Pain

Pain is an unpleasant sensation typically associated with any form of trauma (illness or injury) to the body. Pain can be acute or chronic and generalized or localized. Depending on the severity and longevity, it can have a significant mental and emotional impact on a person's life. Pain treatment and management can be controlled with prescription, non-prescription painkillers and alternative therapies.

What is pain? 

Pain affects everyone differently, with various ways to describe it, such as an unpleasant sensation, pinching, stabbing, dull ache, sharp stab, burning, sore or stinging. Levels of uncomfortableness can range from annoying to debilitating. This uncomfortable and unpleasant sensation occurs from the activation of the nervous system. 

Pain can be acute (short-term), developing suddenly, or chronic (long-term), lasting over six months or a year.  

Pain can be generalized, such as overall body aches associated with fever, or pain can be localized, which affects a specific part of your body (e.g. a broken wrist or arm). 

Pain can be classified as: 

• Nociceptive pain: This is chronic pain that occurs when pain receptors are stimulated by inflammation, chemicals released by damaged cells, temperature, and stretching. 
• Non-nociceptive pain (sympathetic pain): This is chronic pain that is not caused by pain receptors. Instead, it is a response to an injury or trauma to a nerve(s). The nerve(s) become unstable or injured, resulting in a confused signalling system. These abnormal signals are interpreted by the central nervous system (CNS) as pain. 
• Neuropathic pain: is a type of non-nociceptive pain that results from damage to the nervous system. Neuropathic pain is often referred to as a pinched or trapped nerve. 

• Somatic pain: This acute, superficial pain results from stimulation of the pain receptors found in your tissues (muscles, skin, bone, connective tissues, and joints). 
• Visceral pain: is a type of nociceptive pain. This acute pain starts in the lining of cavities and internal organs of the body. 
• Referred (reflective) pain: A person experiences this type of acute pain in a different location from the source of tissue damage. For example, shoulder pain is often experienced during a heart attack.  

Your medical practitioner will conduct a physical examination and ask you for a complete medical history. As there is no objective scale for identifying the type of pain, as it is a subject to individual experience, your doctor will take a pain history. 

You will be asked to describe: 

• The times during the day that the pain occurs. 
• The description of your pain, such as stabbing, short stabbing, stinging, burning, etc. 
• If there is anything that aggravates or relieves the pain. 
• The site and severity of the pain in/on your body.
• How the pain affects your mental health and daily functioning. 
• The understanding of your pain.  

Measuring Pain

There are several systems that can be used to grade and identify pain. Getting an accurate diagnosis relies on clear communication between the person and their doctor. 

Some of the pain measuring systems used:

• Faces scale: The healthcare professional will show the individual in pain an expressive face chart. The emotions on the faces range from depressed to happy. This chart is usually used with children and autistic people. 
• McGill Pain Questionnaire (MPQ): The MPQ provides people with words from a 20-word group to help them understand how their pain feels. 
• Numerical rating scales: This scale measures pain from 0-10, where 0 represents no pain and 10 represents the worst pain imaginable. 
• Brief pain inventory: This detailed written questionnaire can help healthcare professionals gauge the effect a person's pain has on their mental health and daily functioning. 
• Verbal descriptor scale: This scale helps children and adults with cognitive impairments to provide doctors measure their pain levels.  

Other indicators of pain for people that cannot accurately describe their pain include: 

• Sleeping problems
• Resistance to care
• Restlessness 
• Moaning and groaning 
• Crying 
• Not eating 
• Reduced social interactions 
• Grimacing 

There are many different treatment options to treat and manage the various types of pain. A treatment type or plan that alleviates or manages one type of pain may not be effective in relieving another. Treatment plans will depend on if there are any underlying conditions and if the trauma causing the pain is known. Chronic pain can be more challenging to treat and manage compared to acute pain. 

If the pain you are experiencing is moderate to severe, you may be prescribed painkillers (analgesics) to help reduce or stop the pain. 

