Pain is a sensation that is felt usually as a response to an injury or illness. Pain can be felt in one or multiple areas of the body and can have a significant impact on peoples daily lives. The sensation can be felt for a short amount of time and controlled with a non-prescription pain killer, however for long-term chronic pain, stronger prescription-only medication may be required.
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The sensation of pain is triggered by the nervous system, usually in response to an injury or illness. The pain sensation hurts, causing discomfort, distress and perhaps agony, depending on its severity.
Pain can be felt in a variety of forms; it can be dull and constant, or short and sharp. Pain may be experienced in one area of the body, such as the back or abdomen, or it can be felt all over, like when your muscles ache during the flu. Pain can be very useful for helping to diagnose a problem. Without pain, trauma may occur without someone even realising it. Alternatively, a medical condition may remain hidden without the associated pain to help identify it. Once the instigating injury or illness has been treated, the pain will usually subside. In these instances, the pain can be classified as being acute.
However, sometimes pain can continue for weeks, months or even years. This is known as chronic pain. Chronic pain can be the result of a long-term condition, such as arthritis or cancer. In other cases, the cause can remain unknown. The most common types of pain include:
Pain can be further classified as being; nociceptive, non-nociceptive, somatic, neuropathic, sympathetic, visceral, and referred.
Nociceptive pain occurs when specific pain receptors are stimulated. These receptors sense vibrations, temperature, inflammation, stretching and the chemicals released by damaged cells.
Non-nociceptive pain isn't caused by specific pain receptors. Instead, it is a response to a nerve(s) becoming injured or unstable, causing its signalling system to become confused. The brain (central nervous system) interprets these abnormal signals as pain.
Somatic pain is a type of nociceptive pain that is experienced on the skin, or in the muscles, joints, ligaments and bones. Somatic pain tends to be sharp and localised at the cause.
Neuropathic pain is a type of non-nociceptive pain. It occurs inside the nervous system itself and is often referred to as a trapped or pinched nerve. This type of pain originates from the peripheral or central nervous system. Causes of neuropathic pain include; nerve degeneration, nerve inflammation, pressure on the nerves or nerve infection.
Sympathetic pain (non-nociceptive) occurs in the sympathetic nervous system. This system controls blood flow, perspiration and the speed at which the peripheral nervous system works. Sympathetic pain usually occurs after bone fractures or soft tissue damage. As with neuropathic pain, sympathetic pain is the result of a nerve becoming injured or unstable, causing it to send abnormal signals to the brain, which then interprets them as pain.
Visceral pain is a type of nociceptive pain. It is usually experienced in the internal organs and main body cavities, such as the thorax, abdomen and pelvis. Visceral pain is harder to localise compared with somatic pain. The sensation will usually resemble a deep ache or cramping.
Visceral pain commonly refers to some type of back pain: Upper back = thoracic, mid-back = abdominal, and lower back = pelvic.
Referred pain is sometimes called reflective pain. This form of pain is experienced next to, or at a distance from the origin of the injury. For example, a person suffering a heart attack may feel pain around the shoulders, back or neck, instead of the chest. The origin and causes of referred pain are still unknown.
Effectively managing pain will start with a comprehensive pain assessment. This assessment will allow the doctor or healthcare provider to characterise the pain, assess its impact, and evaluate other associated aspects, such as medical or psychological issues. This initial assessment will determine whether an additional evaluation is required to fully understand the pain.
Pain is very subjective, meaning only the sufferer can describe it adequately. The healthcare provider will ask about the pains location and duration. They will then seek to identify the quality and severity of the pain, as well as what factors make the pain better or worse.
The next step will be to assess the changes that have occurred in the sufferers life as a consequence of the pain. This assessment will require a physical examination, coupled with a review of the patients medical records.
Part of the pain assessment will require discussing all previously tried pain-relief treatments. The doctor or healthcare provider will enquire as to what medicines and conventional treatments have been tried in the past. If the sufferer has been using complementary or alternative treatments, these are also important to discuss. These alternative treatments may include; acupuncture, massage therapy, herbal and nutritional therapies, yoga and chiropractic care.
