PAIN MANAGEMENT - Adults

Summary

Pain may be caused by medical conditions, injury or surgery. Management strategies include pain-relieving medicines, physical or occupational therapy, complementary therapies (such as acupuncture and massage) and cognitive behavioral therapy (CBT). Always see your doctor for diagnosis, treatment and advice on the best pain-management option for you.

Pain is a very common condition. Around one third of Australians are in pain, with one in five reporting that their pain is constant. The occurrence of pain rises as people get older, and women are more likely to be in pain than men. Pain management strategies include pain-relieving medications, physical or occupational therapy, and complementary therapies (such as acupuncture and massage).

Studies suggest that a person’s outlook and the way they cope emotionally with long-term (chronic) pain can influence their quality of life.  Counseling can help support you to manage the emotional and psychological effects of chronic pain. Understanding the causes of your pain can help reduce your fear and anxiety.

Causes of pain

Pain may be anything from a dull ache to a sharp stab, and can range from mild to extreme. Pain may be located in one part of the body or it may be widespread.

Causes of pain in adults include medical conditions (such as cancer,  arthritis and back problems), injuries and surgery. The most commonly reported pain is back pain. Pain involving the limbs, shoulder, neck and head is also common. 

See your doctor if pain continues

Seven out of 10 people seek professional help for their pain, mostly from a doctor. For some people, the cause of the pain won’t be found or there will be no available treatment for it. In other cases, the cause may be remedied, but the associated pain lingers on. Always see your doctor for diagnosis and treatment of persistent pain.

How pain affects the body

There are two types of pain. Acute pain is a normal response to tissue injury, which starts suddenly and is usually short lived. Chronic (ongoing) pain persists beyond the normal time of healing and generally lasts for longer than three months.

The vast majority of people with chronic pain have it for more than a year. This type of pain is usually the result of an injury (for example, a sports or work accident), illness or other health problem. The cause is unknown in around one third of cases.

The body’s reaction to unrelieved pain includes:

·         Increased heart rate and blood pressure

·         Changes to blood gases, namely reduced oxygen and increased carbon dioxide

·         Higher levels of stress hormones including cortisol and adrenaline

·         Gastrointestinal problems such as slowed digestion

·         Musculoskeletal problems such as tension and fatigue

·         Emotional problems such as anxiety and depression.

Pain receptors

Pain receptors are attached to two main types of nerves – one relays messages quickly (resulting in a sharp, acute pain) and the other relays messages slowly (resulting in a dull, throbbing pain). Some areas of the body have more pain receptors than others. For example, the skin is loaded with receptors that can give specific information on the exact location and type of pain, while the relatively few receptors in the gastrointestinal tract (gut) means it is harder to pinpoint the precise location of a stomach ache. 

The pain message relay

Pain receptors in the body relay the sensation of pain along the nerves to the spinal cord, which sends it to a structure in the brain called the thalamus. The thalamus also contributes to mood and arousal, which helps to explain why our interpretation of pain partly depends on our state of mind. The pain message is then delivered to the brain’s cerebral cortex.

Interestingly, some people who have injuries to areas of their cerebral cortex still experience pain, but don’t care so much about it.

Pain-relieving medications

Pain relievers (analgesics) are common medicines that many people use at some time in their lives. There are two broad categories of analgesics:

·         Non-opioid – such as aspirin and paracetamol, mainly used for mild to moderate pain

·         Opioid – such as morphine and oxycodone, mainly used for severe pain.

Medications available for the management of pain include:

·         Paracetamol

·         Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen – these medicines reduce inflammation (redness and swelling)

·         Opioid drugs, such as codeine and morphine – these medicines treat moderate to severe pain

·         Local anaesthetics.

How pain-relieving medications work

Analgesics work in various ways. For example, opioid analgesics alter pain messages by influencing brain chemistry, which is why these drugs can be addictive. Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) work by blocking an enzyme in the body needed to create prostaglandins. Prostaglandins are chemicals that trigger physiological changes such as increased temperature and dilation of blood vessels. They also cause an increased sensitivity to pain.

Blocking the action of prostaglandins reduces fever, inflammation and pain. However, prostaglandins also help the stomach lining to resist gastric acid, which is why aspirin and NSAIDs can cause stomach irritation and bleeding in some people.

Choosing the right pain-relieving medication

The right choice of medication for you will depend on your pain. Issues you need to discuss with your doctor include:

·         The location, intensity and type of pain

·         Any activities that ease the pain or make it worse

·         The impact your pain has on your lifestyle, such as how it affects your appetite or quality of sleep.

Your other medical conditions and the medicines you take can also determine which pain-relieving medication is right for you. You should discuss these with your doctor so that you choose the safest and most effective option. 

Managing your medications effectively

Always follow instructions for taking your medications safely and effectively. By doing so, your pain is more likely to be well managed, you are less likely to take larger doses of medication and you can reduce your risk of side effects.

Medications for chronic pain are best taken regularly. Talk to your doctor or pharmacist if your medicines lose their ability to reduce your pain or are causing you other problems, such as side effects. These are more likely to occur if you are taking pain-relieving medications for a long time.

People can lower their levels of felt pain by learning self-management skills, such as coping with depression and stress. Some studies have shown that medication can undermine the value of developing these skills. It is important to learn the skills you need to cope with your pain and not rely on medications alone to do this.

Side effects of pain-relieving medicines

Some of the side effects of common analgesics include:

·         Paracetamol can cause skin rash, liver and kidney damage (if used in large doses for a long time).

·         Aspirin can cause stomach irritation, allergic reactions in susceptible people (such as triggering an asthma attack), tinnitus (ringing in the ears), kidney damage (if used in large doses for a long time) and reduced blood-clotting ability.

