Family Health Diary

Pain can be felt in one place, like when you cut yourself, or all over your body, such as muscle pain that comes with the flu. Sometimes pain is sharp or acute, directly related to an injury, short-lived and goes when you are healed. But pain can persist and become chronic and this is often associated with a long-term illness or injury which can be very debilitating. Although treatment of chronic pain can be difficult, effective relief is always possible using different techniques and drug combinations.

What causes the sensation of pain?

You feel pain by one of two mechanisms:

  • Sensory pain or nociception – is the process whereby special nerve endings distributed throughout the body are triggered by mechanical stimulation (cut, tear, break, pressure), chemical stimulation (external poisons, toxins and also internal chemicals produced by inflammation, trauma, lactic acid build-up after extreme exercise) or thermal stimulation (extreme heat or cold). Messages are sent from these nerve endings up nerves into the spinal cord and to the brain, where they are interpreted as pain. Muscular or skeletal pain is usually sharp and easy to pinpoint because of the large number of receptors in skin, muscle and bone. Internal pain in the gut or organs is usually a dull pain and may not be easy to identify as there are fewer pain receptors in these areas. You usually feel pain where the nerve endings are stimulated but sometimes you can get referred pain, such as pain in the arm caused by angina or pain down the leg from a slipped disc (sciatica).
  • Nerve pain or neuralgia – is caused by malfunction of a nerve anywhere in the nervous system. When a nerve is damaged or inflamed it becomes unstable and fires off random signals which are felt as sharp pain like an electric shock or as a burning pain. It is caused by pressure, such as a trapped nerve or slipped disc, compression by a blood vessel or tumour, inflammation due to an infection such as shingles, or after surgery. Nerve degeneration, which happens as a result of some diseases like multiple sclerosis, diabetes or following a stroke, can also cause nerve pain.

Living with chronic pain

Chronic pain is defined as persistent pain for more than six months. It is usually associated with an ongoing disease process like arthritis or cancer, but can linger long after the initial cause has healed, going on for months or years. Nerve damage can cause chronic pain, by faulty transmission of messages to the brain and is difficult to treat because there is no obvious cause, which is where pain management techniques can be important. Recent studies have identified changes in the nervous system and brain function in chronic pain sufferers, which may be why problems with attention, sleep and depression often accompany chronic pain and interfere with normal life activities.

Prevention and treatment

1. Identify the type of pain
You need to identify what type of pain you are experiencing and its cause before it can be treated. Often pain is one of several symptoms so you may need a combination of treatments. Taking a history will identify the site of the pain, its nature, character and severity and determine what helps and what makes it worse.

2. Simple pain relief

  • Paracetamol  – acts on pain-receiving pathways in the brain and is good for mild pain or in combination with other drugs for more severe pain.
  • Non-steroidal anti-inflammatory drugs (NSAID) – reduce inflammatory pain (muscular or arthritic) by blocking the COX 1 and COX 2 enzymes that form pain-inducing chemicals in the tissues, causing them to swell. By blocking these enzymes, NSAIDs reduce swelling and pain. Simple NSAIDs include diclofenac (Voltaren), ibuprofen and aspirin and can be obtained from your pharmacy; newer drugs include the more specialised COX 2 inhibitors and are prescription only.

3.  Seek your GP for medical treatment

  • Narcotics or opiates – affect the way the brain interprets pain and induce sedation; they include simple codeine or morphine, and others. These drugs are used for severe pain either alone or in combination with other drugs.
  • Pain modifiers – these are drugs used for other purposes (such as anti-depressants and anticonvulsants) but are used in combination with painkillers to treat chronic pain. They work by reducing pain signals getting to the brain, and stabilising damaged nerve endings that keep firing pain signals.
  • Muscle relaxants – reduce muscle spasm.
  • Capsaicin – is an active ingredient extracted from chillis available as a cream which can help with some types of pain when rubbed on the skin, particularly with shingles and other neuropathic pain.

4. What you can do to help yourself

  • Give up smoking as this can make medication less effective.
  • Keep moving and don’t let pain prevent use of injured limbs or back as this may cause stiffness and muscle wasting.
  • Exercise as much as possible as this stimulates blood flow and oxygen to muscles, helping to reduce stress which can help alleviate pain.
  • Use an ice pack or hot water bottle particularly with lower back pain.
  • Respond to the first sign of pain and take medication regularly to prevent pain getting out of hand.

5. Alternative therapy for pain management

Acupuncture is an ancient Chinese healing based on application of needles to specific points on the body and is thought to work by stimulating release of natural pain-relieving chemicals in the brain called endorphins.

Hypnotherapy is often used for management of chronic pain and is thought to control the way the brain receives pain messages.
Chiropractic and osteopathic therapy and massage can relieve pressure on nerves to reduce muscle spasm in back pain.

TENS or Transcutaneous Electrical Nerve Stimulation is electrical stimulation of specific nerves through patches on the skin surface and is thought to relieve pain by stimulating natural endorphins, which can be helpful for chronic nerve pain.

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