Pain Awareness Month

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September is Pain Awareness Month

What is pain?

According to the International Association for the Study of Pain (IASP), pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Pain is a unique symptom that is different for each individual. The intensity of pain can be classified on a numeric scale, with 0 being no pain and 10 being the worst imaginable pain. With this scale, mild pain is a score from 1 to 3, moderate pain from 4 to 5, and severe pain is a score of 6 or more. Another common way to measure pain is by using a 5-point faces pain scale, which starts with a picture of a pleasant smiley face to represent a patient in no pain (see the figure below). The scale continues on with each face getting progressively worse, with finally a picture that shows a facial expression of a patient in severe pain. This type of scale can be useful in children or elderly patients.  

How common is pain?

The most common reason patients seek out medical attention is due to their experience with pain. According to the US government’s annual report on the health of Americans, within the past 30 days, 1 in 4 adults experienced pain, and 10% experience pain every day. The most common type of pain is back pain, followed by headache and joint pains. 

What types of pain are there?

There are many ways to classify pain including duration, location, or cause of pain. The most common way to classify pain is as either acute or chronic. Acute pain results from some sort of injury or a medical condition. It begins suddenly and is usually a sharp pain. Examples of acute pain include burns or cuts, broken bones, surgery, and dental work. Acute pain can also have other symptoms such as fast heart rate, elevated blood pressure, dilated pupils, and excessive sweating.

Chronic pain continues even after an injury has healed.  Unlike acute pain, symptoms of chronic pain can occur at odd times that may not seem to match up with an obvious cause of pain. Examples of chronic pain can include headaches, low back pain, and joint pain. Although there is no clear point at which acute pain changes to chronic pain, it is generally accepted that pain lasting beyond the expected healing period of an injury (3 to 6 months) can lead to chronic pain.

In addition to chronic and acute, pain can be classified as neuropathic, nociceptive, or visceral pain. Neuropathic pain results from disease or injury to the peripheral or central nervous system. A common example of neuropathic pain is a condition called diabetic neuropathy. This condition commonly occurs in diabetic patients because high blood sugars can cause damage to the nerves. The damage on the nerves can then cause sharp pains, usually in the patients’ legs or feet. Another type of pain, known as nociceptive pain, usually results from injury or damage that affects somatic or bodily structures. Some examples of these bodily structures include skin, muscle, bone, ligaments, tendons, and joints. Lastly, visceral pain is pain caused from pressure or aggravation from the internal organs. A common example of this would be pain caused from cancer cells that are spreading and pressing against different internal organs. This type of pain is very hard for patients to pinpoint the exact source of pain and is usually described by patients as a deep, squeezing, pressure-like pain.

What are the common causes or risk factors for pain?

Some risk factors for pain include old age, genetics, race, obesity, and previous injury. ⁶ There can also be psychological risk factors for pain which include childhood trauma and emotional disorders, such as depression. Other risk factors may be due to having a high-intensity job, stress, engaging in strenuous activity, and or a history of smoking.

Why is early diagnosis/treatment important?

Early diagnosis is important because it is possible for acute pain to eventually lead to chronic pain. As mentioned earlier, acute pain may become chronic pain when the pain continues after the original cause of pain has apparently resolved. Therefore, it is important to treat the pain as soon as possible so that it does not lead to any further complications. Additionally, patients should not “tough out” the pain because pain is easier to control when treated early on. For example, medications used to treat migraines should be taken as soon a headache starts or else the medication will not be as effective. All in all, pain is a very serious issue that can affect a patient’s quality of life and, therefore, early treatment of pain is important to control the pain and to prevent the pain from becoming a chronic, persisting pain.

What are the treatments for pain management?

Some non-drug treatments of pain include chiropractic care, psychological treatment, physical therapy, and regular exercise; sometimes surgery may be required.

As for drug therapy management, opioid analgesics and non-opioid analgesics are commonly used. Non-opioid analgesics are used to treat mild to moderate pain and they are easily bought over the counter at local pharmacies. A commonly used non-opioid analgesic is acetaminophen, widely known as Tylenol. Acetaminophen is used mostly for mild pains in backaches, headaches, and toothaches and is also commonly used for its fever-reducing effects. Other non-opioids analgesics includes NSAIDs (non-steroidal anti-inflammatory drug), which are also generally safe for short term but should be used with caution if needed long term. There are many different NSAIDs but some examples of commonly used NSAIDs are ibuprofen (Advil) and naproxen (Aleve). At low doses, NSAIDs help muscle aches, headaches, and fevers. At higher doses, NSAIDs help reduce joint inflammation. Before selecting an over the counter analgesic, be sure to discuss with a pharmacist or physician about what dosage strength is best for you.

For patients who don’t have enough pain relief with non-opioid analgesics, opioid analgesics are an option. Some examples of commonly used opioid analgesics include morphine, oxycodone, hydromorphone, and methadone. Opioid analgesics are much more effective for controlling moderate to severe pain; however, their use is limited primarily by their many side effects that include constipation, sedation, itchiness, and respiratory depression. Furthermore, long-term use of opioids can be associated with tolerance to their analgesic effects and physical dependence.

Some non-analgesic medications may also be used in treatment of certain chronic pain states, particularly neuropathic pain. Certain medications typically used to treat depression and seizures can also be used to treat neuropathic pain. Depending on the particular drug and condition, these adjuvant analgesics may provide significant pain relief in patients with neuropathic pain.

What can I do to prevent pain?

Some episodes of pain are inevitable but some can be avoided with exercise, a healthy diet, and by avoiding high risk activities. For example, try to stay away from heavy lifting to avoid lower back pain. If heavy lifting cannot be avoided, then make sure to use proper body mechanics, such as keeping your back straight and lifting with your legs. Make sure to do proper stretching and warm-ups before engaging in physical activities, such as playing sports. These are just a few things that you can do to prevent yourself from some common causes of pain. Be sure to talk to your doctor to see what else you can do to avoid certain types of pains and to see which options are best for you.

Where can I find more information on pain?

Pain can be a debilitating so be sure to discuss with your doctor or pharmacist about any concerns you may have. More information on pain can be found at the following websites.

·      International Association of Pain:

http://www.iasp-pain.org/am/template.cfm?Section=Home

·      American Pain Society: http://www.americanpainsociety.org/

·      American Chronic Pain Association: http://theacpa.org/

Written by:              

Joseph Truong

Doctor of Pharmacy Candidate

College of Pharmacy, University of Illinois at Chicago

UIC Pharmacy

September 2013