Pain Management

What is pain?

The occurrence of pain rises as people get older, and women are more likely to experience pain than men.

The most common causes of pain in adults include:

  • injury
  • medical conditions (such as cancer, arthritis and back problems
  • surgery

There are 2 main types of pain:

  • Acute pain – a normal response to an injury or medical condition. It starts suddenly and is usually short-lived.
  • Chronic pain – continues beyond the time expected for healing. It generally lasts for longer than 3 months.

Pain may be anything from a dull ache to a sharp stab and can range from mild to extreme. You may feel pain in one part of your body or it may be widespread.

Chronic pain is a condition that describes persistent pain that lasts from weeks to years. While the duration of pain is not definitive, the term typically applies to persistent pain that endures for more than 3 months. Chronic pain is most common in people between 40 and 60 years of age.

Acute pain occurs suddenly, and is associated with injury or short-term illness. Pain that is acute will resolve within 3 months time. Examples of acute pain include sprains, minor burns, cuts, and muscle spasms. Unlike acute pain, chronic pain is persistent, subjective, and may arise from a variety of illnesses or psychological state of mind.

The causes of chronic pain are as broad as the condition itself. Some reported causes of chronic pain are illness, old injury, and genetic conditions. More specifically, some people have been able to establish a correlation of their pain with: arthritis, nerve damage, depression, motor vehicle accidents and more.

Chronic pain can do more than just cause discomfort, it can negatively impact sleep cycles and appetite. This often results in extreme fatigue and mood changes, with an increased risk of depression. The severity of pain can vary greatly.

Pain is a complex protective mechanism. It is an essential part of evolution that protects the body from danger and harm.

The body has pain receptors that are attached to 2 main types of nerves that detect danger. One nerve type relays messages quickly, causing a sharp, sudden pain. The other relays messages slowly, causing a dull, throbbing pain.

Some areas of the body have more pain receptors than others. For example, the skin has lots of receptors so it is easy to tell the exact location and type of pain. There are far fewer receptors in the gut, so it is harder to pinpoint the precise location of a stomach ache.

If pain receptors in the skin are activated by touching something dangerous (for example something hot or sharp), these nerves send alerts to the spinal cord and then to part of the brain called the thalamus.

Sometimes the spinal cord sends an immediate signal back to the muscles to make them contract. This moves the affected body part away from the source of danger or harm.

This is a reflex reaction that prevents further damage occurring. It happens before you feel pain.

Once the ‘alert!’ message reaches the thalamus, it sorts the information the nerves have sent, taking into account previous experience, beliefs, expectations, culture and social norms. This explains why people have very different responses to pain.

The thalamus then sends the information on to other parts of the brain that are linked to physical response, thought and emotion. This is when you may feel the sensation of pain, think ‘That hurt! What was it?’, and feel annoyed.

The thalamus also contributes to mood and arousal, which helps to explain why your interpretation of pain partly depends on your state of mind.

What steps can I take to manage my pain?

Accessing specialist pain management services often takes months to years, and in the meantime an individuals’ dependence on medications can increase while their mood deteriorates.

A person’s emotional wellbeing can impact the experience of pain. Understanding the cause and learning effective ways to cope with your pain can improve your quality of life. Key pain management strategies include:

  • pain medicines
  • physical therapies (such as heat or cold packs, massage, hydrotherapy and exercise)
  • psychological therapies (such as cognitive behavioural therapy (CBT), relaxation techniques and meditation)
  • mind and body techniques (such as acupuncture)
  • community support groups.

Reasons you might need pain management

People suffer from varied types of pain, which can fall into a number of different categories. If you are experiencing any of the following, you may want to see a pain specialist:

  • Low back pain;
  • Neck pain, including whiplash;
  • Leg pain, including sciatica;
  • Headaches;
  • Facial pain;
  • Nerve pain or
  • Arthritis

Chronic pain and depression commonly co-exist; pain can be a result of persistent depression and depression can be a result of persistent pain.

