Understanding Pain

First in a Series

 The word pain is derived from the ancient Greek word for punishment or penalty.  Since all of  us have experienced pain, we understand the derivation of the word.  Yet we may not know as much as we should about pain, and what to do about it.  In the next few articles, we’ll explore pain in greater depth. 

Pain and the treatment of pain is an often discussed and debated issue.  Pain has various classifications: acute, chronic, neuropathic, somatic and visceral.   Its characteristics are just as diverse:  aching, soreness, tenderness, burning, throbbing or stabbing.  Although each of us experiences pain differently, we share common concerns:   how long will it last and what will make it stop?

When healthcare professionals consider the duration of pain, they use the terms acute and chronic. The distinction between acute and chronic pain is generally based on the interval of time from onset to relief. 

• Acute pain is more easily treated; for example, the pain following a surgical procedure responds to the medication prescribed and the pain improves within a specific timeframe.  Most agree that acute pain should be relieved between 3-6 months after initiation. 
• Chronic pain is long-standing and not easily relieved; the pain of arthritis may persist for the remainder of an individual’s lifetime.  The management of chronic pain frequently requires the coordinated efforts of the treatment team and often requires a variety of treatments along with the use of medications.

All types of pain can be treated safely and effectively using various types of treatments, including medication and non-drug treatments.  What works for one person may not work for another.  Pain may be treated through the use of one or a combination of the following:

·         Drug therapies--

Anti-inflammatory drugs (NSAIDS) -- These are usually used to treat mild pain.  Many are available over the counter and include acetaminophen, aspirin and ibuprofen. It is important to remember that these are medications and have the potential to interfere with other medications and can cause side effects.  It is always best to ask your health care provider before beginning the use of these medications.

Opioids (narcotics) – These medications are usually used to treat moderate to severe pain and require a prescription.

Adjunct analgesics -- These are usually used to treat conditions other than pain but have been found to relieve some painful conditions.  These include antidepressants, anticonvulsants and corticosteroids.

·         Psychological therapies --

                        Deep breathing and relaxation exercises (such as Lamaze breathing for childbirth)

                       Distraction

                       Counseling

·         Rehabilitation therapies-

Physical therapy, occupational therapy, exercise and stretching as allowed.

·         Invasive interventions-

                        Surgery

Cortisone injections

Nerve blocks

Local anesthetics

                        ·   Non-drug therapies-

                        Acupuncture, acupressure 

                        Electrical stimulation (TENS)

                        Massage, light touch therapy

                        Meditation, prayer

Yoga, tai chi

                        Herbal remedies

Well-meaning family and professional caregivers will often interject their own opinions of the degree of pain or the relief of pain an individual is experiencing.  It is impossible to know what another’s pain feels like.  

• Pain is what the individual says it is.  Everyone experiences and copes with pain uniquely; past experiences with pain, coping styles, emotional supports, the severity of the illness or injury, and the general physical condition of the person can affect the current experience with pain.
• Reaching a completely pain-free state is not always possible.  Pain should be able to be controlled to a tolerable level for the individual.
• Pain does not always have a physical source.  Individuals with amputated limbs can experience very real pain in “phantom” limbs.
• Pain can cause depression and anxiety, just as depression and anxiety can make pain worse.