Pain management. It’s a reality of life as we are typically very physical beings. We move, work, play, and challenge our bodies in various ways in our daily lives. With those freedoms comes the opportunity to experience injury, harm and resulting pain.
According to the National Institutes of Health (NIH), “pain affects more Americans than diabetes, heart disease and cancer combined.” It is the number one reason Americans access the health care system, is the leading cause of disability and is a major contributor to high health care costs.
In 2006, it was estimated that approximately one in four Americans (76.2 million) have suffered from pain that lasts longer than 24 hours (millions more suffer from pain lasting less than 24 hours; also known as acute pain). In addition, according to the American Chiropractic Association (ACA), more than 31 million Americans experience back pain at any given time. Because of this pain management strategies and interventions are essential to a better quality of life.
WHAT IS PAIN
Pain is a complex experience that occurs after an event is processed by the brain and is deemed dangerous. Nerve cells throughout the body sense changes and report information back to the brain (i.e., mechanical changes, temperature changes, and chemical changes). Nociceptors are specific sensory nerve cells that respond to damaging (or potentially damaging) stimuli by sending signals to the spinal cord and the brain. The sensation of pain is typically the central nervous system’s way of responding to these signals and alerting the body to quickly respond and avoid further damage. There are two types of pain – acute and chronic.
WHAT IS ACUTE PAIN
Acute pain is a sharp pain that begins suddenly, in response to an event. It serves as a warning of disease, damage, or potential threat to the body. The following scenarios may cause acute pain:
- Burns or cuts
- Broken bones
- Dental work
- Labor and childbirth
Acute pain might be mild, lasting just a moment, or it might be severe and last for weeks or months. In most cases, acute pain does not last longer than six months, and disappears when the underlying cause of pain has been treated or has healed. Unrelieved acute pain, however, might lead to chronic pain.
WHAT IS CHRONIC PAIN
Chronic pain persists beyond the typical three to six months it takes for the body to heal from an acute injury. Pain signals remain active in the nervous system for weeks, months, or even years. As a result muscles can remain tense, the body experiences limited mobility, there is a lack of energy throughout the day, and changes in appetite. Emotional effects include depression, anger, anxiety, and fear of re-injury. This fear can often hinder a person’s ability (and desire) to return to normal work or recreational activities. Common chronic pains include:
- Low back pain
- Arthritis or cancer pain
- Neuropathic pain (physical pain resulting from damage to nerves in various parts of the body)
- Psychogenic pain (physical pain that is caused, increased, or prolonged by mental, emotional, or behavioral factors)
An initial trauma or injury may have resulted in chronic pain or there might be an ongoing cause of pain that goes beyond an acute injury. However, some people suffer chronic pain in the absence of any past injury or evidence of body damage.
Chronic pain typically occurs due to an increased sensitivity of the nervous system beyond an acute injury or incident. The peripheral nerves become more sensitive and the area of pain can become larger. For example, if the pain started in the wrist it may spread to the entire arm. In addition, pain receptors fire much quicker and for longer periods of time (because they are more sensitive and cautious in protecting the affected area).
Pain can be a chronic disease, a barrier to cancer treatment, and can occur alongside other diseases and conditions (e.g. depression, post-traumatic stress disorder, traumatic brain injury). In addition, chronic pain has further long-term effects, including:
- Decreased immune response
- Increased risk if type 2 diabetes (i.e., stress causes an increase in sugars in the bloodstream which then over-taxes the production of insulin over time)
- Increased auto-immune response (i.e., arthritis, anemia, irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome)
- Changes in mood and/or sleep
Inflammation is often discussed when talking about pain. As a result, the inflammation response is an important aspect of pain to be considered when discussing pain management. Inflammation is what occurs when, upon injury, the injured area becomes red, swollen, and sensitive to the touch. The redness and swelling is a physical representation of our immune system at work – white blood cells and cytokines protecting the body from invading pathogens and doing “damage control” in the affected area. The sensitivity of the tissues is the body’s response to irritate the nerves in the area as a way to protect the damaged tissues. If the injured area is sensitive to the touch, it subconsciously prevents us from using it, provoking it, or potentially re-injuring it. So, managing inflammation can help to alleviate pain and the pain response.
In the end, pain can cause incredible disruption to one’s quality of life (and the lives of those who care for and support them). There are pain management solutions designed to help individuals find solutions to guide them through their chronic pain journey.
WHAT IS PAIN MANAGEMENT
Consisting of a team of medical practitioners, pharmacists, clinical psychologists, physiotherapists, occupational therapists, physician assistants, nurse practitioners and other specialists, pain management is a branch of medicine focused on easing the suffering of patients and improving the quality of life of those living with chronic pain. Depending on the situation and the level of pain, this pain sometimes resolves itself once the underlying trauma or injury has healed. A single team member with the appropriate medications, such as analgesics and anxiolytics, provides this treatment. Effective management of chronic pain, however, frequently requires the coordinated efforts of a more comprehensive management team and significantly more time.
Treatment approaches to chronic pain include pharmacological measures (such as analgesics, antidepressants and anticonvulsants), interventional procedures, physical therapy, physical exercise, application of ice and/or heat, and psychological measures, such as biofeedback and cognitive behavioral therapy. In the end this could take weeks, months, or years beyond the initial 6 months of injury repair and healing.
