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A Guide To Pain Management

Pain can be informative. At a most basic level, the feeling of physical discomfort is a signal from our body that something is wrong. We react to pain in a way that may protect us from further injury – like quickly pulling your hand back when you’ve touched something hot.

Pain is experienced in many different ways. It can feel sharp or dull. Throbbing or searing. Pain can be deeply influenced by and cause changes in how a person feels emotionally, and it can affect any part of the body – from a cut that causes only only minor discomfort, to prolonged joint pain and even internal aching from conditions like irritable bowel syndrome that radiates from the intestines and other organs.

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For many people, pain isn’t temporary. It’s an excruciating part of life that profoundly undermines their ability to function. According to the Centers for Disease Control and Prevention, an estimated 50 million adults in the U.S. – more than 1 in 5 – suffer from chronic pain, defined as having pain on most days or every day during the past six months. Chronic pain is often the result of chronic conditions like arthritis.

Many more experience what’s referred to as acute pain – discomfort from things like an injury from a burn or surgery that’s temporary and typically resolves in days or weeks. However, some people have what starts out as acute pain but eventually becomes a chronic pain that doesn’t go away.

Pain – More General Information

In the broadest terms, pain falls into three very large categories:

  • Acute pain.
  • Chronic pain.
  • Cancer pain.

The third category includes pain from the cancer itself as well as from the treatment, which can include surgery and chemotherapy. Post-chemo patients can, for example, experience neuropathic pain, which results from an injury or inflammation, notes Dr. Magdalena Anitescu, chief of the division of pain management and director of the pain medicine fellowship program at the University of Chicago Medicine.

When it comes to chronic pain, chronic conditions ranging from multiple sclerosis to AIDS, migraines and stomach ulcers may be to blame. Arthritis is a leading cause of chronic pain.

Broken up by body region, chronic pain often frequently centers around the spine and joints.

Of course, the origins of both acute and chronic pain can be internal, as well. “There is also visceral pain – the pain which is coming from the internal organs,” Anitescu says. That includes pain associated with conditions such as pancreatitis, in which the pancreas becomes inflamed, and endometriosis, when tissue lining the uterus grows onto other nearby organs like the ovaries.

Other causes of acute, or short-term, pain can range from kidney stones to bladder infection. Muscle strains, sprains – stretching or tearing of ligaments in joints like the ankle and knee – and broken bones are also common sources of acute pain, while discomfort from injuries sometimes persists and can become chronic as well.

Chronic pain can be debilitating – which is also why experts say it’s important not to delay seeking medical attention when pain persists. While primary care physicians may be able to help initially, often a referral to a pain medicine specialist is warranted.

Pain Management Specialists

Pain management doctors specialize in areas like anesthesiology – where the focus is relieving pain related to surgery. They also receive additional pain management training covering areas such as the physiology of pain, its causes and ways to treat different types of pain.

In the U.S., specialists receive certification in pain management from one of three boards recognized by the American College of Graduate Medical Education: the American Board of Anesthesiology, the American Board of Psychiatry and Neurology or the American Board of Physical Medicine and Rehabilitation.

Experts say its important not to wait to seek medical attention when what should be a temporary pain, from a surgery or injury, for example, persists.

If pain persists beyond the normal time of healing, a pain management specialist should be sought out early, says Dr. Dennis Patin, an associate professor of anesthesiology and division chief of pain management at the Silvester Comprehensive Cancer Center at the University of Miami Health System. “We could make a big difference in the nation’s burden of pain if we saw patients earlier on. Too many times the pain has persisted,” Patin says. “It’s become more entrenched or more intractable in the nervous system.” The nervous system is made up of the brain and spinal cord and includes nerves that reach every part of the body. Those far-reaching nerves are what alert a person to sensations like pain.

The more intense pain is and the longer it lasts, the harder it becomes to treat, and the more likely it is to become chronic. That’s because in such cases, Patin explains, “pain changes the structure and functioning of the nervous system.” Persistent pain can wreak havoc on this system.” Chronic pain can make the nervous system more sensitive to pain,” as noted by the health resource Merck Manual. “For example, chronic pain repeatedly stimulates the nerve fibers and cells that detect, send, and receive pain signals.”

That’s all the more reason not to let pain linger without seeking treatment, experts say, because it can become even more difficult to manage the longer one lives with it.

Experts emphasize that pain management specialists can help prevent the development of chronic pain – if they’re able to intervene early enough. That’s in addition to helping many other patients who have chronic pain manage it.

Even in cases where the exact source of chronic pain remains a mystery, treatment to manage the pain can still effectively lessen discomfort. Pain management can help a person live a fuller life, from getting back to work to engaging with family and friends.

Just as with controlling blood sugar in a person with diabetes, controlling pain isn’t the end goal but the beginning – a way to help patients be healthier and vastly improve their quality of life. Given the concerns about opioid addiction and overdoses, pain management also focus on being less reliant on opioids.

“You want to do this to prevent further disability, to prevent being dependent on drugs, to prevent lost work, to prevent depression from chronic pain (and) isolation” – as well as other complications from chronic pain like suicide, says Dr. Samer Narouze, president-elect of the American Society of Regional Anesthesia and Pain Medicine and chairman of the Center for Pain Medicine at Western Reserve Hospital in Cuyohoga Falls, Ohio.