Opioid Analgesics 

If the pain is severe, doctors may prescribe opioid painkillers. These are the strongest painkillers and are only available with a valid prescription. When taking opioid painkillers, the doctor's instructions should always be followed, as there is a possibility of developing an opioid dependency when taken over long periods. 

Examples of opioid painkillers: 

• Fentanyl 
• Meperidine 
• Codeine 
• Methadone
• Hydrocodone 
• Morphine 
• oxycodone
• Hydromorphone 

Common side effects of opioid analgesics include: 

• Itching
• Nausea/Vomiting 
• Constipation
• Drowsiness

Non-opioid Analgesics 

Non-opioid painkillers are typically used to treat mild to moderate pain. They are not addictive, unlike opioid painkillers. 

Paracetamol: This mild painkiller is safe for most people to take with minimal side effects. They are available in tablets, capsules, suppositories, sachets, effervescent tablets, and liquids. 

Possible side effects of paracetamol include: 

• Liver and kidney damage
• An allergic reaction
• Low blood pressure and a fast heart rate
• Blood disorders such as Leukopenia and Thrombocytopenia 

If you experience any issues when taking paracetamol, contact your doctor or pharmacist as soon as possible. 

Nonsteroidal anti-inflammatory drugs (NSAIDs): Depending on the dosage and strength, these medicines are available as a prescription or over-the-counter. NSAIDs are some of the most frequently used medications for pain relief. 

Types of NSAIDs used for pain relief: 

• Nurofen 
• Brufen retard 
• Ibuprofen 
• Ibuleve
• Cuprofen 
• Asprin
• Naproxen 
• Diclofenac 
• Asprin 
• Disprin 
• Anadin 
• Mefenamic Acid 
• Celecoxib 
• Indomethacin 
• Etoricoxib

Like all medications, there is a risk of side effects, although not everyone may experience them. 

Common side effects of NSAIDs include: 

• Headaches 
• Ingestion 
• Stomach ulcers
• Dizziness
• Stomach aches 
• Drowsiness

Anticonvulsants usted to treat chronic pain 

Anticonvulsants are drugs used to treat seizure disorders and, in some cases, used to treat pain. Anticonvulsants can inhibit (block) certain types of nerve transmissions, thus reducing neuropathic pain sensations. This medication is only available with a valid prescription. Anticonvulsants that are commonly used for the treatment of pain include:

• Phenytoin Valproate
• Gabapentin (Neurontin)
• Carbamazepine (Tegretol)
• Pregabalin (Lyrica)
• Lamotrigine (Lamictal) 

Antidepressants for chronic pain 

Antidepressants have proven to be effective in managing specific types of chronic pain (for example, neuropathic pain). Antidepressants can be prescribed either on their own or in conjunction with other painkillers. 

Some antidepressants that are commonly used to treat chronic pain include: 

• Duloxetine 
• Amitriptyline 
• Paroxetine 
• Fluoxetine 
• Fluvoxamine 
• Citalopram 
• Venlafaxine 
• Nortriptyline

Nerve blocks 

Nerve blocks are usually used in the treatment of chronic pain. The group of nerves (plexus or ganglion) is blocked by injecting medicine into the affected area. This blocks the pain signals from being sent to the central nervous system. Nerve blocks can be used for:

• Diagnostic nerve blocks 
• Pre-emptive nerve blocks 
• Prognostic nerve blocks 
• Therapeutic nerve blocks
• Facet joint block 
• Sympathetic nerve block 
• Stellate ganglion block 

Transcutaneous Electrical Nerve Stimulation

Transcutaneous electrical nerve stimulation (TENS) is a popular method of relieving pain using mild electrical currents. The TENS machine delivers mild electrical impulses to the affected areas of the body via electrodes. TENs works by reducing the pain signals being sent to the brain and spinal cord, which should result in reduced or dulled pain sensations. TENs stimulation can also act as a natural painkiller as the production of endorphins can also be stimulated. 

TENS can be used to treat a variety of conditions such as: 

• Arthritis 
• Menstraul (period) pain
• Keen pain
• Sport injuries 
• Neck pain 
• Back pain

If your pain worsens or does not subside, contact your healthcare provider or pharmacist for other treatment and management options.