·         Non-steroidal anti-inflammatory drugs (NSAIDs) can cause headache, nausea, stomach irritation and upsets, skin rashes, fatigue, dizziness and sleep problems.

·         Combination analgesics such as preparations that contain paracetamol and codeine can cause nausea, vomiting, constipation, dizziness, liver and kidney damage (if used in large doses for a long time).

·         Opioid analgesics such as morphine, oxycodone and codeine can cause nausea, vomiting, constipation, drowsiness, and reduced physical coordination and balance.

Non-drug pain management

Many non-drug treatments are available to help you manage your pain. A combination of treatments and therapies is often more effective than just one. Understanding the causes of your pain can help reduce your fear and anxiety. Ask your doctor to suggest other pain-management strategies that might work for you and complement your current regimen.

Some non-drug pain-management strategies include:

·         Heat or cold – heat packs can aid relief of chronic musculoskeletal injuries and associated pain. An icepack can be used to help reduce swelling immediately after an injury

·         Physical therapies – walking, as well as stretching and strengthening or aerobic exercises, may help relieve pain, depending on the cause. Physical activity can also help you stay active and improve your mood. Ask a physiotherapist or osteopath to design a program specifically for your pain condition

·         Massage – this is better suited to soft tissue injuries and should be avoided if the pain originates in the joints

·         Acupuncture – a component of traditional Chinese medicine. Acupuncture involves the insertion of thin needles into specific points on the skin and is believed to restore balance, encourage the body to heal itself and release natural pain-relieving compounds within the body (endorphins)

·         Relaxation and stress management techniques – including meditation and yoga

·         Transcutaneous electrical nerve stimulation (TENS) therapy – a minute electrical current is passed through the skin via electrodes, prompting a pain-relieving response from the body

·         Cognitive behavioural therapy (CBT) – this form of therapy can help you learn to change how you think and, in turn, how you feel and behave about pain. This is a valuable strategy for learning to self-manage chronic pain.

Always be guided by your doctor or other healthcare professional and follow their instructions carefully to avoid making your pain worse.

Chronic non-cancer pain

Sometimes, pain will persist and cannot be relieved. Some suggestions for how to emotionally handle this difficult and distressing situation include:

·         If all medical avenues have been exhausted, it may not be helpful to continue to raise false hopes by searching fruitlessly for a cure.

·         Accept that your pain may not go away and that flare-ups may occur. Talk yourself through these times.

·         Find out as much as you can about your condition so that you don't fret or worry unnecessarily about the pain.

·         Enlist the support of family and friends. Let them know what support you need, find new ways to stay in touch that are less painful for you to handle, and maintain healthy relationships with people in your social networks who may be able to support you.

·         Take steps to prevent or ease depression by any means that work for you, including talking to friends or professionals.

·         If pain-relieving medications can't ease the pain, talk to your doctor or pharmacist first about what you should do. Increasing your dose may not help your pain and might cause you harm.

·         Improve your physical fitness, eat healthy foods and make sure you get all the rest you need.

·         Don't allow the pain to curtail your life more than necessary. If you miss activities you used to do before the pain, try reintroducing those activities in a gently paced way. You may need to cut back on some activities if pain flare-ups occur, but it may be possible to increase slowly again as you did before.

·         Concentrate on finding fun and rewarding activities that don't make your pain worse.

·         Seek advice on new coping strategies and skills from a healthcare professional such as an occupational therapist or psychologist.

Be cautious when taking pain-relieving medications

Over-the-counter analgesics need to be treated with respect and caution, just like any other medication. It’s always a good idea to discuss any medication with your doctor.

General suggestions include:

·         Don’t self-medicate with analgesics during pregnancy – some medications can reach the fetus through the placenta and potentially cause harm.

·         Take care if you are elderly or caring for an older person. Older people have an increased risk of unwanted side effects. For example, taking aspirin regularly for chronic pain (such as arthritis) can cause a dangerous bleeding stomach ulcer.

·         Always tell your pharmacist about any prescription medicines you are taking so they can help you choose a safe analgesic. Over-the-counter medicines can interact with other medicines, possibly by stopping them working correctly and sometimes dangerously.

·         Don’t take more than one over-the-counter medicine at a time, or you may unintentionally take an overdose. For example, many ‘cold and flu’ tablets already contain paracetamol, so it is important not to take any other paracetamol-containing medicine to avoid an overdose.

·         See your doctor or healthcare professional for proper treatment for sport injuries. Don’t use pain-relieving medications to ‘tough it out’.

·         Consult your doctor or pharmacist before using any over-the-counter medicine if you have a chronic physical condition, such as heart disease or diabetes.

Where to get help

·         Your doctor

·         Pharmacist

·         National Chronic Pain Information Line Tel. 1800 218 921

·         NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)

·         Medicines Line (Australia) Tel. 1300 MEDICINE (1300 633 424) – for information on prescription, over-the-counter and complementary medicines

·         Adverse Medicine Events Line Tel. 1300 134 237

·         Austin Health Acute Pain Service Tel. (03) 9496 3485

·         Physical therapist

·         Occupational therapist

·         Counsellor or psychologist

Things to remember

·         At any given time, around one third of Australians are in pain.

·         Management strategies for pain include pain-relieving medications and complementary therapies (such as acupuncture and massage).

·         Studies suggest that a person's quality of life is influenced by their outlook and by the way they cope emotionally with chronic pain.

·         Seek advice on new coping strategies and skills from an occupational therapist or psychologist.

Source: http://www.betterhealth.vic.gov.au