Pain Management

Pain Management

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Pain is a complex and individualized experience, often resulting from injury or illness-induced tissue inflammation. The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” This article explores the dimensions of pain, the nuances of pain management, various types of pain, and the diverse treatment approaches available.

What is Pain?

Pain is influenced by biological, psychological, and social factors, and its definition remains subjective. Six keynotes provided by the International Association for the Study of Pain emphasize the importance of respecting a person’s report of pain, acknowledging that pain is not solely inferred from sensory neuron activity, and recognizing that verbal expression is just one way to communicate pain.

What is Pain Management?

Pain management is a crucial aspect of healthcare aimed at alleviating suffering and improving the quality of life for patients experiencing pain. Whether dealing with acute injuries or chronic conditions, healthcare providers employ various strategies, including medication, multidisciplinary approaches, and psychological interventions, to address pain and enhance well-being.

Types of Pain

  1. Nociceptive Pain: Associated with tissue damage or inflammation, signaling the brain about a noxious stimulus. Includes somatic pain (injury or inflammation) and visceral pain (organ-related, often associated with autonomic nervous system symptoms).
  2. Neuropathic Pain: Due to nervous system damage, not necessarily in response to external stimuli. Common in conditions like diabetes, cancer, and stroke.
  3. Other Types: Chronic low back pain, migraines, dysfunctional pain, somatoform pain, fibromyalgia, interstitial bladder disease, irritable bowel syndrome, and cancer-related pain.

Pain Treatment Approaches

  1. Pain Management Medication: Includes over-the-counter medications (use with caution), nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, narcotic and prescription medications, antidepressants, and anti-seizure medications.
  2. Physical Therapy: Exercise, stretching, ultrasound, and electrical stimulation for musculoskeletal pain.
  3. Interventional Procedures: Nerve blocks, nerve ablation, steroid injections, spinal cord stimulators, and intrathecal pumps for acute and chronic pain.
  4. Psychologic Treatment: Cognitive-behavioral therapy (CBT), mindfulness, meditation, acceptance therapy, and hypnosis as complementary approaches.

The Goal of Pain Management

The primary goal of pain management is to minimize suffering and improve the quality of life for each patient. While complete freedom from pain may not always be achievable, the focus is on providing dignity, pain minimization, and enhancing the overall well-being of the patient. The approach varies based on individual circumstances, ensuring a personalized and evolving treatment plan that adapts to the patient’s changing physical condition and life circumstances.

Note: This article provides general pain management guidelines and may not necessarily apply to children or individuals at the end of life.

References

  1. Raja, SN, Carr, DB, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. PAIN. 2020. 161(9):1976-1982.
  2. Bai Y, Ouyang SL, et al. Treatment for Persistent Somatoform Pain Disorder via Electroacupuncture and a Low Dosage of Fluoxetine Hydrochloride. Integr Med (Encinitas). 2017. 16(4):28-31.
  3. Nagakura Y. Challenges in drug discovery for overcoming ‘dysfunctional pain’: an emerging category of chronic pain. Expert Opin Drug Discov. 2015. 10(10):1043-5.
  4. National Institute of Arthritis and Musculoskeletal and Skin Disorders. Fibromyalgia. Updated Jun2021. Accessed 24Nov2023
  5. Boezaart AP, Smith CR, et al. Visceral versus somatic pain: an educational review of anatomy and clinical implications. Reg Anesth Pain Med. 2021. 46(7):629-636.
  6. Chen YK, Boden KA, Schreiber KL. The role of regional anaesthesia and multimodal analgesia in the prevention of chronic postoperative pain: a narrative review. Anaesthesia. 2021. 76 Suppl1:8-17
  7. Finnerup NB, Kuner R, Jensen TS. Neuropathic Pain: From Mechanisms to Treatment. Physiol Rev. 2021. 101(1):259-301
  8. Saracoglu I, Akin E, Aydin Dincer GB. Efficacy of adding pain neuroscience education to a multimodal treatment in fibromyalgia: A systematic review and meta-analysis. Int J Rheum Dis. 2022. 25(4):394-404
  9. Davin S, Lapin B, et al. Comparative Effectiveness of an Interdisciplinary Pain Program for Chronic Low Back Pain, Compared to Physical Therapy Alone. Spine. 2019. 44(24):1715-1722
  10. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on Pain Management and Regulatory Strategies to Address Prescription Opioid Abuse. Evidence on Strategies for Addressing the Opioid Epidemic. In: Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use, Phillips JK, Ford MA, Bonnie RJ (Eds), National Academies Press, Washington (DC) 2017. Accessed 24Nov2023

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