About Pain Management

Pain management is a term that is used to describe various healthcare techniques that are available to help reduce pain and discomfort that is associated with a variety of pain conditions. In addition, these therapies often help to improve the patient’s quality of life. Pain management is particularly relevant to patients suffering from chronic pain conditions as these conditions often have a significant negative impact on a patient’s physiological and psychological health if left untreated.

The experience of pain is very subjective and differs among patients, which makes measuring and recording pain experiences difficult for the medical community. Some patients may find it incredibly difficult to function with pain, while others may not have this problem. It is vital that medical professionals thoroughly assess pain levels reported by patients and develop an appropriate treatment plan for each case. The goal of pain management is to efficiently and effectively reduce pain, improve function, and improve quality of life.

Many pain management treatment plans take an interdisciplinary approach to care, which involves the co-operation of many healthcare professionals working on the same case. The team of healthcare professionals may involve pain specialists, nurses, physical therapists, occupational therapists, mental health practitioners, and other alternative practitioners. These healthcare professionals, together with the patient, aim to determine the best treatment approaches for optimal results. Most pain management plans are dependent on the underlying pain condition and the type of pain that is being experienced by the patient.

 

Conditions Related To Pain Management

Pain management can help to manage pain associated with numerous conditions, including:

  • Bone fractures
  • Sprains and strains
  • Tendon damage
  • Fascia damage
  • Muscle damage
  • Joint damage or degeneration
  • Headaches
  • Back pain
  • Visceral pain
  • Genital pain

Various factors have been identified which increase the risk of developing chronic pain conditions, including:

  • Age
  • Genetics
  • Mechanical wear and tear on the joints
  • Inflammation
  • Nerve damage
  • Muscle tissue loss
  • Bone loss (i.e. osteopenia, osteoporosis)

Approach To Pain Management

Pain management treatment plans need to be individualized for each patient based on their condition or injury and the pain levels that they are experiencing in order to be effective. A single treatment plan may combine a number of different approaches including pharmacological treatment, interventional treatment, and alternative treatment options.

The pharmacological approach to pain management uses a wide array of conventional drugs that have been approved by various regulatory bodies around the world. Drugs used for pain management are usually prescribed in an oral or transdermal form. However, medications may be delivered by other routes into the body, including: epidural, intranasal, intramuscular, intravenous, subcutaneous, topical, and rectal. Furthermore, new drugs are currently undergoing development and testing to determine if they may be suitable options for pain management.

First line treatment, from a pharmacologic standpoint, usually involves over-the-counter medications including acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs help to reduce pain by decreasing inflammation in the affected area. However, long-term use of NSAIDs is associated with adverse effects including kidney damage, gastric ulceration, and elevated liver enzymes. Therefore, they should only be used for short-term pain relief.

If acetaminophen and NSAIDs fail to provide adequate pain relief, alternative drug options may be recommended, including opioid medications. Common opioids used for pain management include codeine and hydrocodone. However, others that may be recommended include buprenorphine, fentanyl, morphine, thebaine, and tarpentadol. These medications bind to pain receptors in the brain and inhibit pain signaling, thereby reducing pain. However, the use of opioid medications is associated with various adverse effects including skin changes, nausea, constipation, sedation, respiratory depression, and organ damage. Additionally, there is the potential of misuse and abuse with opioids. Therefore, they should only be used for short-term pain management.

Certain medications that were originally developed for the treatment of other conditions may also be used in pain management as some have been shown to have analgesic properties. These medications include: anticonvulsants (commonly used to treat epilepsy), antidepressants, and muscle relaxants (sometimes referred to as sedatives).

Interventional therapies are procedures or therapies that utilize drugs or other medical applications in a way that require them to be performed by a licensed and competent healthcare provider. Alternative treatment options are commonly used combined with other medical therapies, or as an alternative to traditional medical management based on the patients’ preference. Many studies have shown that a combination of one or more alternative or interventional therapies, combined with drug therapy, results in the most effective pain management.

