Who Let The Doc Out?! #002: What to know about pain and managing it

pain and pain management

Pain is an important part of our daily lives. It can be hard to believe, but the sensation of pain is vital to out survival. Pain is the body’s way of letting us know something isn’t right. In fact, in the extremely rare cases where people are born with a congenital insensitivity to pain, life expectancy is drastically reduced.

So, we understand that pain is important. But that doesn’t make the sensation any less unpleasant. This is why it’s important to know how to deal with pain without having to seek medical attention from a professional.

Types of pain

Pain is usually categorized as either acute pain – a normal short-lived response to an injury or medical condition – or chronic pain – which continues beyond the time of healing and generally lasts longer than 3 months. However, there are four primary types of pain which can help you and your physician pinpoint the cause of the pain and what treatment you may need:

  • Nociceptive pain: This results from tissue injury, which can include a laceration, a burn, arthritis pain, or post-surgical pain. It’s the most commonly encountered type.
  • Inflammatory pain: This results from your body’s inflammatory immune response. Conditions which cause this pain include cellulitis, rheumatoid arthritis, and gout.
  • Neuropathic pain: This occurs as a result of injury or irritation of the nerves, and is seen in conditions like peripheral neuropathy and trigeminal neuralgia.
  • Functional pain: This is pain without obvious organic origin, for example musculoskeletal pain in fibromyalgia or visceral pain in IBS.

Medical management of pain

Your physician will likely recommend a stepwise approach to managing both acute and chronic pain with painkillers as follows:

1.      Non-opioids

This includes medications like acetaminophen (also known as paracetamol), aspirin, and NSAIDs, a group of anti-inflammatory painkillers that includes diclofenac, ibuprofen, and mefenamic acid. These drugs are usually preferred as the first course of action because they’re not addictive like opioids and can be acquired over-the-counter without needing a prescription.

2.      Weak opioids

These include medications like tramadol and codeine. They can also be bought from a pharmacy without a prescription with the guidance of a pharmacist, and are the next course of action if pain isn’t controlled with non-opioids alone. However, they should be used with caution as prolonged abuse can lead to addiction.

3.      Combination opioids

These contain a non-opioid combined with an opioid for stronger relief, and they include combinations of tramadol and acetaminophen, and acetaminophen and hydrocodone.

4.      Strong opioids

These are the final line of defense in pain management. They include medications like morphine, fentanyl, and oxycodone. These are used only under the strict supervision of trained medical professionals to manage severe pain, and must not be used as long-term solutions as they can cause serious addiction disorders. Exceptions for long-term use of strong opioids are made for palliative care patients with terminal conditions like cancer.

Non-medical management of pain

Alternatively, especially in the management of chronic pain with known causes, you can use non-medical methods to ease your discomfort. These methods include:

  • Physiotherapy: This is the use of special techniques to improve movement and function impaired by an injury or disability. It is done with the assistance or guidance of a physiotherapist and employs pain-relieving techniques to aid treatment.
  • Exercise: Research shows that regular exercise can diminish pain by improving muscle tone, strength, and flexibility. Additionally, it releases endorphins, the body’s natural painkillers, which can help ease discomfort.
  • Alternative therapies: Although research proving the efficacy of alternative therapies like acupuncture, chiropractic treatment, and massage therapy is still inconclusive, many people have reported satisfaction with their use for chronic pain in conditions like headache, lower back pain, osteoarthritis, and fibromyalgia.
  • Psychotherapy: Chronic and severe pain can come with feelings of anger, helplessness, sadness, and despair. Psychotherapy can treat pain by reducing the high levels of physiological stress that may aggravate pain.

What you need to know

Like all medications, pain medications come with adverse effects that can range from mild to life-threatening. For example, mixing high amounts of acetaminophen with alcohol can cause liver injury. High doses of NSAIDs have been known to cause kidney injury, and their long-term use can cause peptic ulcer disease and bleeding. Opioids come with the risk of addiction. Different medications may also interact adversely with each other.

Because of this, it’s important to have a word with your physician or pharmacist about which pain medication is best for you and what possible side effects you should look out for.

Innocent Immaculate Acan is a medical doctor and writer currently working at Adjumani Hospital. She won the Writivism Short Story Prize in 2016 and has published an illustrated children’s book titled The Pearl Trotters in Black, Yellow, Red. She was part of the 2018 class of the Young and Emerging Leaders Project.

Innocent Immaculate Acan