It’s also not uncommon to experience anxiety alongside chronic pain. Anxiety disorders are the second most diagnosed disorder after depression in those with chronic pain.

Some people may find that their pain and mental health issues cause them to avoid certain situations and become inactive.

Both of these behaviours can become chronic issues in themselves. Avoidance can lead to social isolation, and inactivity can worsen chronic pain. In turn, this can make depression even worse.

Here are conditions that can cause chronic pain

Chronic pain can be caused by many different conditions or illnesses. Some of the most common causes include:

  • Endometriosis
  • Past injuries or surgeries
  • Back problems
  • Arthritis
  • Nerve damage
  • Fibromyalgia
  • Migraines
  • Cancer pain
  • Slow healing after surgery

Not only can depression make day-to-day life difficult, but it can also slow down the healing process after surgery and lead to further complications.

People with moderate anxiety and depression have an increased chance of wound complications, hospital re-admissions and longer hospital stays. The complications can be even worse for those with severe anxiety or depression.

Mental health is something that shouldn’t be overlooked before having surgery. If you think you might be depressed and are going to have surgery, it’s important to seek help to make sure you’re physically and mentally prepared.

10 signs you might be depressed

Symptoms vary from person to person and can include physiological, physical and social symptoms. There are many different symptoms of depression, but they can include:

  • Loss of interest in things you used to enjoy
  • Persistent low mood
  • Feeling hopeless
  • Feeling anxious
  • Having low self-esteem
  • Lack of energy
  • Isolating yourself from friends and family
  • Feeling irritable and intolerant of others
  • Experiencing suicidal thoughts or thoughts about harming yourself

If you’re suffering from chronic pain and depression, it’s important to treat both problems at the same time. Considering one without the other isn’t likely to resolve the overall issue. However, when the two occur simultaneously, it can be harder to treat.

Chronic pain can be treated in a number of ways. Everyone is different and what works for someone else may not work for you.

However, chronic pain can be managed with the aim of going back to everyday life.

Some ways chronic pain can be managed are:

  • Acupuncture
  • Massage therapy
  • Reflexology
  • Yoga
  • Pilates
  • Pain Management
  • Physiotherapy
  • Surgery (depending on the condition)
  • Medication

What to do next

When it comes to depression and chronic pain, it’s clear that there is a need for action and a greater understanding of how these conditions are interlinked. Both conditions should be treated at the same time to ensure the most positive outcomes and most effective management.

If you think you might be depressed, it’s important to speak up and seek help. See our local and national organisations sections.

Many non-medicine treatments are available to help you manage your pain. A combination of treatments and therapies is often more effective than just one.

Some non-medicine options include:

  • Heat or cold – use ice packs immediately after an injury to reduce swelling. Heat packs are better for relieving chronic muscle or joint injuries.
  • Physical therapies – such as walking, stretching, strengthening or aerobic exercises may help reduce pain, keep you mobile and improve your mood. You may need to increase your exercise very slowly to avoid over-doing it.
  • Massage is another physical therapy; it is better suited to soft tissue injuries and should be avoided if the pain is in the joints. There is some evidence that suggests massage may help manage pain, but it is not recommended as a long-term therapy.
  • Relaxation and stress management techniques – including meditation and yoga.
  • Cognitive behaviour therapy (CBT) this form of psychological 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.
  • Acupuncture is a component of traditional Chinese medicine. Acupuncture involves inserting thin needles into specific points on the skin. It aims to restore balance within the body and encourage it to heal by releasing natural pain-relieving compounds (endorphins). Some people find that acupuncture reduces the severity of their pain and enables them to maintain function. However, studies on the effectiveness of acupuncture in managing pain is inconclusive.
  • Transcutaneous electrical nerve stimulation (TENS) therapy – low voltage electrical currents pass through the skin via electrodes, prompting a pain-relieving response from the body. There is not enough published evidence to support the use of TENS for the treatment of some chronic pain conditions. However, some people with chronic pain that are unresponsive to other treatments may experience a benefit.

Your doctor or other healthcare professional can guide you through the best treatments for you.

