Pain and Pain Management Methods



Pain and Pain Management

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.
  • Non Steroidal Anti Inflammatory Drugs (NSAID)
    Generally have a limited effect in Chronic pain treatment due to the adverse effects of long-term use.
  • Opioids
    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 drugs
    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 effects 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.
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.

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.





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Pain & Pain Management