Pain is not visible; you can t see pain in scans, X-rays, and blood tests. Pain is difficult to explain. You may find it hard to describe the pain you are experiencing and it is as hard for your family and friends to understand what you are going through. But your pain is real!
Although pain specialists recognize that not every patient s pain can be eliminated, it can definitely be managed. Pain management is defined as pharmacological, nonpharmacological, and other approaches to prevent, reduce or stop pain.
Consequences of chronic pain
Managing pain, whether acute or chronic, is essential because inadequately treated pain has major physiological, psychological, economic, and social ramifications for those who suffer from pain, their families, and society.
Here s how.
Physically, pain results in reduced mobility and consequent loss of strength, disturbed sleep, immune impairment, and greater susceptibility to diseases.
Pain has huge psychological ramifications as well. For example, a World Health Organization study found that individuals who live with chronic pain are four times more likely than those without pain to suffer from depression or anxiety. [1]
If you suffer from chronic pain you may have difficulty working resulting in low work productivity and reduced effectiveness, or maybe you d have to take leave from work. Chances are you become dependent on family members and caregivers. Pain has a detrimental effect on all aspects of quality of life. Here are some ohome remedies to manage aches and pains)
The good news is you can treat pain and you can successfully manage pain.
Pharmacological approach
1. NSAIDs and opioids
Generally, the first line of treatment for chronic pain are non-opioid analgesics or NSAIDs such as aspirin, ibuprofen, celecoxib, indomethacin, and diclofenac. NSAIDs have 3 desirable pharmacological effects: anti-inflammatory, analgesic, and antipyretic effects.
However, gastrointestinal adverse effects are the most common and most worrisome complication of NSAIDs.
Sameer lived with back pain for more than 20 years. What with his corporate job and family responsibilities, he hardly had the time or energy to focus on his back pain. Popping a pain killer (NSAID) when the pain got worse became his routine. Over time the pain got really debilitating. Pain killers became more frequent. He started losing weight rapidly, became fatigued easily and irritable. No other symptoms. Everyone was very worried. At last, he decided to consult a doctor. Series of tests revealed ankylosing spondylitis in the vertebrae and ulcers in his digestive tract. When his doctor asked him if he was taking any medicines for his arthritis, Sameer told him about the OTC pain killer he was taking (for years). The doctor said, You know what, its possible that these ulcers are the side effect of the drug X you have been taking for so long.
GI side effects are not the only ones it seems. Now doctors have found that NSAIDs have cardiovascular risks too, so instead of NSAIDs, they are recommending acetaminophen, nonacetylated salicylates and even short-term opioids.
Acetaminophen has analgesic and anti-pyretic effects similar to NSAIDs, but it is not anti-inflammatory. This drug is a slightly weaker analgesic than NSAIDs, but it is a reasonable first-line option because of its more favourable safety profile and low cost. But studies have found that acetaminophen is associated with elevations of aminotransferase levels leading to liver damage at dosages of 4 g/day even in healthy adults. [2] (Read: 5 alternatives to pain medication)
Researchers say The danger of this agent (NSAID acetaminophen) is veiled beneath its complex metabolic process and the multiple patient-specific characteristics that factor into the heightened predisposition of some to develop this toxicity , that is, some people are more at risk to have an adverse reaction. [3]
Not everyone will have side effects with pain killers though. For most people though, the problem is resolved after discontinuing the drug.
Opioids are effective for both nociceptive pain as well as neuropathic pain. While nociceptive pain includes sprain, burns, bumps, myofascial pain and inflammation (from infection and arthritic disorder) and is time limited, neuropathic pain is the result of injury or malfunction in the nervous system and include conditions such as neuralgia, cancer pain, carpal tunnel syndrome, diabetes, vitamin deficiencies, and other medical conditions. Substance abuse and addiction are not the only downside of opioid drugs. It also causes adverse effects viz. nausea, constipation, drowsiness, and endocrinological abnormalities with long term use. In women opioid use has been associated with amenorrhea and decreased levels of sex hormones.