Many people will use a pain medicine at some time in their lives.

The main types of pain medicines are:

  • Paracetamol – often recommended as the first medicine to relieve short-term pain.
  • Aspirin – for short-term relief of fever and mild-to-moderate pain (such as period pain or headache)
  • Non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen – these medicines relieve pain and reduce inflammation (redness and swelling).
  • Opioid medicines, such as codeine, morphine and oxycodone – these medicines are reserved for severe or cancer pain.
  • Local anaesthetics (drops, sprays, creams or injections) – used when nerves can be easily reached.
  • Some antidepressants and anti-epilepsy medicines – used for a specific type of pain, called nerve pain.

How pain medicines work

Pain medicines work in various ways. Aspirin and other NSAIDs are pain medicines that help to reduce inflammation and fever. They do this by stopping chemicals called prostaglandins. Prostaglandins cause inflammation, swelling and make nerve endings sensitive, which can lead to pain.

Prostaglandins also help protect the stomach from stomach acid, which is why these medicines can cause irritation and bleeding in some people.

Opioid medicines work in a different way. They change pain messages in the brain, which is why these medicines can be addictive.

Choosing the right pain medicine

The right choice of medicine for you will depend on:

  • the location, intensity, duration 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
  • other medicines you take.

Discuss these with your pharmacist, doctor or other health professional, so that you choose the safest and most effective pain relief option.

Always follow instructions for taking your medicines safely and effectively. By doing so:

  • your pain is more likely to be well managed
  • you are less likely to need larger doses of medicine
  • you can reduce your risk of side effects

Medicines for chronic pain are best taken regularly. Talk to your doctor or pharmacist if your medicines are not working or are causing problems, such as side effects. These are more likely to occur if you are taking pain medicines for a long time.

It is important to use a variety of strategies to help reduce pain. Do not rely on medicines alone. People can lower the levels of pain they feel by:

  • staying active
  • pacing their daily activity so as to avoid pain flares (this involves finding the balance between under- and over-doing it)
  • avoiding pain triggers
  • using coping strategies.

Treat over-the-counter pain medicines with caution, just like any other medicines. It’s always good to discuss any medicines with your doctor or pharmacist.

General suggestions include:

  • Don’t self-medicate with pain medicines during pregnancy – some 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 side effects. For example, taking aspirin regularly for chronic pain (such as arthritis) can cause a dangerous bleeding stomach ulcer.
  • When buying over-the-counter pain medicines, speak with a pharmacist about any prescription and complementary medicines you are taking so they can help you choose a pain medicine that is safe for you.
  • Don’t take more than one over-the-counter medicine at a time without consulting your doctor or pharmacist. It is easier than you think to unintentionally take an overdose. For example, many ‘cold and flu’ medicines contain paracetamol, so it is important not to take any other paracetamol-containing medicine at the same time.
  • See your doctor or healthcare professional for proper treatment for sport injuries.
  • Don’t use pain medicines to ‘tough it out’.
  • Consult your doctor or pharmacist before using any over-the-counter medicine if you have a chronic (ongoing) physical condition, such as heart disease or diabetes.

Sometimes pain will persist and cannot be easily relieved. It’s natural to feel worried, sad or fearful when you are in pain. Here are some suggestions for how to handle persistent pain:

  • Focus on improving your day-to-day function, rather than completely stopping the pain.
  • 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 ways to stay in touch.
  • Take steps to prevent or ease depression by any means that work for you, including talking to friends or professionals.
  • Don’t increase your pain medicines without talking to your doctor or pharmacist first.
  • 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.
  • Try not to allow the pain to stop you living your life the way you want to. Try gently reintroducing activities that you used to enjoy. You may need to cut back on some activities if pain flare-ups occur, but 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 a psychologist.

Concerned about someone else and their pain?

The lack of reprieve from pain can be exhausting for the one suffering from the pain and loved ones.

If you are a family member or loved one of someone suffering from chronic pain, you may feel stress, frustration, and even anger. These are common emotions when dealing with the significant impact of chronic pain. However, supporting someone with chronic pain is extremely important. If you have never experienced anything similar yourself, you may have difficulty understanding the complexity of it.

