Management of pain

Dr Rohit Lahori
Pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
Pain can be reported in absence of any tissue damage or any likely patho-physiological cause. If person regard their experience as pain……it should be accepted as pain.  Pain alters the quality of life more than any other health-related problem. It interferes with sleep, mobility, nutrition, thought, sexual activity, emotional well-being, creativity, and self-actualization. Surprisingly, even though pain is such an important obstacle to comfort, it is one of the least understood, most undertreated and often-discounted problems of healthcare providers and their clients.
Types of Pain
ACUTE PAIN These are Recent pains .Also called Physiological Pain, they arise mostly from bones, muscles(Nociceptive) or Viscera .The pain is typically well localized, constant, and often with an aching or throbbing quality .Pain is either Symptom of a disease or disease process in itself .Treatment of diseases cures pain & it is self-limiting e g fracture of bone ,muscle sprain .Post-operative pains
CHRONIC PAIN (Nonmalignant Pain) Duration of pain is more than 1 month, some accept it as 3 months. They are also called Pathological Pain and are associated with Nerve pain (Neuropathic). It is a disease itself, a disease of nervous system, difficult to treat & sustaining in nature e g low back pain radiating to lower limb,or neck and shoulder pain radiating to arms, Post herpatic Neuralgia, Trigeminal Neuralgia, carpal tunnel syndrome, diabetic peripheral neuropathy (widespread nerve damage) or any other neuropathy
Chronic Malignant or cancer pain Malignant, cancerous chronic pain may be due to tumor progression, invasive procedures, infection, toxicities of treatment, and physical limitations. Such pain may be felt at the tumor site or some distance from it. Since patients with cancer may experience both chronic and acute pain, healthcare providers need to investigate immediately any new pain in these clients.
On a scale of 0 to 10, with 0 representing no pain, how much pain would you say you are experiencing?
Management of  pains
Patient knows his pain better than any one else and it is his experience that holds the key to make a plan to treat it. Each person and his pains are unique. The treatment depends upon following factors
.The cause ,intensity, duration ,provocative and reliving factors
WHO has developed a step ladder for pain management which include acute, chronic  and cancer pains
NSAIDS :- These are the group of pain relieving drugs, These drugs also reduce swelling (Inflammation). They are use ful in acute painful conditions for a short duration as they have cause lot of side effects .Paractmol is only one of the safest NSAID and can be prescribed for longer period
Opioids these are medications that relieve pain. They reduce the intensity of pain signals reaching the brain and affect those brain areas controlling emotion,which diminshes the effects of painful oxycodone. codine, morphine etc. they are more commonly used in moderate to intense pain along with Cancer pains
The commonest side effects are dependancy, constipation, respiratory depression  and sedation
Adjuvant pain medications  they are not typically used for pain but may be helpful for its management. There is a long list of these drugs which include
Antidepressants They help in treatment of pain associated with depression,they work by increasing the levels of certain chemicals(norepinephrine,serotonin) at nerve endings. These drugs improve the quality of life
Anti seizure medications are helpful for for nerve related pain
Muscle relaxants are used in pain management , there use is limited for short period.
Calcium channel blockers are the group of drugs used in chronic pain treatment
BOTULINUM TOXIN TYPE A -known commercially as Botox is used to treat muscle spasticity associated with many diseases.
Presently the drug is being used in the treatment ofchronic migraine headache
Interventional pain managment is a subspecialty of pain management, devoted to the use of invasive technique to  diagnose and treat pain . They interrupt the flow of pain signals along the specfic neural pathway thus confirms the diagnosis. certain drugs eg local anesthetics and local steroids are used to decrease the swellings of specfic nerves and nerve roots thus by  decreasing the swelling and irritation of nerves, pain is treated. Radiofrequency procedures are done to treat the back pain by abilating certain nerves. Newer concepts eg Ozonolysis , Platlet rich plasma,Prolotheraphy are being used in intervention pain managment .
(The author is a Specialist in Pain Management)