What is pain?
Pain starts in receptor nerve cells located beneath the skin and in organs throughout
the body. When there is an illness, injury, or other type of problem, these receptor
cells send messages along nerve pathways to the spinal cord, which then carries the
message to the brain. Pain medicine works by reducing or blocking these messages before
they reach the brain.
Pain can be anything from a slightly bothersome, such as a mild headache, to something
excruciating and emergent, such as the chest pain that accompanies a heart attack,
or pain of kidney stones. Pain can be acute, meaning new, subacute, lasting for a
few weeks or months, and chronic, when it lasts for more than 3 months.
Chronic pain has been said to be one of the most costly health problem in U.S. Increased
medical expenses, lost income, lost productivity, compensation payments, and legal
charges are some of the negative economic consequences of chronic pain. Consider the
Low back pain is one of the most significant health problems. Back pain is a common
cause of activity limitation in adults.
Cancer pain affects the majority of people with intermediate or advanced stages of
Arthritis pain affects more than 50 million Americans each year.
Headaches affect millions of U.S. adults. Some of the most common types of chronic
headaches are migraines, cluster headaches, and tension headaches.
Other pain disorders such as the neuralgias and neuropathies that affect nerves throughout
the body, pain due to damage to the central nervous system (the brain and spinal cord),
as well as pain where no physical cause can be found--psychogenic pain--increase the
total number of reported cases.
What are the different types of pain?
Two types of pain include the following:
Acute pain. This pain may come from inflammation, tissue damage, injury, illness, or recent
surgery. It is of short duration, usually lasting less than a week or two. The pain
usually ends after the underlying cause is treated or has been resolved.
Chronic pain. Pain that persists for months or even years.
What is chronic pain?
Chronic pain is long standing pain that persists beyond the usual recovery period
or occurs along with a chronic health condition, such as arthritis. Chronic pain may
be "on" and "off" or continuous. It may affect people to the point that they can't
work, eat properly, participate in physical activity, or enjoy life.
Chronic pain is considered a major medical condition that can and should be treated.
What causes chronic pain?
There are many causes of chronic pain. It may have started from an illness or injury,
from which you may have long since recovered from, but pain remained. Or there may
be an ongoing cause of pain, such as arthritis or cancer. Many people suffer chronic
pain in the absence of any past injury or evidence of illness.
What is the "terrible triad?"
When pain becomes such a problem that it interferes with your life's work and normal
activities, you may become the victim of a vicious circle. Pain may cause you to become
preoccupied with the pain, depressed, and irritable. Depression and irritability often
leads to insomnia and weariness, leading to more irritability, depression, and pain.
This state is called the "terrible triad" of suffering, sleeplessness, and sadness.
The urge to stop the pain can make some people drug-dependent, and may drive others
to have repeated surgeries, or resort to questionable treatments. The situation can
often be as hard on the family as it is on the one suffering with the pain.
How is chronic pain treated?
Chronic pain involves all aspects of your life. The most effective treatment includes
symptom relief and support. A multidisciplinary approach to pain management is often
required to provide the needed interventions to help manage the pain. Pain management
programs are usually conducted on an outpatient basis. Many skilled professionals
are part of the pain management rehabilitation team, including any or all of the following:
Special pain programs are located in many hospitals, rehabilitation facilities, and
The pain management rehabilitation program
A pain management rehabilitation program is designed to meet your individual needs.
The program will depend on the specific type of pain, disease, or condition. Active
involvement by you and your family is vital to the success of the program.
The goal of pain management programs is to help you return to the highest level of
function and independence possible, while improving the overall quality of life--physically,
emotionally and socially. Pain management techniques assist in reducing your suffering.
To help reach these goals, pain management programs may include the following:
Medical management of chronic pain, including medicine management:
Over-the-counter (OTC) medicines may include nonsteroidal anti-inflammatory drugs
(NSAIDs), aspirin, or acetaminophen.
Prescription pain medicines, including opioids, may be needed to provide stronger
pain relief than aspirin. However, these drugs are reserved for more severe types
of pain, as they have some potential for abuse and may have unpleasant and potentially
very dangerous side effects.
Prescription antidepressants can help some people. This is because these medicines
increase the supply of the naturally produced neurotransmitters, serotonin and norepinephrine.
Serotonin has been found to be an important part of a pain-controlling pathway in
Heat and cold treatments to reduce the stiffness and pain, especially with joint disorders
such as arthritis
Physical and occupational therapy interventions such as massage and whirlpool treatments
Exercise to reduce spasticity, joint contractures, joint inflammation, spinal alignment
problems, or muscle weakening and shrinking to prevent further problems
Local electrical stimulation involving application(s) of brief pulses of electricity
to nerve endings under the skin to provide pain relief
Injection therapies, such as epidural steroid injection
Emotional and psychological support for pain, which may include the following:
The philosophy common to all of these varied psychological approaches is the belief
that you can do something on your own to control pain, including changing your attitudes,
the perception of being a victim, feelings, or behaviors associated with pain, or
understanding how unconscious forces and past events have contributed to pain.
Patient and family education and counseling
Alternative medicine and therapy treatments, as appropriate
In addition, treatment may include:
Surgery. Surgery may be considered for chronic pain. Surgery can bring release from pain, but
may also destroy other sensations as well, or become the source of new pain. Relief
is not necessarily permanent, and pain may return. There are a variety of operations
to relieve pain. Consult your doctor or more information.
Acupuncture. Acupuncture is a 2000-year-old Chinese technique of inserting fine needles under the
skin at selected points in the body, and has shown some promise in the treatment of
chronic pain. Needles are manipulated by the practitioner to produce pain relief.