People with chronic pain tend to communicate differently with those who are well. They may be reluctant or unable to talk about their pain and their feelings. They may tell you they are fine when they are not, and it may simply be that they don’t have the right words to describe how they feel. This can lead to a breakdown in communication.

First, it’s crucial to let go of some common misconceptions about what chronic pain actually is. The concept of pain has undergone considerable revision in recent decades. While once thought of in purely physical terms, we now know that it is made up of physical, psychological, and neurological factors. But many people still treat those suffering from pain as though it’s only a sign of physical injury.

Pain sufferers may be met with disbelief if they do not have a visible injury. We now realize that the involvement of neurological factors explains why pain can occur in the absence of external causes. Oftentimes, when pain persists, part of that pain turns into anxiety and depression.

Whether physical or emotional, pain is very difficult to convey in language, making it even harder to understand what the pain sufferer is experiencing. So to understand a person in pain, you have to remember that pain is a highly complex and individual thing. Pain is different for everybody, depending on personality and past experiences. You will never truly understand another person’s pain, but you can do your best to try.

Truly listening is one of the most helpful things you can do for a person in pain. To be a good listener, you must let go of any preconceived notions or assumptions. Listening also involves more than just hearing what is being said. You may need to read between the lines and interpret unspoken non-verbal cues. Pay attention to how they are saying something as much as what they are saying.

While listening, look for signs of severe or inadequately controlled pain, including sweating, irritability, sleep disturbances, restlessness, difficulty concentrating, decreased activity, and suicidal thoughts. Many chronic pain sufferers are so accustomed to these negative feelings they do not recognize their significance.

Unfortunately, those suffering from pain are sometimes not believed when they do open up about their pain. There are many reasons for this, including a myth that chronic pain sufferers exaggerate their pain in order to gain sympathy or avoid responsibilities. Research has shown that exaggerating pain to get sympathy is very rare. You love the person who is in pain, so make sure you have an open mind about what they are telling you and believe what they say.

Every person with chronic pain has a unique, individual experience. People that live with chronic pain do not always show any visible symptoms, so it is helpful to be knowledgeable about their condition. If they are having treatments done, look those up as well.

The pain scale is a tool we use to measure and describe the intensity of the pain an individual feels at any given moment. This includes values from 1 to 10 to describe levels of pain. A rating of 1 indicates “free of pain and feeling wonderful,” while a rating of 10 indicates the “most horrible pain ever experienced.” If you are familiar with the pain scale, it can be a useful, objective tool at home in identifying and understanding pain levels.

As a support person or caregiver, there is no way for you to know how the pain sufferer feels. You must believe them when they say they need a break or a day off. It is important to respect their physical capabilities. When the person in chronic pain says that they need to lie down, sit down, or take medication immediately, listen to them without judgment. Also, understand that just because the individual with chronic pain was able to walk around to see a friend yesterday does not mean they can do it again today.

Don’t ever give up on someone with chronic pain. Even if they have canceled the last three times you invited them to an event or social engagement, invite them again. They may feel up to going next time. Chronic pain can be very isolating, and sometimes just being asked or invited is the most important thing.

Chronic pain is often accompanied by secondary depression. Depression can lead to the individual hiding their pain, masking their emotions, and isolating themselves. Be sure to discuss any depression symptoms you notice and offer love, support, and understanding. Gently suggest that they bring it up to their doctor, or if you are going to the next appointment, ask for permission to bring it up on their behalf.

Chronic pain is very difficult to deal with for the one going through it and for the ones who love that person. While most people mean well, being smart about how you help and how you provide support is very important. Sometimes listening well, providing encouragement, and never giving up can make all the difference in the world.

Local support

See what local support is available for Pain Management.

National support organisations

See what national support is available for Pain Management.

Tel: 0300 123 0789

Email: help@painconcern.org.uk

Pain Concern offers telephone and email services to individuals in the UK through our helpline.

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