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What a Pain!

Pain management FAQs by Hugh McKenna

Headache At some stage or another we have all experienced some level of physical pain. Whether it is a head ache, tooth ache, sprained ankle or a fracture, pain is present in one form or another. Some of us are able to cope with higher levels of pain than others. What one person describes as agony, another may describe as a bit tender. This is what makes pain in itself a subjective matter and as such, each case must be dealt with on an individual basis, according to the patient’s verbal explanation and medical exploration.

The basic rule is ‘pain is what the patient says it is’.

What is Pain Management?

The basic premise of pain management is to enable the individual to continue with daily life as normally and pain free as possible. This process is normally established between the individual suffering pain and their doctor and may require medical intervention, medication, holistic treatments such as acupuncture or a combination of the above. Two individuals with the same pain may require totally different pain management so to a degree there is a certain level of trial and error but good communication between doctor and patient, normally resolves the issues swiftly.

What are the different types of pain?

Normally pain only lasts as long as there is a stimulus and ceases upon the removal of that stimuli. For example, if you burn your hand on the oven, you feel pain and quickly remove the hand from the oven. Generally pain that lasts a fairly short period of time is described as acute pain. Many theorists believe that acute pain makes the transition from acute pain to chronic pain at about 12 months. Others however believe acute pain to last less than 30 days and pain lasting six months or more to be chronic pain.

There are several categories of pain:

Nociceptive - Initiated by stimulation of the peripheral nerves

- Thermal (hot or cold),
- Mechanical (crushing or tearing) and
- Chemical (vinegar in a cut or chilli powder in your eyes).

Neuropathic - A form of pain which can be triggered even without a harmful stimulus. This is caused by damage to the nervous system and activation of abnormal circuits. There are two categories:

- peripheral (originating in the peripheral nervous system) and
- central (originating in the brain or spinal cord).

Psychogenic - Initiated by mental, emotional or behavioural factors. Back ache or tummy ache are psychogenic pain. All too often however, people assume the person’s pain is ‘all in their head’ or not real at all. Most medical professionals and specialists however treat psychogenic pain as being just as harmful as other forms of pain.
Phantom pain - Many amputees experience this form of pain upon the removal or loss of a limb. Often described as a burning, crushing, shooting or cramping it is a form of neuropathic pain. Surgical intervention rarely provides relief.

How do you treat pain?

The good news is that there is a myriad of treatments available for all kinds of pain depending on the location and severity of pain, some more effective than others. Remembering what I mentioned earlier that pain is a subjective condition and it can take some time to find the best treatment or combination of treatments. Your doctor will be more than happy to work with you to establish the safest and most appropriate ‘Pain Management Regime’ for you.

Remember: your doctor should always be aware of any treatments you are considering.

The key is not to suffer in silence but discuss your options with your doctor or consultant. There are treatments to suit everyone; the key is not to give up hope just because you still suffer pain. Communicate and keep exploring new ways to manage your pain.

Here are a few of the most common treatments:

Medication

There are many, many forms of medication used to help relieve pain (analgesia).

Simple analgesics eg Paracetomol and Calpol
Non-steroidal anti-inflammatory drugs (NSAIDS) eg Ibuprofen and Diclofenac.
Opiate medication eg Codeine, Tramadol and stronger opiates eg Buprenorphine, Fentanyl patches, morphine.
Combination preparations eg Codeine and Paracetamol (Co-codamol and Co-dydramol).
Anticonvulsants are used for conditions that cause seizures but can also be used in neuropathic pain.
Antidepressants are also sometimes used in the treatment of neuropathic pain along with muscle relaxants.
Nerve Blocks: The use of drugs, chemicals or surgical techniques to interrupt the flow of messages between parts of the body and the brain.

Electrical Stimulation

TENS machine There are several types of electrical stimulation used to treat or identify pain. Electrical stimulation needs trained professionals to administer the treatment to maximise the success rate and even then it is not 100% effective. It is also not a treatment for everyone so again

Biofeedback: This is an electrical machine used to help the patient become more aware of pain, where it is and how to control their responses to pain. It is often used in conjunction with other treatment methods and often without side effects.
TENS, pictured right, meaning ‘transcutaneous electrical stimulation’. A series of tiny electrical impulses are sent through the skin to the nerve fibres causing changes in the muscles such as numbness or small contractions that can cause a temporary pain relief.
Peripheral Nerve Stimulation: Surgically placed electrodes are placed on specific parts of the body. The electrical stimulation is then delivered by the patient as required to manage pain using an antenna and transmitter.
Spinal Cord Stimulation. Again controlled by the patient, electrodes are surgically placed in the epidural space of the spinal cord. The patient can then deliver an electrical pulse to the spinal cord.
Deep Brain/ Intracerebral Stimulation: An extreme treatment involving surgical stimulation of the brain. It is used for a limited number of conditions such as severe pain, central pain syndrome, cancer pain, phantom pain and other neuropathic pain.

There are however other forms of pain management that have proven to be very effective for some, but, as always with pain, not all.

Exercise

Now more commonly being prescribed by doctors due to the fact that there is a link between chronic pain and tension or weakness in the muscles.

There is no need for vigorous, intense exercise! A gentle walk or swim can have many pain relieving properties. Exercise is proven to help with back pain and stress can cause more pain so exercise, sleep and relaxation can often reduce stress and thus pain. Let’s not forget pain often causes inactivity and that can lead to even bigger issues down the line. There is generally something for everyone.

Alayways tell your doctor and if using a trainer, make sure they are a registered exercise professional.

Other therapies

The list of therapies is endless - low power lasers, hypnosis, magnets, cognitive behavioural therapy, counselling, opioids, placebos and good old fashioned R.I.C.E (rest, ice, compression and elevation).