One of the most frequent reasons our after hours doctors get called out for is pain. It’s a very generic word and encompasses a long list of conditions, accidents and falls that results in chronic, debilitating pain. So we thought we’d put together some information on the subject.
There is also another reason to talk about it. According to statistics provided by Pain Australia, one in five Australians suffer from chronic pain, many of them children and adolescents. By the age of 65, one in three Australians will be affected. And more than 80% of chronic pain sufferers are missing out on the right treatment! This just highlights that pain management does not always get the priority it needs in the healthcare system.
What is pain?
It would be impossible to discuss pain in one blog post, but we can talk about pain more generally and ways to manage it. So what is pain? Simply put, pain is an uncomfortable sensory feeling that signals tissue damage (in any part of the body or organ) that has occurred or may occur. The pain is transmitted through the spinal cord to the brain. When this message reaches the brain – we have the perception of pain.
Types of pain:
Pain can be of two kinds – acute and chronic.
- Acute pain is one-time and mostly short term pain triggered by an accident, injury, surgery etc. It is felt immediately and the cause is known.
- Chronic pain, on the other hand, is long-term pain such as lower back pain, tennis elbow, arthritis and fibromyalgia (chronic pain is the key symptom). It can take a while to diagnose the cause of the pain and the treatment can be quite complex. If you have any pain that has persisted for more than three months, it could be chronic. Chronic pain may take over a year to resolve or may be life long.
Most pain conditions belong to these categories:
- Inflammatory pain is a sign of tissue damage. For instance, if you sprain your ankle, you may notice inflammation around the area. It is the body’s way of protecting you by shielding the damaged tissue and also signalling that it needs rest. GPs refer to this as a protective pain that helps in recovery. This type of pain is also called Nociceptive and includes the body’s reaction to insect stings, burns etc. In cases like an ankle sprain, the pain can be acute and treatable with oral pain killers and/or topical applications. In cases like osteoarthritis it may be chronic pain requiring complex treatment and a management plan.
- Neuropathic pain is caused when the nervous system, which is the carrier of pain impulses to the brain does not function normally. This may be due to nerve damage or overstimulation and it is often very hard to diagnose the underlying cause. The pain is often magnified compared to the severity of the underlying cause. Also, OTC painkillers are not effective in treating this condition. Neuropathic pain encompasses several pain conditions.
Pain can overlap classification. For instance, there could be tissue damage (which is the underlying cause) and nerve damage (messenger is not functioning normally).
Secondary conditions caused by pain:
Intense pain is debilitating and can have spin-off effects such as:
- Tension and fatigue – this has big implications for people’s professional and personal lives. In children and adolescents, it has the potential to impact their academic performance and confidence at school.
- Increased heart rate and blood pressure – this is often the body’s reaction to pain that has not been addressed.
- Anxiety and depression – this can sometimes be a two-way street, with chronic pain causing mental health issues and the latter aggravating nerve and tissue damage. In some cases, mental health issues can be the underlying reason for pain.
Treatment of pain:
Pain is in the brain. Look at how anaesthesia works – it prevents pain transmission to the brain – ensuring we feel no pain while being operated on. Most painkillers belong to two categories:
- Non-Opioid medication, usually OTC products such as Panadol, Tylenol, Ibuprofen, Nurofen etc. are used for mild to medium pain. They contain substances such as aspirin or paracetamol. These work by blocking enzymes that trigger pain signals. These are best taken for a very limited period of time, following which you must see your GP.
- Opioid medications can only be prescribed by your GP and are used to treat severe pain. They could contain drugs such as morphine, codeine and/or narcotics. These drugs work by altering brain chemistry and are known to be addictive in case of prolonged use. Overdoses can be fatal. It is therefore very important that this medication is constantly reviewed and monitored by your GP.
Alternatives to medication:
Pain management is a very specialised area of medicine and now incorporates management plans that use medication and alternative therapies to control pain.
- There are simple and frequently used options like hot and cold packs and physiotherapy.
- Alternative sciences like acupuncture, remedial yoga and meditation are increasingly popular.
- TENS – a therapy that uses minute electrical currents to prompt pain-relieving response from the body is being used in pain management plans.
- CBT has proved quite effective in self-managing pain by teaching people mental strategies to cope.
Counter-intuitive as it sounds, pain is protective. It is both, an early warning system telling you that something is wrong and a constraint forcing you to rest. Pain, especially chronic, needs to be managed well. So if you’ve had a niggling pain that has lasted more than 3 months do not hesitate to see your GP. By getting onto the right plan and seeing a pain specialist if you need to, you will prevent further damage and improve your quality of life.
Organisations such as Pain Australia, Chronic Pain Australia and Pain Management Australia are all working towards raising awareness of pain as a medical condition that needs resources, specialists and recognition. Their websites contain excellent information on programmes, treatment, alternative therapies and support groups.
Here are resources that you can check out: