Basic description and management of pain(Part 4)

Management of “pain”

Steps to undertake when experiencing “pain”

Determine the cause(s) of “pain”

For every pain that you experience, there is a cause or set of causes. Initially, by yourself, you may be able to determine the cause or causes. However, if you have a hard time doing it, then you need to consult a medical doctor who will help you find out your problem and prescribe you with the necessary medication(s).To help your medical doctor, pay attention to the details of your pain. You should fully describe it in terms of location, time of occurrences, intensity, aggravating and relieving circumstances, and whether it stays in one location or spreads to other area(s).

Have the necessary rest

If your leg or knee, for instance, is painful, you need to have rest. If you have scheduled gym sessions, you need to forego those activities for the moment. If you need to go out to buy something, probably it is better that you stay home and do it on a day that your aching part is no longer painful. There are times when your knees are painful because you are overdoing a certain activity, like running on a concrete road! While in pain, have rest.

Take your medications as prescribed

By the mouth[1]

When you experience pain and you have decided to take analgesic(drug to relieve pain), it is advisable that you take it (them) by mouth. It is easier to do it; you can do it by yourself. In addition, the occurrence of side-effects is lesser because the entry of the said medication(s) to your systems is not as fast as when you use injectable drugs.

By the clock[1]

If you were prescribed with a medication which should be taken every six hours, then take it every six hours. If you missed one dose at a certain time, then you will lack certain amount of the medication in your system, and you will experience the so-called breakthrough pain (BP). After you have been free from pain for several days or months, BP all of a sudden takes place because you lack the necessary medication(s). To prevent this, takeit (them) as prescribed and as scheduled.

By the ladder[1]

The World Health Organization (WHO) prescribes that the medication(s) to be used in treating pain should be selected based on the strength of the drug. In this method, medications for pain are categorized into the following: (1) non-opioid, (2) opioid drugs for mild to moderate pain, and (3) opioid drugs for moderate to severe pain. Based on WHO’sprescription—which is otherwise called as the “by the ladder” method—the first drug to be used should come from the non-opioid group, which include the paracetamol, acetaminophen, aspirin, and the non-steroidal anti-inflammatory drugs[1]. The opioid medications should only be used, and reserved, forpain that cannot be controlled by the non-opioid drugs.

For the individual[1]

Whatever dose of medicine you need, it is only good for you. It cannot be used by another person, for everyone inpain needs individualized dosage.

With attention to detail[1]

Pain treatmentrequires great attention to details. This means that you need to take note of when the pain occurs, what are the aggravating and palliating circumstances, the duration when it occurs, and other details that may help you and your attending physician. The correct determination of your medical problem—relatively dependent on what you tell the medical doctor—is of utmost importance because the ensuing medical management will highly depend on it.

(To be continued)

Reference:

[1]United States. U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, Clinical Practice Guideline, Number 9, Management of Cancer Pain, Rockville, March 1994.

 

Basic description and management of pain(Part 3)

General types of “pain”

Somatic[1]

Somatic pain arises from the stimulation of your pain receptors either from the surface of your body or from your muscles and bones. After you have undergone any surgical procedure in your muscle or bone, the pain that you experience is a good example of somatic pain. More often than not, it is described as dull or aching, andit is usually aggravated by activity or movement and relieved by rest or inactivity[1].

Somatic pain usually occurs in the shoulder, hip, and hand, including the lower baPhysical Effects of painck and buttocks, and it is usually caused by the combination of several factors, such as inflammation, repetitive injury, and excessive activity[1].

Visceral [1]

When there is a problem in one or more of your internal organs, you might be able to experience pain. When this takes place, this can be classified as visceral pain.It is the most common among the general types of pain, and it is caused by the stimulation of the pain receptors in your chest, abdomen, and pelvic area. Thus, the problem could be in the heart, intestine, liver,   uterus, or ovary—to mention some[1].

Visceral pain is characterized as vague, and it does not clearly indicate its source. It is further described as pressure-like, deep squeezing, dull or diffuse. You will experience this pain when there is obstruction or perforation of your intestine, or when any one of your abdominal organs is inflamed. If you have this problem, aside from the pain, you may experience feeling of vomiting, body weakness, and/or fever[1].

Neuropathic[1]

Neuropathic pain originates from the spinal cord and peripheral nerves which are injured or malfunctioning.It is described as burning, tingling, shooting, stinging, and with “pins and needles” sensation. Others describe it as stabbing, piercing, cutting, or drilling pain. It occurs within a period of days, weeks, or months of the injury, and it varies in frequency and intensity. It is wide-spread, and it usually occurs at the level or below the level of the injury. This type of pain is very common in the legs, back, feet, thighs, and toes. In some instances, however, it can also take place in the buttocks, hips, upper back, arms, fingers, abdomen, or neck [1].

Management of the different types of pain

Prior to knowing the exact nature of the painthat you are experiencing, you may, as the first step, take in analgesic whose action is to increase the level of pain that your body could feel, thereby blocking the unpleasant sensation. The first analgesic that you could take is paracetamol, which is very cheap and safe to use.The maximum dose that you could take is 500 mg tablet every 6 hours. If, after 48 hours, you are not significantly relieved with it, and you believe that you have been suffering from either somatic or neuropathic pain, you can shift to taking the so-called non-steroidal anti-inflammatory drugs (NSAIDs), such as diclofenac, ibuprofen, naproxen, celecoxib, mefenamic acid, etoricoxib, and indomethacin[2,3]. Before you start taking any of these drugs, however, you need to consult a medical doctor who would decide if you really need any one of them. If ever you need to take any one of the NSAIDs, take it for some days only. They are not meant to be taken daily for so long because they could have possible side-effect(s) on the kidneys—which may turn out to be irreversible!

If you believe you have been suffering from visceral pain, you need to take an antispasmodic(an agent that quiets spasm)[4], such as hyoscine-n-butylbromide. If the oral medication could not stop your abdominal pain, then you need to consult a medical doctor who could administer the injectable medication.

(To be continued)

 

References:

[1]RehabTeamSite, Other complications of spinal cord injury: pain: types of pain.

http://calder.med.miami.edu/pointis/typepain.html

[2] NSAID (List of non-steroidal anti-inflammatories).

http://cdn.dupagemedicalgroup.com/userfiles/file/patientForms/nsaid-list.pdf

[3] eMedExpert, Non-steroidal anti-inflammatory drugs comparison.

http://www.emedexpert.com/compare/nsaids.shtml

[4]Stedman’s Medical Dictionary, Thomas Lathrop Stedman (Dec. 06, 2005).