|Pain can be
Short Term, as caused by an underlying trauma or disease,
which is eased once healing occurs, and/or treated with drugs.
Effective Long Term Pain
Management, however, often demands Pharmacologic measures, Physical
Therapy, Interventional procedures, and Psychological measures, either
individually or in various combinations.
Acute pain medication is for
rapid onset of pain such as from an inflicted Trauma or from Post-operative pain.
Chronic pain medication is
for alleviating long-lasting, ongoing pain.
It is beyond the scope of
this report to discuss the various types
of drugs that are used to treat pain, as the following generic groups
each contain so many types, the lists growing constantly.
Inadequate treatment of pain
is common in all departments, in the management of all forms of chronic
pain including cancer pain, and in end of life care. This neglect is
extended to all ages, from babies to the frail elderly.
- Non Steroidal Anti Inflammatory
Generally have a limited effect in Chronic pain treatment due to the
adverse effects of long-term use.
Can provide a short, intermediate or long acting pain relief, depending
upon the specific properties of the medication, and whether it is
produced as an extended release drug.
- Antidepressants and Anti-epileptic
These drugs are often prescribed 'Off-Label' for chronic pain
management and act mainly within the pain pathways of the central
nervous system. They are generally more effective in treating
neuropathic pain disorders, and have a longer list of side
than opiate or NSAID treatments for chronic pain, and including the
risk of siezures resulting from suddenly ceasing Antiepileptics.
- Interventional procedures
Typically used for Chronic Back pain, include Epidural Steroid
Injections, Neurolytic Blocks, Facet Joint Injections, Spinal Cord
Stimulators, and Intrathecal Implants.
The number of Interventional Procedures done for pain has grown over
the last few years.
- Physical Therapy is
either used alone, or simultaneously with
Pharmacologic measures, Interventional procedures, and Behavioral
Therapy to treat pain, usually as part of a multidisciplinary program.
- Acupuncture has shown
effectiveness for the treatment of pain, and, in
some cases of acute pain in the abdomen area, face, headache, knee, low
back, neck, dentistry and sciatica.
Further proof is needed for claims of effectiveness in other conditions
because trials originating in China are all positive (not as a result
of fraud, but of publication bias), whereas trials in the West show a
mixture of positive, negative and neutral results.
- Cognitive and Behavioral Therapy
using stress reduction and relaxation
has been found to reduce chronic pain in some patients, although a
large number of patients gain no benefit.
- Hypnosis was reviewed
in 2007, which found evidence for its
effectiveness in the reduction of pain in some conditions, although the
trial only included 13 cases. The report concluded that a lot more
research would be needed.
The World Health Organization
(WHO) estimated in late 2008 that about 80 percent of the world
population has either no or inadequate access to treatment for moderate
to severe pain. Yet the pain treatment medications cheap, safe,
effective, relatively uncomplicated to administer, and international
law obliges countries to make adequate pain medications available.
Reasons for under-treatment in pain management include
cultural, societal, religious, and political attitudes. Furthermore,
the physicians concentrate on the physical aspects of the trauma or
disease rather than quality of life.
Other reasons may have to do
with inadequate training, personal biases or fear of prescription drug
abuse and fear of being accused of over-prescribing.
Current strategies being
applied for improved pain management include, drawing it up as an
ethical issue, advancing it as a legal right, classifying failure to
provide pain management as professional misconduct, and publishing
guidelines and standards of practice by professional bodies.