Complete Pain Management Guidelines

Although pain is an unpleasant sensation and an emotional experience, it still is a part of the body’s own defense mechanism, which warns the body of something going wrong and compels us to react and protect from further harm. Any noxious signal sent through nerves, from the site of the problem to the brain, is interpreted and felt as pain. This feeling of pain may mostly be felt at the real site of the signal, or it may be referred to a remote site of the body.

Pain is neither experienced nor described in an identical way by different people.

Types of Pain:

Depending on the intensity, spread, or duration of pain, it could be described as acute, chronic, localized, or diffused over an area of the body.

Acute pain is generally intense and short-lived. It normally is resolved by treating the cause of pain.

Chronic pain: It can be mild or severe, continuous (arthritis) or intermittent (migraines). Chronic pain typically lasts far longer than acute pain and is often, not easily, resolved.

According to researchers, people in the United States (U.S.) lose 560 to 635 billion dollars each year in terms of treatment costs, lost wages, and missed days of work because of pain alone.

Diagnosis of Pain: 

  1. For identification of the type of pain, there is no objective scale available. Diagnosis depends on
  2. the character of pain, as described by the patient. Such as burning, stinging, stabbing, or radiating.
  3. Factors involved in aggravating or relieving the pain.
  4. Time of the day pain occurs.
  5. The impact of pain on a person’s mood and daily life functions.
  6. Thus, the most important factor in identifying and diagnosing pain is the degree of pain the patient feels and its clear communication to the physician.

Measuring pain:

To assess the efficacy of any treatment for pain, there must be a baseline value to which a post-treatment condition could be compared. In trying to measure pain, professionals have come up with a few methods, like

Numerical rating scales: pain is measured on a scale of 0 to 10, where 0 means no pain at all and 10 means the worst pain imaginable. The patient is asked to allot a number to his pain initially, and further assessment is done by an increase or decrease in this number.

Verbal descriptor scale: This type of measure may be used for cognitively impaired children, seniors, and people with autism or dyslexia. Instead of numbers, different descriptive questions are asked to narrow down the type of pain the patient is feeling.

Face scale: A series of faces is shown to the person in pain, ranging from distressed to happy. This is mainly used with children and has also been shown to be effective in people with autism. It is sometimes used as a standard method of pain assessment.

Brief pain inventory: This is a more detailed written questionnaire gauging the effect of pain on mood, activity, sleep patterns, and how the pain may have affected the patient’s interpersonal relationships. It also charts the timeline of the pain to detect any patterns.

McGill Pain Questionnaire: This encourages people to choose words from a group of 20 words to obtain an in-depth understanding of the type of pain felt. Group 6, for example, is “tugging, pulling, wrenching,” and group 9 is “dull, sore, hurting, aching, heavy.”

Other indicators of pain:

When people with cognitive impairments cannot accurately describe their pain, there can be clear indicators as to the presence of pain, which include:

  1. restlessness
  2. crying
  3. moaning and groaning
  4. grimacing
  5. resistance to care
  6. reduced social interactions
  7. increased wandering
  8. not eating
  9. sleeping problems

After making an assessment, the physician either will actively treat the underlying cause of pain or will prescribe medication to manage the pain.

Treatment and management:

There are different ways to treat different types of pain, as all types may not respond.

Pain is mostly managed by medicines, some of which may be available over the counter (non-steroidal anti-inflammatories (NSAIDs)) and others may require a prescription (opioids) from a doctor.

Due to an emerging realization of painkiller side effects, non-medicinal or alternative therapies to manage pain are gaining popularity.

Alternative Therapies for Pain Management:

A range of non-drug therapies can help relieve pain. These include

Acupuncture: Based on centuries-old recognition of “Qi” (Chi), a vital energy circulating in the body and

Modern-day Acupuncture needles are sterilized, single-use, precision-made, and have specific designs for use in different areas of the body for different treatment needs. The needles are approved for use by the US Food and Drug Administration Authority (FDA).

