Pain is something that everyone has felt at some time in his or her life. That unpleasant sensation is usually caused by an injury, which leads to release of chemicals that the local nerves pick up. They are then carried by the nervous system to the brain. Pain is protective. It signals danger, and alerts the body to try and avoid the stimulus that leads to it.
Acute pain is usually due to an injury, infection or trauma. It lasts only as long as the condition is present. It responds to medication and treatment. Chronic pain on the other hand persists for weeks, months, even years. It may follow an attack of acute pain, (fracture, surgery), persist because of an untreated condition (sinusitis, ear or tooth infections) or incurable disease (arthritis, cancer). Some people may also suffer pain for a long time despite there being no history of injury or any sign of damage. Even doctors and clinical tests may be unable to find out its cause.
Headache, backache, leg pain, sharp electric nerve pains and other chronic pains are commoner in older adults and women. Four to five per cent of the adult global population suffers from pain. It is the commonest reason for medical consultations across all specialties, as the patient picks and chooses consultants, depending on their perception of the diagnosis (back ache — orthopedics, headache — neurologist).
Patients in constant pain lose manhours at work, are unable to concentrate, feel depressed and lethargic and suffer from insomnia. Their efficiency and productivity are affected. They feel that their lives are out of control.
Pain is of several types, superficial, deep, visceral, spasmodic or neuropathic. It is treated with a group of drugs called analgesics. Many are available OTC (over the counter) and do not require a doctor’s prescription. Some are even advertised. Patients often self medicate with inappropriate analgesics in inadequate or excessive dosage but you have to remember that the same medication does not work for all pain. It is best to consult a doctor who can make an educated choice of medication. More than 60 per cent of the patients who approached doctors for pain relief improved, and had fewer side effects compared to the less than 40 per cent of those who treated themselves.
Treatment for pain starts with the lowest dose of the mildest agent and the analgesics should gradually be increased step by step. Once the maximum dose is reached, another group can be added or the medication changed.
The safest drugs are paracetemol, salicylates and NSAIDs (non-steroidal anti-inflammatory agents). For best results, the prescribed dose and the time between each dose should be followed meticulously. Do not supplement prescribed painkillers with OTC drugs or herbal preparations as all of them may actually contain the same ingredients. Then the total dosage may unknowingly exceed the safety limits and produce dangerous side effects.
All these drugs can cause gastric irritation and prolong bleeding time. Long term use can result in aggravation of ulcers, liver and kidney toxicity. Hearing loss can occur subtly and be gradually progressive.
The next group of drugs is the COX inhibitors. Various derivatives are available but across the board, they have been associated with deleterious effects on the heart. Opioid derivatives like tramadol, codeine and morphine are effective but can be addictive.
The traditional analgesics may not work satisfactorily for “nerve pain”. To be effective and reduce the stimulus to the nerves, they may have to be combined with medications traditionally considered antidepressants or anticonvulsants.
All painkillers (even aspirin and paracetemol) can be habituating, with higher doses gradually required to produce the same effect. They can be addictive as well.
Before starting medication try a few simple remedies.
Chronic pain (particularly arthritis and back pain) responds to topical applications of ointments containing capsaicin, ibuprofen, diclofenac or menthol. These need to be gently applied over the affected site every four hours, followed by an ice pack.
Yoga, acupressure, Tai chi and meditation are traditional but effective methods to reduce pain perception.
Physiotherapy helps with mobility and pain relief.
Bio-feedback techniques can be used to alter pain perception and trick the body into feeling that the pain has disappeared.
Exercising regularly — walking, jogging, running, cycling or swimming — teaches the body discipline and enables it to work through pain and fatigue. It has also been proven that exercise can prevent many of the diseases responsible for chronic pain.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at firstname.lastname@example.org