There are numerous interventional and alternative therapies available for pain management including: injection therapy, Botox, implantable medical devices, acupuncture, active release technique (ART), biofeedback training, cognitive behavioral therapy, exercise and nutrition counseling, cold laser therapy, and chiropractic care.

Injection therapy involves the direct delivery of medication, often a steroid combined with an anesthetic, to the affected area or to the spinal tissue associated with the affected area.

Treatment with Botox (botulinum A-toxin) disrupts the connections between the muscle and nerve cells, which helps to reduce pain. This type of therapy has been shown to be effective for the treatment of neck pain and migraines in some patients.

Implantable devices, including intrathecal pain pumps, can be implanted into patients with chronic, severe pain that is unresponsive to more conservative methods. These devices are connected to a small reservoir of pain medication, which is delivered through the device to the affected area.

Acupuncture is a drug-less therapy, which involves inserting tiny needles into specific areas of the body. The needles may be placed in the area of the pain, as well as at distant sites, which may be contributing to the patient’s pain. Acupuncture is thought to promote the release of endorphins, thereby helping to improve the patient’s response to pain. It has also be associated with an increase in blood flow to the affected area, which may help to improve the patient’s response to pain.

Active release technique is a hands-on therapy, which involves using specific manipulations with the hands and fingers, while the patient makes opposing muscle movements. This therapy is believed to relieve strain and tissue damage and improve the function of the affected area.

Biofeedback training involves teaching patients how to cope with their pain to alter their body’s physiological response to pain.

Cold laser therapy utilizes a highly focused laser light to alter cell behavior in human tissue. It has been found to improve healing and reduce pain in some patients with acute and chronic pain conditions.

Cognitive behavioral therapy focuses on the promotion of positive and constructive thinking as opposed to negative thinking. This type of therapy may provide beneficial results in patients suffering from back pain, rheumatoid arthritis, fibromyalgia, and cancer.

Exercise and nutritional counseling may include patient education on the positive effects of living a healthy lifestyle including regular exercise and eating a healthy, balanced diet.

Chiropractic care usually includes chiropractic manipulation of the spine and other joints in the body in an effort to restore normal joint movement, reduce muscle spasm, and improve function. Chiropractic care has been shown to provide beneficial results for patients suffering from hip back, cervical and lumbar pain, shoulder pain, and migraines.

Summary

Many people experience pain, which may be the result of physiological or mechanical damage. Acute and chronic pain conditions can have a significant impact on an individual’s ability to function normally and maintain an optimal quality of life. There are many treatment options available for pain management therapy. Effective treatment involves an accurate diagnosis of the underlying condition.

Often pain management plans use an interdisciplinary approach involving many healthcare practitioners including pain specialists, mental health practitioners, nurses, and alternative medicine practitioners. Pain management treatment plans often include a combination of drug therapy, interventional therapy, and alternative therapy.

Throughout the course of care, treatment plans may need to be adapted based on the patient’s response to care. The goals of pain management are to reduce pain, improve function, and improve the quality of life. Individuals suffering from acute or chronic pain conditions should speak to their provider about the array of options that are available to manage their pain symptoms.

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References

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D’Arcy Y. Interventional management for chronic pain. Nurse Practitioner. 2010;35(7):11-14.

Debono DJ, Hoeksema LJ, Hobbs RD. Caring for patients with chronic pain: pearls and pitfalls. J Amer Osteo. 2013;113(8):620-627.

Hines, R. Essentials of Pain Management. New York, NY: Springer; 2011.

Institute of Medicine of the national Academies Report. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington DC: The National Academies Press. http://www.iom.edu/~/media/Files/Report%20Files/2011/Relieving-Pain-in-America-A-Blueprint-for-Transforming-Prevention-Care-Education-Research/Pain%20Research%202011%20Report%20Brief.pdf. Accessed June 30 2015.

Pasero C, McCaffey M. Pain Assessment and Pharmacologic Management. St. Louis, MO: Elsevier Mosby: 2011.