By providing relevant, comprehensive data, the doctor or healthcare provider can better understand the nature of the pain and the potential benefits from specific treatments. The goals of a comprehensive pain assessment are to:
If the pain is being caused by an underlying disorder, treating said disorder will also relieve the associated pain. For example, if suffering from a bacterial infection, taking the appropriate course of antibiotics should clear up the infection, which should result in the elimination of the associated pain. If the pain is moderate to severe, it may also be necessary to use analgesics (painkillers), until the underlying cause has been treated.
Analgesics are effective at relieving nociceptive pain but aren't effective at combating neuropathic pain.
Opioid Analgesics
If suffering from a mild headache or a muscle strain, an over-the-counter pain reliever will usually be enough to ease the pain. However, if the pain is more severe, the doctor may recommend something a lot stronger, such as an opioid analgesic.
Opioid analgesics are the strongest painkillers, which are only available with a valid prescription. They are commonly used after surgery, for broken bones, burns, cancer, and under various other circumstances where the pain is likely to be severe. Opioid analgesics work by binding to the opioid receptors in the brain and spinal cord. This causes a reduction in the pain messages being sent to the brain, thus reducing the feelings of pain. An opioid will usually be administered in gradually increasing dosages. The aim of this method of administration is to achieve the ideal dose, which is when the pain is sufficiently relieved, whilst the side-effects remain tolerable. By taking too high a dose, the side-effects can become too much for the sufferer. Opioid dosages are generally much lower for infants and the elderly.
The most common side-effects that opioid analgesics produced include;
Usually, these side-effects lessen with time. Opioid analgesics should always be taken with great care, as taking too much can be dangerous. Opioids can also cause addiction - patients who use opioids frequently over long periods, can find themselves dependent on them. For these patients, if treatment were suddenly stopped, they would suffer withdrawal symptoms, which makes it important that their dosage is instead gradually tapered off. Examples of opioid analgesics include:
Non-opioid Analgesics
Non-opioid analgesics are generally used to treat mild to moderate pain. Unlike opioid analgesics, they are not addictive and their pain-relieving effects do not dwindle with repeated use.
Paracetamol
Paracetamol is classed as a mild analgesic. It is typically recommended as the first line of treatment for pain, as it is safe for most people to take and side-effects are rare. It is commonly used to treat mild to moderate pain, such as headaches, toothache, strains and sprains. Paracetamol is also an effective means of reducing fevers caused by viral infections, such as colds and flu. Paracetamol usually starts to work within an hour, with the effects lasting on average for several hours. Do not exceed the recommended dose if it isn't relieving your symptoms. Paracetamols mechanism of action is still not fully understood. It is thought to work by blocking specific enzymes found in the central nervous system, which in turn, dampen the sensations of pain. Paracetamol is produced by multiple manufacturers in a wide variety of forms, including:
Unlike other pain-relief medication, paracetamol is considered safe to take during pregnancy and breastfeeding. If you are not sure whether paracetamol is safe for you, check with your doctor or pharmacist first – especially if:
Side-effects associated with paracetamol are quite rare but can include:
It is always advised to speak to your doctor or pharmacist should you develop any troublesome side-effects as a result of taking paracetamol.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
These medicines can be obtained over-the-counter or as a prescription medicine, depending on the strength and dosage. NSAIDs are one of the most common pain-relieving medicines in the world. Low NSAID doses are effective for treating minor ailments, such as muscle aches, headaches, fever, minor strains and other daily discomforts. Higher doses of NSAIDs will help to relieve more moderate pain, such as joint inflammation. NSAIDs work on the chemical level by blocking the effects of certain enzymes, specifically the Cox-1 & Cox-2 enzymes. These enzymes play an important role in the production of prostaglandins, which are chemicals like hormones. When the body is injured, the damaged tissue releases prostaglandins, which amplify the pain signals from the nerves, as well as causing the damaged tissue to swell. By blocking the enzymes that produce prostaglandins, NSAIDs will effectively reduce the swelling and decrease the sensations of pain.
