Pain

Introduction

Your body hurts. Whether your pain is throbbing or nagging, sharp or dull, you would like to ignore it. But pain demands your attention. Pain is the warning light on the dashboard of your body. It signals you to stop what you're doing and find out what's going on.

What is it?

Pain is an unpleasant experience primarily associated with some kind of tissue damage. Pain is your body's way of warning your brain that something might be wrong.

There are two types of pain:

  • Acute - This type of pain is usually immediate and lasts less than two weeks. Acute pain is a normal response to an injury but, if untreated, can cause significant emotional or physical problems.

  • Chronic - This is the type of pain that persists over the long term, usually for more than three months. The cause of chronic pain may not be evident but could be a sign of a serious illness that needs professional treatment. Chronic pain may be continuous, as with cancer-related pain, or intermittent. An example of intermittent pain is ulcer pain that is relieved or made worse by eating. Chronic pain is an abnormal state and should be evaluated by a doctor. No one should have to live with constant pain.

What causes it?

Nerve cells located in and beneath your skin sense heat, cold, touch, pressure, and pain. When your body is injured, or if pressure is applied to your body's nerves, these tiny cells send messages into your spinal cord and up to your brain. Your brain then interprets these signals as pain. Sometimes the brain perceives pain even when there is no detectable injury or pressure on the body's nerves. In other cases, the nerves themselves may become damaged or diseased and cause pain. This is called neuropathic pain, and the pain is often described as shooting or aching. When nerves are damaged, pain may be experienced even when there is no clear cause.

Who has it?

The National Center for Health Statistic's 2006 report on pain indicated that approximately 76.2 million Americans (or 25%) suffer from pain. Pain is a more common condition than diabetes, cancer, and heart disease combined, making it one of the most costly health problems in America. Estimated annual costs are close to $100 billion a year. These costs include direct medical expenses, lost income, lost productivity, compensation payments, and legal charges.

Here is more evidence about the prevalence of pain:

  • Women are slightly more likely to report pain than men (27.1% vs 24.4%).

  • Those with lower incomes are more likely to report pain than those with higher incomes.

  • Non-hispanic whites are more likely to report pain than other ethnicities (27.8% vs 15.3% Hispanics and 22.1% African Americans).

  • 26 million Americans report frequent back pain, making it the most common type of pain.

  • More than 40 million Americans suffer from some form of arthritis pain, and many have chronic pain that limits daily activity. Osteoarthritis affects 15 to 20 million Americans and is by far the most common form of arthritis. Rheumatoid arthritis is the most crippling form of the disease and affects 8 to 10 million Americans.

  • An estimated 60 to 80 million Americans experience pain in the form of recurring headaches. For at least half of these people, the problem is severe and sometimes disabling. It can also be costly: headache sufferers make over 8 million visits to doctor's offices each year. Migraine victims alone lose over 157 million workdays because of headache pain.

Back pain, headaches, and arthritis are just three health conditions that commonly cause pain. Numerous other health conditions such as cancer, sickle cell disease, shingles, and stomach or intestinal conditions cause millions of patients to experience acute and chronic pain.

What are the risk factors?

Risk factors are characteristics that may increase your chance for developing a condition. You are more likely to be at risk for pain if you experience any of the following:

  • Injuries
  • Surgery
  • Cancer
  • Other chronic diseases such as arthritis

What are the symptoms?

In addition to its physical sensation, pain can affect you in many ways. For example, when pain is not properly relieved, you may experience:

  • Fear
  • Depression
  • Limitations in day-to-day activities
  • Trouble sleeping

Pain may cause differing sensations. It can many times be described as:

  • Sharp
  • Shooting
  • Stabbing
  • Aching
  • Burning
  • Needle prickling or numbness/tingling
  • Throbbing
  • Cramping
  • Constricting or squeezing sensation
  • Feeling of pressure

Pain is also felt in varying degrees. Typically, your doctor will ask you to describe your pain and rate it on a scale from 1 to 10 with 1 being very little pain and 10 representing the worst pain possible.

How is it treated?

The effectiveness of pain medications, also called analgesics, varies from person to person. Even if the medication is used correctly, it may not provide the same level of relief for everyone. For this reason, pain management is usually a multi-step process. The World Health Organization has developed a "Ladder" of three steps for managing pain.

The first agents on the ladder are the "simple" analgesics. These refer to analgesics such as acetaminophen, salicylates (such as aspirin), and non-steroidal anti-inflammatory drugs (NSAIDs such as ibuprofen or naproxen). For milder forms of pain, the doses available in over-the-counter products may be enough to control pain symptoms. There are two ways to take analgesics: as needed or scheduled. For mild acute pain, these medications can generally be taken on an "as needed" basis. This means that the product is taken at the recommended dosing interval only when pain is present. If the mild pain is more chronic in nature, these simple analgesics should typically be taken on a scheduled basis (sometimes called "around the clock") to help control pain and prevent it from "breaking through." A scheduled basis refers to taking the product at a set interval regardless of whether pain is present. Refer to the product label for proper dosing intervals for each product and how long you can safely take a product before you should see a doctor. For more moderate forms of pain, prescription doses of these simple analgesics may be needed.

