Pain...Oh, What a Pain!
"Nothing begins, and nothing ends,
That is not paid with moan;
For we
are born in other's pain,
And perish in our own."
-- James Kenneth Stephen
Medical Author: William C.
Shiel, Jr., MD, FACP, FACR
Pain is an unpleasant sensation in
animals that is caused by actual or perceived injury to body tissues and
produces physical and emotional reactions. Presumably, pain sensation has
evolved to protect our bodies from harm by causing us to perform certain actions
and avoid others. Pain might be called a protector, a predictor, or simply a
hassle. In this article, I will discuss some basic concepts of pain. For an
extensive review of pain and its management, please visit MedicineNet's Pain Center.
We all experience pain to greater or lesser degrees at
various points of our lives. It is said that pain is the most common reason
patients seek medical attention. But, each of us perceives a given pain stimulus in our own unique
manner. The intensity of the response to a pain stimulus is largely subjective,
meaning the severity of the pain can most accurately be defined by the person
with the pain, rather than by other observers.
Our individual pain perception can vary at different
times, even in response to the identical stimulus. For example, an athlete
during competition may not be able to feel the tissue injury of a cut or a
bruise until the competition has finished. We may feel more or less pain
depending on our mood, sleep pattern,
hunger, or activity.
Pain is typically classified as either acute or chronic.
Acute pain is of sudden onset and is usually the result of a clearly defined
cause such as an injury. Acute pain resolves with the healing of its underlying
cause. Chronic pain persists for weeks or months and is usually associated with
an underlying condition, such as arthritis. The severity of chronic pain can be mild,
moderate, or severe.
The treatment of pain depends on its cause and the
overall health of the individual affected. The primary goal of pain treatment is
to return the patient
to optimal function. Treatments of pain can be classified as either non-medical
or medical.
Non-medical treatment options for various forms of pain
include observation, rest, stretching, exercise, weight reduction, heat or ice applications, and
various alternative treatments including acupuncture, chiropractic, massage,
manipulation, electrical stimulation, biofeedback, hypnosis, and surgical
procedures.
Medical treatments include three basic drug forms to treat pain (analgesics):
Non-opioid drugs, opioid drugs,
and drugs that are used to complement other analgesics (adjuvant drugs).
- Opioid drugs include
tramadol (Ultracet, Ultram), morphine, hydromorphone (Dilaudid and others),
codeine (Tylenol #3 and others), hydrocodone (Vicodin, Lortab), methadone, meperidine
(Demerol), pentazocine (Talwin), propoxyphene (Darvon), and butorphanol
(Stadol).
- Adjuvant drugs are often
used for other purposes, but can also be very effective in the treatment of
pain. Examples of adjuvant pain medications include muscle relaxants, antidepressant medications (such as
amitriptyline/Elavil or duloxetine/Cymbalta), anti-seizure medications (such as
carbamazepine/Tegretol, gabapentin/Neurontin), topical anesthetic sprays, pain patches
(Lidoderm and others), and nerve blocks with anesthetics.
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