Ibuprofen– is manufactured by many different companies and is available in a variety of forms, including; tablets, gels, sprays and liquids. In some products, Ibuprofen is combined with other active ingredients, such as a decongestant, and sold as a cold & flu remedy. Examples of pain relief treatments containing ibuprofen include:
Aspirin – belongs to the group of NSAIDs known as Salicylates. It is available in many forms and has a number of other uses besides pain relief. It can also be used to help reduce the risk of heart attacks and strokes.
Some types of Aspirin can be bought over-the-counter, while others are only available on prescription. Aspirin that can be bought over-the-counter include:
Diclofenac – is used to treat mild to moderate pain, including the signs and symptoms of osteoarthritis and rheumatoid arthritis. Diclofenac can be bought as a topical gel (Voltarol), over- the-counter, or as an oral tablet with a valid prescription.
Naproxen – is usually used to treat pain and inflammation caused by conditions like; arthritis, tendinitis, bursitis, ankylosing spondylitis, gout and period pain. Naproxen is available in immediate, slow, or extended-release formulas. For chronic pain conditions, such as arthritis, the slow or extended release would be the preferred choice, as this form will not work fast enough to treat acute pain. Examples of Naproxen based products include; Naprosyn Tablets (prescription-only-medicine), Vimovo modified-release tablets and Feminax Ultra (over-the-counter pharmacy medicine).
Other examples of NSAIDs include:
NSAIDs can be taken by most people, however, there are some who will need to be careful about taking them. It is recommended to ask your pharmacist or doctor for advice if:
Under these circumstances, NSAIDs may not always need to be avoided. However, they should only be used on the advice of a healthcare professional. If deemed inappropriate, your doctor or pharmacist may recommend an alternative method of pain relief, such as paracetamol.
Like all medicines, NSAIDs carry a risk of side-effects. These will tend to be more common if you are taking higher doses for long periods of time, or if you are elderly or in poor physical health. The strengths and formulations of over-the-counter NSAIDs are generally better tolerated than the stronger prescription-only medicines. The most common side-effects associated with NSAIDs include:
Anticonvulsants used to treat chronic pain
Anticonvulsants are a group of medicines used to treat seizure disorders, but can, in some cases, be used for pain-relief. This is because anticonvulsants will also act as an adjuvant analgesic, which means it can inhibit certain types of nerve transmissions. This action will lead to a reduction of neuropathic pain sensations, such as those caused by diabetic neuropathy or trigeminal neuralgia. Examples of anticonvulsants commonly used as pain relief include:
Anticonvulsants are only available with a valid prescription.
Antidepressants for chronic pain
Antidepressants can also act as an adjuvant analgesics. Although they aren't specifically formulated as a pain relief medication, they have proven effective at treating certain types of chronic pain. Antidepressants are believed to control chronic pain in two ways. Firstly, they alter the manner in which pain is perceived from the spinal cord to the brain. Secondly, they help to reduce anxiety, which will help to improve and regulate sleep. Antidepressants can be prescribed for pain relief, either in conjunction with other analgesics or on their own. Adjuvant analgesics, like antidepressants, tend to be less effective in treating musculoskeletal pain, such as joint or back pain. However, they have proven effective at treating neuropathic pain and chronic headaches, such as tension headaches or migraines. Examples of antidepressants commonly used as pain relief:
Antidepressants are only available with a valid prescription.
