PAIN MANAGEMENT

PAIN MANAGEMENT

Pain management, pain medicine,  and pain control is a branch of medicine that uses an interdisciplinary approach for easing the suffering and improving the quality of life of those living with chronic pain. The typical pain management team includes medical practitioners, pharmacists, clinical psychologists, physiotherapists, occupational therapists, physician assistants, nurses, dentists. The team may also include other mental health specialists and massage therapists.

 

Defining pain

In the nursing profession, one common definition of pain is any problem that is “whatever the experiencing person says it is, existing whenever the experiencing person says it does”.

Pain management includes patient communication about pain problems. To define the pain problem, a health care provider will likely ask questions such as:

• How intense is the pain?
• How does the pain feel?
• Where is the pain?
• What, if anything, makes the pain lessen?
• What, if anything, makes the pain increase?
• When did the pain start?

After asking such questions, the health care provider will have a description of the pain.

 

Adverse effects

There are many types of pain management. Each has its own benefits, drawbacks, and limits.

A common challenge in pain management is communication between the health care provider and the person experiencing pain. People experiencing pain may have difficulty recognizing or describing what they feel and how intense it is. Health care providers and patients may have difficulty communicating with each other about how pain responds to treatments. There is a risk in many types of pain management for the patient to take treatment that is less effective than needed or which causes other difficulties and side effects. Some treatments for pain can be harmful if overused. A goal of pain management for the patient and their health care provider is to identify the amount of treatment needed to address the pain without going beyond that limit.

 

Another problem with pain management is that pain is the body’s natural way of communicating a problem. Pain is supposed to resolve as the body heals itself with time and pain management. Sometimes pain management covers a problem, and the patient might be less aware that they need treatment for a deeper problem.

 

 

Example of a pain management solution:

• Exercise interventions
• Acupuncture
• Cognitive-behavioral therapy
• Hypnosis
• Mindfulness meditation
• Mindfulness-based pain management
• Medications

 

What Type of Pain do I Have?

Sometimes it can be hard to identify exactly what type of pain you are experiencing. The checklist below can help you to identify your pain type and other contributing factors. Fill it in before you see your doctor.

 

 

If you have a child that is experiencing pain, The Faces Pain Scale may help. This uses a series of diagrams depicting a face with no pain (0) to intense pain (10).

 

 

How Do I Manage My Pain?

There are many different types of pain-relieving medications and each class works in a slightly different way. Most medications can be grouped under one of the following:

 

• Nonopioids: a medicine that is not similar to morphine (an opioid) but is not addictive (eg, acetaminophen, aspirin, NSAIDs)
• Weak opioids: a medicine that is similar to morphine (an opioid) but not considered as strong (eg, codeine, tramadol)
• Combination opioids: these contain a nonopioid and either a weak opioid or a strong opioid (eg, acetaminophen and hydrocodone)
• Strong opioids: a medicine such as morphine or similar to morphine that has the potential to cause addiction (eg, fentanyl, morphine, oxycodone)
• Adjuvant treatments: a medicine that can help relieve pain by relieving inflammation or by improving the functioning of other systems (eg, cannabidiol, capsaicin cream, gabapentin)
• Nonpharmacological treatments (drug-free treatments): psychotherapy or counseling.

 

The choice of pain-relieving medication comes down to how effective it is for that type of pain and the likelihood of side effects in that particular person.

Some types of pain (such as cancer-related pain) have an unpredictable course that can vary dramatically in severity and duration, depending on the type of treatment and disease progression. Pain management needs to have some flexibility to account for this.

Changing the method of delivery of pain medication may improve its effectiveness. For example, changing from an oral treatment to a patch or a subcutaneous pain pump.

Traditionally, most experts have recommended a stepwise approach to pain management, starting with acetaminophen or NSAIDs, then progressing to a weak opioid (such as codeine, dihydrocodeine, or tramadol), before changing to a strong opioid (such as fentanyl, morphine, oxycodone).

 

Pain Management for Specific Types of Pain

Some medications are considered better for some types of pain compared with others, although factors such as the cause of the pain, genetics, interacting medications or supplements, as well as coexisting conditions,  can all impact on how effective a medicine is. Possible treatment options for different types of pain are:

• Acute pain: nonopioids, weak opioids, opioids, nonpharmacological treatments such as ice or bioelectric therapy
• Chronic pain: nonopioids, weak opioids, opioids, antidepressants, capsaicin cream, nonpharmacological treatments such as bioelectric therapy, radiation therapy
•  Breakthrough pain: short-acting opioid, nonpharmacological treatments such as acupuncture or relaxation techniques
• Bone pain: nonopioids, bisphosphonates, opioids, nutritional supplements, surgery
• Nerve pain: antidepressants, anticonvulsants, capsaicin cream, nonpharmacological treatments such as cognitive-behavioral therapy
• Phantom pain: nonopioids, antidepressants, anticonvulsants, ketamine, nonpharmacological treatments such as acupuncture or repetitive transcranial magnetic stimulation (rTMS)
• Soft tissue pain: nonopioids, corticosteroids, nonpharmacological treatments such as ice, physiotherapy, or ultrasonography
• Referred pain: nonopioids, cold/warm compresses, nonpharmacological treatments such as massage or transcutaneous electrical nerve stimulation (TENS).

 

Always talk to your doctor about which pain medication is right for you.