CONDITIONS

What Is Pain Management

Pain can be caused by a number of things; from an injury, a disease, or a strain on the body. Sometimes pain may continue long after the original cause has gone away. Sometimes, persistent pain may occur for no obvious reason.

100 million Americans suffer from some form of chronic pain. That’s more people than cancer, heart disease, and diabetes put together. Many more suffer from pain caused by acute or health problems such as cancer, arthritis, or lower back strain.

Pain management is a medical specialty devoted to diagnosing and treating serious pain. Pain management is a multidisciplinary specialty, meaning that pain management specialists use knowledge from other branches of medicine, including: 

  • Anesthesiology
  • Neurology and neurosurgery
  • Internal medicine
  • Psychiatry
  • Physical therapy and rehabilitation

What Causes Pain Management

Pain is different for every individual. Most of the time, pain is caused when an illness, injury, or some strain on your body causes your nerves to send a signal to your brain, causing the unpleasant sensation we call pain. Usually, pain helps us by warning us something is wrong. But sometimes pain can cause suffering that is out of proportion to the problem that caused it. Pain may continue long after the disease or injury has been treated, or you may feel pain that seems to have no cause.

Pain that seems to happen for no reason or continues long after it should have ended is called chronic pain. Usually, chronic pain occurs when your nervous system just can’t stop sending pain signals because of something that happened in the past. This type of chronic pain may cause you to suffer for months or even years unless it is treated. Chronic pain may also be caused by damage to your nerves, caused by diabetes or some other condition. This is known as neuropathic pain.

Typical causes of long-term, or chronic pain include: 

  • Migraines
  • Arthritis
  • Fibromyalgia
  • Injury or trauma
  • Surgery
  • Lower back problems
  • Cancer
  • Diabetes
  • Stroke

Causes of short-term, or acute pain include: 

  • Infections
  • Serious injuries or burns
  • Childbirth
  • Dental problems
  • Appendicitis
  • Surgery or medical procedures

Risk Factors For Pain Management

There are things that can increase your risk for chronic pain. You can’t control all of these risk factors, but being aware of them may help you understand your condition.

Physical risk factors for chronic pain include: 

  • Your age. The older you are, the more likely you are to need pain management
  • Your weight. Being overweight can worsen diseases that cause pain and raise your risk of chronic pain.
  • Your race. According to some studies, your risk is higher if you are Latino or African American.
  • Your genes. Some genetic conditions can make you more sensitive to pain.
  • A past injury. If you’ve had an injury that caused serious pain in the past, your nerves may have been primed to feel three to five times as much pain as you should, the next time you’re injured.

Psychological risk factors for chronic pain include: 

  • Childhood trauma, such as abuse or neglect.
  • Mood disorders, such as depression or an anxiety disorder.

You may also have risk factors based on things that occur in your day-to-day life, such as: 

  • Smoking
  • Stress
  • A job that involves heavy lifting or puts you at risk of injury.

Diagnosing Pain Management

Pain can be a symptom of many different illnesses. Sometimes it’s easy to tell what’s wrong, but other times the cause may be harder to find. Diagnosing complex or chronic pain may require a team of health care professionals, possibly including:

  • A general practitioner
  • A neurologist or neurosurgeon
  • A rheumatologist
  • A psychologist or psychiatrist
  • A physical or occupational therapist

Your diagnosis may involve a complete physical and psychological assessment, as well as tests. Tests used in pain assessment include

  • Imaging tests such as x-ray or magnetic resonance imaging (MRI)
  • Stimulus response tests such as nerve conduction studies or electromyography (EMG)

Some chronic pain disorders do not have tests, and can only be diagnosed by ruling other conditions out based on your medical history and your physical exam.

Symptoms of Pain Management

In most cases, pain is a symptom of a disease or injury, but in others, pain itself is the disorder. Your problem may be a chronic pain disorder if: 

  • You continue to feel pain more than three weeks after an injury, illness, or surgery
  • You feel pain for no obvious reason

Prognosis

Some types of pain can be easily recognized and treated. Others are chronic problems that need lifelong management. Often, chronic pain can be managed. Because of ongoing scientific research, many doctors believe pain disorders that are problematic now may be easier to control in years to come.

Living With Pain Management

Sometimes the effects of pain can be more severe than the injury or illness that caused it. What’s more, many people with chronic pain have to cope with

  • Uncertainty
  • Social stigma
  • Inadequate treatment or misdiagnosis

For many people, chronic pain impacts quality of life and makes it hard to concentrate, to sleep, or to get stuff done at work and in day-to-day life. Chronic pain can also lead to depression. According to one study, more than four out of five people with chronic pain also felt depressed.  So what can you do to help yourself manage when you suffer from chronic pain? Start by asking for help when you need it.

If you need help, talk to your doctor. If you feel depressed, or like it’s too much to bear, tell your doctor or talk to a psychologist or psychiatrist. If you find yourself thinking about suicide, talk to a doctor right away. If your doctor isn’t available, visit the emergency room or call the National Suicide Prevention Lifeline at 800-273-8255. 

Also, don’t be afraid to ask for help from friends and family in your day-to-day life. Overextending yourself can lead to stress and trigger pain flare-ups. So don’t be afraid to call on friends or family for help. Sometimes you may need to delegate a task or put it off until later, and that’s OK.