Nerve Blocks
Nerve blocks are typically used to help treat neuropathic pain. There are groups of nerves, called a plexus or ganglion, which can often cause pain to specific regions of the body. These nerves can be blocked by injecting medicine directly into the affected area, numbing the nerves and blocking the pain signals sent to the central nervous system. Nerve blocks can be used for various purposes, including:
Transcutaneous Electrical Nerve Stimulation
Transcutaneous electrical nerve stimulation (TENS) is a method of relieving pain by using mild electrical currents. A TENS machine is usually a compact, battery-operated device, which has leads connected to adhesive electrodes. These electrodes are attached directly to the skin. The machine, when switched on, will deliver mild electrical impulses through these electrodes to the affected area(s) of the body. These electrical signals are designed to reduce the pain signals being sent to the spinal cord and brain, which should dull the pain sensations, as well as relaxing the surrounding muscles. TENS stimulation can also stimulate the production of endorphins, which act as the bodys natural painkillers. TENS machines are a popular method of pain relief that can be used on a wide variety of conditions, including:
It is worth noting that TENS does not cure pain. Using a TENS machine will only provide short-term relief whilst the device is being used. Also, TENS isn't suitable for everyone. It is important not to use a TENS machine without first seeking medical advice if:
It is commonly accepted that more research is needed to ascertain whether TENS is a reliable method for providing pain-relief. If you are considering TENS treatment, it is recommended you speak to your doctor or pharmacist first.
For some people, complementary and alternative medicines may also prove helpful for neuropathic pain relief. These treatments can include acupuncture and herbal remedies. Most alternative medicine is available without a prescription, however, it is always advised to consult your doctor before starting any new treatments for neuropathic pain.
Both acute and chronic pain cannot always be prevented. However, staying in good physical and mental health is probably the best method for staving off injury or illness, or at least helping to cope with it.
Non-prescription alternatives for the treatment of pain are;
If your pain does not ease or becomes severe, contact your GP or Pharmacist for further advice.
Pain is a sensation triggered by the nervous system, usually as a response to an injury or illness. The pain sensation is unpleasant; it hurts and causes discomfort, and perhaps even agony.
Pain can be experienced in a variety of ways; from short and sharp, to dull and constant. Pain can serve a purpose - acting as a useful mechanism from which to diagnose health problems. Without pain, illnesses may go undetected, or injuries unnoticed.
Words that are commonly used to describe pain’s varying sensations include; stinging, burning, throbbing, shooting and aching.
Chronic pain describes the type of pain that persists long after the instigating injury or illness has healed.
In a lot of cases, chronic pain will have originated from a past trauma or infection. However, some sufferers experience chronic pain in the absence of previous physical injury or illness. Common examples of chronic pain include:
Chronic pain can cause a number of unpleasant physical effects including; tense muscles, lethargy, reduced mobility, and changes in appetite. Also, it can impact on a sufferer’s quality of life, which will likely result in a number of emotional effects too. These can include; depression, anxiety, and anger.
Paracetamol is an analgesic (pain killer) and an antipyretic (temperature reducer). It relieves mild to moderate pain such as headaches, sprains, toothache and cold and flu symptoms and reduces fever. Paracetamol is sold under several brand names and is sometimes combined with other medications to form some well-known preparations, such as: Co-codamol: paracetamol and codeine and Co-dydramol: paracetamol and dihydrocodeine.
Paracetamol is also commonly combined with decongestants in cold and flu remedies.
Certain medicines that are used to treat depression can also be effective at treating certain types of pain. Specifically, pain caused by damaged or sensitive nerves, such as shingles or sciatica. You don’t have to be depressed for these treatments to work. An example of an antidepressant commonly used for pain relief is Amitriptyline.
Other medicines can share a similar dual purpose, in the same way antidepressants do. For example, Gabapentin is an antiepileptic medicine, which is also an effective treatment for pain relief.
Both antidepressants and antiepileptic treatments are only available with a valid prescription from your doctor.
Your choice of pain relief will depend on the type of pain you have. If the pain is mild to moderate with associated inflammation, for example; mild back pain or headaches, then Paracetamol or NSAIDs will be a suitable choice. If however, the pain is being caused by damaged or sensitive nerves, then Amitriptyline or Gabapentin would be a better choice.
If the pain is severe and isn’t effectively being managed by over-the-counter medicines, then stronger doses or alternative options, such as opioid analgesics, are available with a valid prescription from your doctor.
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