamed joints by injecting the drug directly into the joint space. They are also called intra-articular injections.
You can have a joint injection as often as three times a year.
Sometimes, surgical implants may be used alongside oral pain medication and other forms of therapy. A surgical implant for pain typically has two parts; the generator, which releases pulses of electricity, and the electrodes, which transmit electricity.
Surgical implantation is also called spinal stimulation because these electrodes are placed in the epidural region. When the patient feels pain, he presses on a remote which commands the generator to send electrical impulses to the spinal cord, stopping the pain. Although the exact mechanism is undefined, surgical implantations can reduce pain by more than 50%.
Radiofrequency ablation (RFA) is a relatively new and promising pain control mechanism. The technique involves sending low energy waves to certain nerves. These waves interrupt the electric signaling of the brain, thus preventing pain perception. It is also called Rhizotomy. Its results are long-lasting, keeping pain away for three to 12 months. Risks and benefits of interventional pain management Generally speaking, interventional pain management has longer lasting effects when compared to oral medications or physical therapy. However, some intervention methods are invasive, requiring surgical procedures and anesthesia. Also, they are relatively more expensive than other management options.
Psychological treatment for pain is yet another important aspect of pain management, especially for chronic pain. Over time, chronic pain causes psychological stress, unhappiness, anxiety and complacency, amongst others. These factors further worsen chronic pain such that it becomes compound and difficult to treat.
Physiological management for pain involves deep relaxation. The extent of relaxation can be monitored using biofeedback. Here, parameters such as muscle tension, heart rate and respiratory rate tell if you’ve achieved adequate relaxation or not. Sometimes, patients may require hypnosis to achieve deep relaxation.
Pain assessment can be difficult because of its subjective nature. Pain assessment also relies on the patient’s descriptive ability. Discussing pain under the following headings usually gives a more comprehensive idea of pain, and can be used to monitor treatment progress.
- When did the pain start?
- Where did it start? Where is it now?
- How long have you felt it?
- What is the pattern of the pain?
- Describe its quality or character
- What makes the pain worse?
- What makes it better?
- How severe is the pain? What does it prevent you from doing?
- What other symptoms occur alongside this pain?
In pediatric and geriatric patients, it may be impossible to obtain this information. In such cases we use physiological markers such as respiratory and heart rate to judge pain intensity. Young children and mentally impaired adults may also be behaviorally assessed by using the FLACC pain assessment system.
Despite the multidimensional approaches available for pain care, some patients still do not get optimal relief. Perhaps these patients are missing a vital step; self-management.
If you want to get rid of pain for good, you need to work alongside your physician and healthcare providers. Pain self-management involves learning your pain patterns, keeping a daily record of pain intensity and onset.
When the pain becomes too great to bear alone, healthy coping mechanisms like talking to a friend and journaling emotions can be an outlet. Coping mechanisms allow you let out the frustration that surely comes with chronic pain.
Opioid use in the United States surged at the beginning of the COVID-19 pandemic, increasing by 30.6% in one year. Unsurprisingly, many states experienced more opioid overdose-related deaths between 2019 and 2020. The main culprit in these overdose instances was Fentanyl, a synthetic opioid. Illegal fentanyl goes by names like China Girl, China Town, Goodfellas and Murder 8.
Medical grade opioids can also be abused. In fact, traces of illegal fentanyl are sometimes found in therapeutic opiates like Oxycontin. In medicine, opioids are not intended for long-term use, unless in cases of extreme pain, or in the end stages of an illness where its benefits outweigh its risks.
Pain is multifaceted and complex. It is as much an emotion as it is physical and biological. Thus, proper pain management must also be multidimensional and intricately designed.
Depending on the kind of pain you experience, you and your physician ought to draw up a schedule of pharmacological and non-pharmacological treatments for pain, especially chronic and severe pain. The best pain management schedule is one that is easy for you and effective in treating or reducing pain.
True, wholesome pain management is enjoyable and relaxing, improving mobility and your participation in daily activities.
The information provided in this article is for educational purposes only and should not replace professional medical advice. If you suspect you are experiencing any type of pain, please consult a healthcare professional for proper evaluation and treatment. Remember to always prioritize your health and well-being.