Think of your energy as a limited resource, and budget what you have. Sometimes people compare this to pennies, or spoons. Assess what you have to do today, and if it takes more “spoons” than you think you have, figure out what you can skip or give someone else to do. And always try to keep one spoon in reserve, to help you cope with things you didn’t expect. 

Don’t be afraid to ask for help when you just need someone to talk to.

Above all, remember to accept your limits and focus on the positive. Don’t dwell on the things you can’t do, but remember the things you can, and find ways to get the most out of life. You can’t always control your pain, but you can control your life and your happiness.

Screening

If you suffer from pain on a day-to-day basis, there are questionnaires and screening tools that your doctor can use to assess the severity of your pain, ranging from a one-question scale with pictures of facial expressions to more complex questionnaires suing 10 or more questions.

Prevention

Pain disorders can’t always be prevented, but there are things you can do to reduce your risk of chronic pain or, if you have a chronic pain disorder, to make flare-ups happen less often.

To help prevent a chronic pain disorder:

  • Take care of your health. Eat properly, stay active, and maintain a healthy weight.
  • Don’t smoke. If you smoke, ask your doctor to help you quit.
  • Manage your stress through meditation, exercise, or other techniques.
  • Take precautions to prevent injury at work.
  • Seek help if you have a mood disorder such as depression or anxiety issues.

If you already suffer from chronic pain, things you can do to prevent relapses include

  • Get enough rest
  • Don’t take on more than you can handle
  • Learn what triggers your pain flares, and avoid your triggers, or, if you can’t avoid them, prepare yourself.

Common Treatment

Effective pain management often involves not just one treatment but a combination of different approaches. 

These are some of the medicines used to treat pain: 

  • Acetaminophen (Tylenol) offers mild pain relief without upsetting your stomach, but taking too much for too long may damage your liver.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil) and naproxen (Aleve) give stronger relief but may cause stomach troubles with long-term use. NSAIDs are also available in prescription strength.
  • Celecoxib (Celebrex), a prescription COX-2 inhibitor, does not affect your stomach, but can increase your risk of heart attack.
  • Opiates (narcotics) are available by prescription only. They offer powerful pain relief but can cause addiction or dependence. Narcotics may also cause constipation or make it hard to think clearly.
  • Other medications, including antidepressants such as amtriptyline (Elavil) and anti-seizure drugs such as carbamazepine (Tegretol, Equetro) are also used sometimes for pain relief.
  • Depending on the cause of your chronic pain, your doctor may also prescribe other medications to treat the underlying condition.

In addition to medicine, your chronic pain treatment may also include other approaches, such as: 

  • Relaxation and stress management
  • Physical and occupational therapy
  • Sleep
  • Group therapy
  • Lifestyle changes
  • Other techniques, including complementary treatments such as biofeedback

Complementary and Alternative Treatment

In pain management, alternative and complementary treatments are included in the approach used by many doctors and hospitals. Some of the alternative treatments endorsed by doctors include:

  • Acupuncture
  • Electrical stimulation
  • Relaxation techniques, such as meditation and yoga
  • Biofeedback

Other complementary pain treatments are being examined in scientific studies. These include:

  • Massage
  • Mangosteen juice
  • Chiropractic

Some people also use herbal treatments for pain relief, although these treatments are not thoroughly tested and may have side effects. Herbal pain treatments include:

  • Topical capsaicin, derived from chile peppers
  • Ginger extract for joint and muscle pain
  • Feverfew for headaches and rheumatoid arthritis
  • Turmeric for arthritis pain
  • Devil’s claw for arthritis and lower back pain
  • Ginseng for fibromyalgia
  • Kava kava for headaches and neuropathic pain
  • St John’s wort for back pain, arthritis, and neuropathic pain
  • Valerian root for muscle cramps
  • Boswellia
  • Willow bark

Always tell your doctor about any treatments you take, including herbal or alternative treatments, as they may have side effects or interact with other medicines you are taking.

Care Guide

Managing chronic pain isn’t limited to the treatments you get from your doctor. You can also learn about your condition and take an active role in your own care. Some things you can do to help manage your chronic pain include:

  • Get enough rest. Sleep helps your body manage pain, and being overtired can intensify your flare-ups, so be sure to rest when your body needs to rest, and sleep when you need to sleep.
  • Don’t take on more than you can handle. Budget our time and energy, and keep a little in reserve for emergencies.
  • Listen to your body. Don’t try to push through the pain. Your body knows what it can do and what it can’t.
  • Learn your triggers. Keep track of the things that cause your pain to flare up, and learn to avoid them or work around them.
  • Enjoy life. Doing things you love to do can help you reduce frustration and manage your pain better.

When To Contact A Doctor

If pain is bothering you, tell your doctor. Pain is already undertreated, and it may be a long-term condition or a sign of a deeper health issue. You should not have to live with pain.

Questions For Your Doctor

Pain management often starts with your family doctor. If your doctor suspects your pain may be a serious problem, then he or she may refer you to a pain management specialist. 

If you do not have a regular doctor, you can find a pain specialist at the Find a Doctor page on the American Academy of Pain Medicine website

Questions For A Doctor

When you go to see your doctor, it’s good to have a list of the questions you’d like to have answered. Take a moment to write down some of the things you want to know. Your questions for your doctor might include some of these:

  • Do you know what is causing my pain?
  • How long do you expect a diagnosis to take?
  • What treatments are available? What are the side effects?
  • What treatment do you recommend?
  • What can I do in my day-to-day life to reduce pain?
  • Is there anything else I should know about my pain?