Pain Management

Pain is a message from the body that something is not right. Pain can signal injury or illness, or indicate that there is a problem with the pain perception mechanism itself. Physiological pain originates with sensory nerves that send signals to the brain, which the brain then interprets. Such signals are protective, intended to remove the body (or body part) from harm’s way. When the pain response is healthy and functioning appropriately the brain immediately sends back a message of response to the location of the pain, often resulting in the jerking away from whatever stimulus is causing the sensory nerves to detect and report pain or the intense desire to hold the body part motionless. Doctors have conventionally referred to such pain as “acute”—it comes on suddenly and has a particular (and usually identifiable) cause. The pain has a protective value, and when its cause is remedied the pain goes away. When the pain response is dysfunctional, sensory nerves continue to send or the brain continues to perceive circumstances that cause pain even when those circumstances no longer tangibly exist. Doctors have conventionally referred to such pain as “chronic”—it continues, often without physiological basis. This is not to say the pain does not exist; it does, and often in a debilitating way. However, chronic pain exceeds the function of the body’s pain mechanisms as researchers understand those mechanisms to function, becoming itself a health condition.

Though the experience of pain is highly subjective, much acute pain is predictable in terms of its occurrence, intensity, and endurance. Doctors know, for example, that pain following the majority of surgeries is most intense during the first 72 hours after the surgery, then begins to subside as the surgical wound heals. Numerous chemicals in the body facilitate both the healing and the easing of pain signals. Pain relief medications given to ease acute pain generally target the brain’s pain interpretation centers, sometimes with a combined effect as well as the nerves in the area of the wound. The pain medication oxycodone, for example, commonly prescribed for postoperative pain, combines a narcotic drug (brain) with an antiinflammatory drug (site). Some acute pain does not resolve in a short period of time, such as the pain associated with end-stage cancer, because the cause for the pain does not resolve.

Chronic pain may be just as intense and debilitating as acute pain, though doctors believe it represents a different dynamic within the pain response. Therapies and medications to relieve chronic pain appear to be most effective when they target the site or region of the pain. Therapies might include heat, cold, therapeutic massage, trigger point massage, acupressure, injections of anesthetic/ CORTICOSTEROID, nerve block injections, TENS stimulation, and CHIROPRACTIC manipulation. Medications to treat chronic pain often include NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs) for localized as well as systemic relief of inflammation, muscle relaxants, and topical analgesics or counterirritants. Other efforts such as regular EXERCISE, ACUPUNCTURE, BIOFEEDBACK, and MEDITATION help to relieve stress associated with chronic pain.