This ancient treatment is now more widely used as complementary care to effectively treat not only aches and pains but also has established its efficacy in the treatment of addictions, anxiety, allergies, asthma, depression, migraines, athletic injuries, and post-stroke rehabilitation.

Acupuncture has gained such popularity that a concept of pain management feels incomplete without its use. The realization of analgesic’s side effects, by the medical profession and public at large, has also been fanning its popularity. Acupuncture is an ancient technique developed in China but is successfully being used for help in a variety of medical conditions.

Does Acupuncture Actually Work?

Acupuncture has survived the centuries-long history, and this has not been without proving its efficacy, or it would have died its own death. The evidence of the efficacy of acupuncture does not only come from the World Health Organization (WHO) but also from the US Department of Veteran Affairs as well. (https://www.acupuncture.org.au/wp-content/uploads/2017/11/28-NOV-Acupuncture-Evidence_plain-English-Web-version_Reissued_28_Nov.pdf). A wide body of research supports the use of acupuncture to treat many medical conditions, including migraines, depression, arthritis, frozen shoulder, and many more.

A 2017 study found that regular acupuncture could help to prevent migraine episodes, and a review from 2012 indicated that acupuncture may treat migraines as effectively as other medical options.

More research is needed to determine whether acupuncture can help to treat arthritis, but some people find a new lease of life with acupuncture, in which their pain is considerably reduced or abolished, and their life is much more manageable, with no medication side effects.

Results of a 2018 medical research review show that acupuncture may reduce the severity of depression in some people when used alongside traditional treatments.

  1. Acupuncture is used for pain management in a wide range of conditions, like
  2. Aches and pains in muscles
  3. Shoulder pain
  4. Elbow pain/Tennis elbow
  5. Wrist pain/Carpal Tunnel Syndrome
  6. Planter Fasciitis
  7. Headache, cluster HA, tension HA
  8. Migraine HA
  9. Back pain, lower back pain, upper back pain.
  10. Neck pain, stiff neck
  11. Knee pain
  12. Hip pain
  13. Pain associated with childbirth and labor
  14. Menstrual pains.
  15. Arthritis

Readers are encouraged to read the following scientific articles as well:

https://www.ncbi.nlm.nih.gov/pubmed/23790229

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3768227

Battlefield acupuncture is a type of acupuncture used by the US Armed Forces. Moreover, the effectiveness of acupuncture in several scientific studies has been verified by using functional brain scans. The release of endorphins by acupuncture needles is also a scientifically proven fact.

Nerve blocks:

These injections can numb a group of nerves acting as a carrier of pain from a specific limb or body part.

Psychotherapy:

This can help with the emotional side of ongoing pain. Chronic pain can often affect the joys of everyday activities and can lead to an inability to work. A psychotherapist can help to enhance an understanding and put in place lifestyle changes to cope with this inability.

Transcutaneous electrical nerve stimulation (TENS):

TENS aims to stimulate the brain’s opioids and pain gate systems to provide relief.

Surgery:

Various surgical procedures done on nerves, the brain, and the spine make it possible to relieve chronic pain. These include rhizotomy, decompression, and electrical deep brain and spinal cord stimulation procedures.

Biofeedback:

This is a mind-body technique. Through biofeedback, people can learn to better control their organs and automatic processes, such as their heart rate, with their thoughts.

Relaxation therapies:

This covers a wide range of controlled relaxation techniques and exercises, mostly in the realm of alternative and complementary medicine. This can include hypnosis, yoga, meditation, massage therapy, distraction techniques, and tai chi.

Physical manipulation:

A physiotherapist or chiropractor can sometimes help relieve pain by manipulating the muscle tension in a person’s body.

Heat and cold: Using hot and cold packs can help. These can be alternated or selected according to the type of injury or pain. Some medications have a warming effect when applied topically to the affected part.

Rest:

If the pain is due to an injury or a repetitive action, rest may be the best option.