[dropcap]T[/dropcap]he International Association for the Study of Pain (IASP) defines pain as “An unpleasant sensory and emotional experience associated with actual or potential tissue damage.” So, what exactly does that mean? Pain is not a stand-alone physical experience; it can affect our emotions as well as be affected by our emotions. Our perception of pain can be influenced by our upbringing and by social environment. What we believe, our attitudes and personality, determine how we feel and react to pain. This is apparent when looking at two people living with chronic pain. One may be governed by their pain and their function limited, whereas the other person with exactly the same problem and pain levels will continue nevertheless to function.
Once the body detects tissue damage or potential tissue damage, the body’s defence mechanism is triggered. Nerves within the tissue send signals from the area affected along the spinal cord and into the brain where the signal is then interpreted. The brain then processes this information and determines the action we should take. When immediate action is required the signal may not even reach the brain before pain has been interpreted and a reaction initiated.
For example, if you tread on a nail or touch something hot, action needs to occur before the brain has the time to register the signal and trigger response. This is called a reflex reaction. The brain, however, still receives and interprets the signal and will associate with it a sensation of pain. This is why certain medications or alcohol can alter the sensation and perception of pain. When the brain is dulled, the processing of signals and a response may be affected until the brain is no longer under the influence of these chemicals.
Acute pain is usually the body’s immediate response to potential damage or trauma. It is the warning system for the body to act in a certain way to prevent further injury, and in cases where there has been tissue damage, it may trigger a response in the body to prevent further damage and begin the healing process. In most cases this reaction to a stimulus does not last long and, as the body heals or the risk is removed, the pain will ease or disappear. However, in some cases, especially when many acute episodes of pain are experienced, the body continues to fire pain signals and the pain continues. Chronic pain describes pain that lasts longer than normally expected and, in some cases, it can be present without an obvious underlying cause.
Exposure to a noxious stimulus or disease can trigger changes within the central nervous system that leads to pain continuing sometimes long after the trigger has gone. Cancer pain is often a symptom in the early and advanced stages and can be one of the first warning signs that something is wrong. In other cases, pain may be a side effect of the (noxious, toxic) treatment regimes. As well as being categorised as acute or chronic, pain can be classified by the type of pain experienced. Being able to describe how the pain feels can also help in identifying the cause and finding an effective solution to pain management. Pain can be neuropathic (damage or disease to peripheral nerves), central (damage to the brain, brainstem or spinal cord), and phantom (common in amputees where pain is felt in the missing limb).
Once the cause of pain has been diagnosed, it is easier to find a way to treat it. Not all pains are equal, and the cause will help guide the best way to manage and reduce pain. The first step in managing pain is to remove the aggravating stimulus. If that is not enough to relieve pain, medication is another option but it is important to understand how different medications work and the type best suited for your needs will depend on the type of pain. Acetaminophen is an analgesic used for the relief of mild aches and pains. It is especially effective for treating headaches, muscular pains, back pain, mild arthritic pain, colds and toothache.
Non-steroidal anti-inflammatory drugs (NSAIDs) are used for minor pains and sprains and pain associated with inflammation and swelling. They can affect the stomach so their use should be monitored. Opioids are strong medications that are only available on prescription and include drugs such as morphine and oxycodone. Opioids can be highly addictive and need to be carefully monitored by a doctor. Corticosteroids can be given orally or by injection and are effective for treating muscular pain, conditions in which the immune system is overactive and inflammatory conditions, e.g. asthma and arthritis.
Antidepressants often are used in low doses to treat chronic pain, some types of headaches and menstrual pain. They work by adjusting the levels of neurotransmitters (natural chemicals in the brain) improving feelings of well-being and relaxation. Anticonvulsant medication has been shown to be effective in treating pain caused by damaged nerves.Topical treatments come in the form of patches and ointments and can be effective in the treatment of localised pain. Another effective tool in the management of pain is physiotherapy and for most, when sought early, can reduce or eliminate the need for medication and may even prevent the pain from becoming chronic.
Physiotherapists are trained professionals who treat pain and improve function through means that do not use medication. Through the use of electrotherapy, exercise and massage, they work with each client to develop an individual programme to speed up recovery and maximise function. So, before you reach for the medicine cabinet, explore all your options.