Options for Managing Pain

While opioids may still be prescribed, a broad range of other approaches are used to manage pain. Those include:

  • Physical therapy.
  • Steroid injections and other medications to reduce inflammation.
  • Non-opioid prescription and over-the-counter pain relievers.
  • Neuromodulation, such as electrical stimulation, to disrupt the sensation of pain in the nervous system.
  • Massage.
  • Mind-body techniques that relieve stress and promote relaxation like yoga and tai chi.
  • Lifestyle changes like exercising and weight loss that may help relieve joint pain.
  • Acupuncture.
  • Counseling and other mental health services.
  • Medical marijuana in states that allow it and where offered as a treatment option.

Pain management specialists says patients have a vast – and growing – array of treatment options to manage pain. This can vary greatly based on the type of pain. It could be anything from steroid injections for an arthritic knee to migraine medications to treat the severe headaches that leave patients incapacitated to surgery to address severe spinal problems.

While there’s no silver bullet for pain management, certain treatments have more research to support their use for managing different types of pain. That includes, for example, physical therapy and exercise for back pain (which are also recommended for other forms of joint pain); steroid injections for hip and knee arthritis; and splinting the wrist to treat carpal tunnel syndrome, which causes pain in the hand and arm.

The Social and Mental Component of Managing Pain

Certain mental health disorders can contribute to chronic pain and be caused or exacerbated by persistent discomfort, including anxiety and depression. How a person feels overall can have a big impact on their sensation of pain – and vice versa: Pain can affect a person psychologically.

“It works both ways – that pain affects people’s mood and affects their concentration and sleep,” says David Cates, director of behavioral health at Nebraska Medicine, a health network based in Omaha, and vice chair of clinical operations in the department of psychiatry at the University of Nebraska Medical Center. “But on the other hand, we know that negative thinking, negative attitudes, feeling helpless, irritability – those kinds of variables affect the experience of pain.”

No, you’re not imagining the pain, experts say. The point is that you’re more than flesh and blood and tissue damage. So a treatment approach that considers not only biological causes of pain but also social and psychological factors, can be highly effective. “It doesn’t mean the pain is in your head,” Cates says. “What it means is that unless you’re looking at the whole picture, you’re likely not benefiting as much as you could. Even if you’re going to continue taking medications, you could still get more benefit.”

More Than Opioids

A collaborative approach involving different disciplines of care provide patients with more tools to manage pain, experts say.

While pain management specialists say opioids are still appropriate in some cases, there’s an ongoing shift toward limiting long-term use of the drugs. That includes helping patients come off the medications and offering other ways to treat their pain.

“For those who have chronic pain and who have been on opioids for a prolonged period of time, we actually offer an opioid tapering clinic,” says Dr. Madhuri Are, chief of the division of pain medicine for Nebraska Medicine and director of cancer pain management at the University of Nebraska Medical Center. “Those that can’t taper actually are referred to addiction medicine services – so they can get that extra support that they need.”

The goal is to get a handle on pain with a wide range of approaches. Experts say with chronic pain, total relief isn’t typically possible, but it’s key to address the suffering that can influence every aspect of one’s life. For one, pain can make a person more sedentary. Given that, there’s an intensive focus on managing the discomfort to regain function so people can be more active – and to ultimately improve their outlook on life.

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3 comments

  1. Watching people dear to me, slide down the razor-blade of orthodox medicine, into their premature coffins, tends to force a total reassessment of this total impotence.

    Of course, the ACTUAL success story is PROFIT, NOT achieving, nor maintaining, nor aspiring, to health-spans that last a life-span. Money is FAR more precious than human quality-of-life.

    Hidden beneath the promises, the “should/could/might lead to treatments” of medical research, the subsequent hype and SELLING of the next miracle/breakthrough, that proffers false, never realized therapies, BEYOND the Initial Public Offering of stock, in the newest biotech start-up, is “alternative” approaches to suffering, unadorned with profit potential.

    Now that medical Mary-Jane is sanctioned by states – for profits derived from fees – it appears Big, Dirty Pharma mite be forced, finally, into admitting it has met its match, viz., UNpatentable substances. In the parlance of squeezing hope-out-of-advertising, i.e., professional lying, patentable, fake, synthesized, me-too molecules could be doomed, as it, finally, sinks-in that bio-identical molecules — read: natural which, in this case, actually MEANS “as found in nature” — are superior; need I mention cheaper??

    But there remain 2 truths:

    the medical business, and cancer industry, can NOT sustain, nor support, itself unless it keeps people SICK; ergo modern medicine = SICK-care, with extremely limited prospects for morphing into an engine of HEALTH-care.

    ALL alternative modalities imbue the POTENTIAL – not PROMISE – of PREVENTION. I predict a poll of people, would show EVERY living human being would opt for PREVENTING any disease or disorder, rather than curing one {or several}. PREVENTION would be the doom of the malaise of modern medicine. Let’s prevent THAT scourge of modern living.

  2. What kind of doctor should I see for chronic back pain from a bulging disc?

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