MEDICATIONS IN PAIN MANAGEMENT
Medications play a huge part in pain management and patient care. A medication is a substance that is taken into (or placed on) the body to accomplish on of the following things:
- To cure a disease or condition (i.e., antibiotics are given to cure an infection)
- To treat a medical condition (i.e., anti-depressants are given to treat depression)
- To relieve symptoms of an illness (i.e. pain relievers are given to aleviate pain)
Pain medication is used to treat injury and pathology, primarily to support and speed healing time. It is also used to treat pain to relieve suffering during treatment and healing. When a painful injury or pathology is resistant to treatment and persists, and when the medical team can’t identify the cause of pain, the task of medication is to relieve suffering. Below is a list of common categories of pain medications to treat chronic pain:
- Non-steroidal anti-inflammatory drugs (NSAIDs) – act on substances in the body that can cause inflammation, pain, and fever.
- Corticosteroids – exert powerful anti-inflammatory effects and are often administered as an injection at the site of musculoskeletal injuries; can also be taken orally to relieve pain (i.e., arthritis).
- Acetaminophen – increases the body’s threshold for pain, but it has little effect on inflammation.
- Opioids – used to modify pain messages in the brain; also known as narcotic analgesics.
- Muscle relaxants – reduce the feeling of pain from tense muscle groups.
- Anti-anxiety drugs – work on pain by reducing anxiety, relaxing muscles, and easing discomfort.
- Tricyclic antidepressants – shown to reduce pain transmission through the spinal cord.
- Anti-convulsant drugs – relieve the pain of neuropathies by stabilizing nerve cells.
INTERVENTIONAL PAIN MANAGEMENT
Interventional pain management is a subspecialty of the chronic pain management field that uses invasive techniques to manage chronic pain, such as:
- Facet joint injections
- Nerve blocks (interrupting the flow of pain signals along specific nervous system pathways)
- Neuroaugmentation (u se of electrical stimulation to supplement activity of the nervous system – including spinal cord stimulation and peripheral nerve stimulation)
- Vertebroplasty (a procedure for stabilizing compression fractures in the spine, using bone cement injected into vertebrae that have cracked or broken; similar to kyphoplasty)
- Nucleoplasty (procedure for treating patients who are suffering from low back and leg pain caused by a herniated disc and involves removing tissue from the disc to relieve pressure on the affected nerve)
- Endoscopic discectomy (a minimally-invasive surgical procedure designed to remove portions of a herniated disc in the lumbar spine that affect nerves)
- Percutaneous spine fusion (minimally invasive procedure used to lock two or more vertebrae together to in order to stabilize the spine using various types of screws, rods, or plates)
- Implantable drug delivery systems (these devices allow for consistent and controlled site-specific drug administration where the drug is needed most)
Some conditions commonly treated using interventional pain management techniques include:
- Chronic headaches, mouth, or face pain
- Chronic low back pain
- Chronic muscle pain
- Chronic bone pain
- Chronic neck pain
In certain situations, interventional pain management techniques play a part in a multi-disciplinary approach to relieve pain and other debilitating symptoms. An example would include the combination of these techniques with mental and emotional therapy and prescription medications.
PASSIVE THERAPIES & PHYSICAL MODALITIES
The idea of pharmaceutical interventions or invasive surgical procedures may not appeal to everyone. Other alternate treatments worth considering (that have proven to be effective in varying levels) include:
- Acupuncture (based in part on the theory that many diseases are manifestations of an imbalance between yin and yang as reflected by disruption of normal vital energy flow in specific locations, referred to as meridians, needling along one of the 361 classical acupuncture points on these meridians is believed to restore the balance. Acupuncture has been utilized to treat chronic pain and is now covered by many insurance policies)
- Hyperbaric oxygen (Hyperbaric oxygen involves the administration of oxygen in a pressurized chamber to increase oxygen delivery to the tissues of the body and has recently been used to treat some chronic pain syndromes)
- Manipulation and mobilization (traditionally performed by Chiropractors, manipulation and mobilization are two types of “hands on” therapy that include a wide array of different techniques and schools of thought)
- Electrical stimulation devices (TENS, the most commonly used form of electrical stimulation, is the therapeutic use of electricity used in the treatment of pain)
- Trigger point injections (given to individuals with a myofascial pain syndrome, a regional painful muscle condition, providing short-term benefit with the potential for greater relief over a longer period of time)
Passive therapy (treatment modalities where patients simply receive the treatment without physical effort) can provide short-term relief during chronic pain flare-ups and is directed at controlling symptoms such as pain, inflammation, and swelling. These therapies can include: massage, ultrasound, iontophoresis, paraffin (wax) treatment, light therapy, or traction. Passive therapies may be useful over the short term but have limited benefit for chronic pain conditions overall.
PAIN MANAGEMENT GUIDELINES & RESOURCES
Every person’s situation is different and management of acute or chronic pain will vary and change. Below are a list of websites that can provide valuable information and guidance regarding the choices you make in the management and treatment of pain.
- American Academy of Pain Medicine – several resources dedicated to “You and Your Pain”
- American Chronic Pain Association – 2016 Resource Guide for Chronic Pain Treatment
- Comprehensive Pain Management – an accredited comprehensive pain management clinic in Baton Rouge, LA
- com – a comprehensive resource regarding non-invasive treatments and pain management tools
- SMART Pain Management – a group of multi-disciplinary pain management treatment facilities in Maryland
ABOUT THE AUTHOR
Andrea Oh is an accomplished writer, published author, podcaster, and local blogger in Calgary, AB (Canada). Follow her adventures at www.sixfootcanasian.ca or on Facebook, Instagram, and Twitter (@sixfootcanasian).