2. Antidepressants
If your doctor prescribes antidepressants for your pain, do not assume that you are being treated for psychological problems. Although, scientists believe that multiple mechanisms may be involved in pain management, the most popular theory is that antidepressants exert their effect on serotonin and norepinephrine in the spinal pathway, and reduce pain signals. [4]
Antidepressants work best for pains caused by arthritis, diabetic neuropathy, low back pain, neuralgia, fibromyalgia, migraine and tension headaches. These drugs don t work immediately. You may expect to see results only after a week or so. (Read: STOP popping painkillers everytime you have a backache)
3. Topical analgesics
Topical analgesics help avoid systemic side effects associated with oral medications. Common topical analgesics include lidocaine, capsaicin, and salicylate.
A 5% lidocaine patch is applied for 12 hours daily.
Capsaicin is an alkaloid derived from chili peppers. The main disadvantage of capsaicin is the initial burning sensation, which may persist for days. Capsaicin must be applied 3-4 times per day over the entire painful area for up to 6-8 weeks before optimal pain relief can be achieved. Capsaicin 0.075% is used for neuropathic pain, and Capsaicin 0.025% is used for arthritic pain.
Topical salicylate may have efficacy in acute pain at seven days but poor to moderate efficacy in chronic pain at 14 days, according to a study. [5] However, another study suggested that topical ibuprofen may be beneficial for knee osteoarthritis, especially in older people. [6]
4. Apart from the above medications, certain medical procedures can also be done for pain management. A pain specialist can suggest the most suitable procedure for you.
Non-pharmacological approach to pain management
There are many non-pharmacological ways you can manage pain. Some of them are listed here.
1. Chiropractic treatment for pain relief: Also called spinal manipulation, it is a therapy that involves application of quick but strong pressure on a joint between two vertebrae of the spine. That pressure twists or rotates the joint beyond its normal range of motion and causes a sharp cracking noise. A bubble is released into the synovial fluid, which is a clear, thick fluid that lubricates the spinal and other joints. Spinal manipulation can be done either directly by pushing on the vertebrae or indirectly by twisting the neck or upper part of the body.
2. Massage: Massage can also work wonders for your pain. A study found that Relaxing (also called Swedish style) massage once a week for 1 hour, or Structural massage (also called deep tissue massage) focusing on specific areas of pain and targeting ligaments and joints once a week for 1 hour, was as effective as standard therapy for pain management. [7]
3. Acupuncture: Acupuncture therapy involves inserting fine needles into the skin at specific points in the body. The theory behind the procedure is that imbalance in the flow of life energy, called chi, causes disease, pain in this case. Acupuncture restores the balance and heals the body. You may require weekly treatments until you see benefits, then you can gradually lengthen the time for your next visit.
4. Physical therapy and exercise: Physical therapy and exercise play a vital role in pain management. Physical therapy can also lessen or help prevent future recurrences of back pain. This therapy includes one or combination of modalities such as electric stumulations (TENS), hot /cold therapy, massage therapy, ultrasound, and manual manipulation. Your physical therapy professional will work out a programme that is best suited for you.
5. Yoga and Meditation: Yoga is a mind-body healing therapy that combines breath control, meditation, and asanas (poses) for pain management. Pain modifies frequency, depth and patterns of respiration. Pranayama is a yogic breathing technique that relaxes most skeleton muscles, lessens central nervous system activation, increases tonicity of parasympathetic nervous system, and consequently helps reduce pain. [8] Following are some asanas for specific pain conditions
6. Psychological interventions such as cognitive-behavioural therapy and progressive relaxation therapy.
Whether your pain is from arthritis, cancer treatment, injury or even irritable bowel syndrome, the first step in pain management, however, is consulting your doctor to determine the cause of your pain and the most effective way to manage the pain.
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