If pain gets worse, a narcotic is added. Often, a narcotic is combined with a simple analgesic to make one tablet or capsule. An example of this is Vicodin which is the combination of the narcotic hydrocodone with the simple analgesic acetaminophen. Other narcotics include codeine and morphine. When pain is too intense for a combination to control, the doctor may move to the third step -higher doses of the narcotic taken separately from any simple analgesics that the patient continues to take. Some people who take narcotics become addicted to the feelings they get from the medication and this often requires intervention by a doctor. However, t is rare for people using these medications as directed for pain relief to become addicted.

Narcotics and simple analgesics are no longer the only options for treatment of pain. Drugs like tramadol are known as non-narcotic analgesics. Unlike narcotics, patients taking this type of medication over long periods of time are less likely to build up a tolerance to the drug's effects and less likely to become addicted.

Sometimes non pain-related medications are prescribed in addition to traditional pain medications. For instance, antidepressants can be used to ease the depression that sometimes accompanies pain. Sleep medications may be prescribed to help the patient get a good night's rest if the pain interferes with sleep. Another example of using non pain-related medicatons occurs with neuropathic pain. With this type of pain, anti-convulsants or anti-depressants may be used to help control pain.

Helping Yourself

You can work with your doctor to develop a plan that meets your individual needs for relieving pain. Things to clarify with your doctor include:

  • When to take your medicine
  • How to take your medicine
  • What to expect from your medicine
  • When to take extra medicine
  • Under what conditions to contact your doctor

Do not skip doses or wait for the pain to get worse before taking your medicine. Be sure to ask your doctor about other medications or treatments you can use to help you with potential side effects of pain medications.

Because pain is a complex interaction between the mind and body, talking about your pain can often help you to better understand it and, sometimes, relieve it. Talking with loved ones, your doctor, or even a mental health professional can be a useful addition to medications for treating pain.

Your mood affects how you perceive pain. If you are generally happy and upbeat, you are more likely to tolerate pain better than if you are down and blue. Diet, exercise, and sleep can all affect your mood and, therefore, your perception of pain. To help decrease pain, the following tips may be helpful:

  • Try eating a balanced diet full of fruits and vegetables. Avoid sugar-sweetened or greasy foods.
  • Limit alcohol, caffeine, and tobacco.
  • Exercise often--every day, if possible. If your pain makes exercising difficult, ask your doctor for alternative ideas.
  • Get plenty of sleep. Pain that interferes with your sleep can sometimes be treated with sleep medications. Ask your doctor for more information about the benefits and risks of this type of medication.

What is on the horizon?

The University of Texas MD Anderson Cancer Center has a Pain Research Group that strives to discover the underlying mechanisms of pain, fatigue and other symptoms. The group also organizes clinical trials to evaluate the best ways to improve symptom management. Their research currently focuses on educational, behavioral, and medical interventions for treating pain, fatigue, and impairments in the way the brain perceives pain. The group uses laboratory work and pictures of the brain to explore the connection between the mind and body. This allows them study the causes of pain and fatigue.

The Pain Research Institute in Liverpool, England is currently involved with several projects examining the neurophysiological response to pain. They have been using painful thermal stimuli to demonstrate which brain regions are responsible for painful sensations, and are developing techniques to investigate various clinical pain conditions (e.g. low back pain, phantom limb pain, post-stroke pain etc.). These new techniques may provide insight into how the brain interprets pain signals following injury.

Researchers are also studying new ways to relieve pain without drug therapy. In a recent study, alternative treatments such as meditation, tai chi, and muscle relaxation were shown to improve pain and functioning in older people with back pain, osteoarthritis, and other types of pain . The results from these and other such studies may someday help patients manage their pain while decreasing the risks and side effects of medication use.

Clinicians from different healthcare fields that treat pain now have common goals of relieving unnecessary suffering. An improved understanding of pain and pain control, coupled with more analgesic alternatives, has attracted broad interest from a variety of medical specialties. The future holds more promising options in pain control.

References

The American Pain Foundation website. Available at URL: http://www.painfoundation.org/ Accessed December 2007 and October 2008.

The American Academy of Pain Management website. Available at URL: http://www.aapainmanage.org/ Accessed December 2007 and October 2008.

MD Anderson Cancer Center's Pain Research Group website. Available at URL: http://www.mdanderson.org/departments/prg/ Accessed December 2007 and October 2008.

The University of Liverpool's Pain Research Institute website. Available at URL: http://www.liv.ac.uk/pri/ Accessed December 2007 and October 2008.

Acute Pain Management Guideline Panel. Pain Control After Surgery. A Patient's Guide. AHCPR Pub. No. 92-0021. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services. Feb. 1992.

CliniSphere 2.0. Facts and Comparisons; St. Louis, MO; December 2007.

Cancer Pain Relief. Ed.2. World Health Organization, Geneva, 1996.

A Virtual Pocket Dictionary of Pain Terms. International Association for the Study of Pain. http://www.iasp-pain.org/dict_toc.html; Accessed: December 2003 and October 2008.

Pain Health Condition Last Updated: October 2008

Note: The above information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist, or other healthcare professional. It is not intended to diagnose a health condition, but it can be used as a guide to help you decide if you should seek professional treatment or to help you learn more about your condition once it has been diagnosed.

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