However, when pain isn’t there to teach us a lesson or it doesn’t fade following a diagnosis, "pain management" techniques may be employed. These can include lifestyle, medical, therapeutic, or surgical measures to eliminate, minimize or control the discomfort.
You Are Not Alone
In 1999, the Society for Neuroscience (a D.C.-based non-profit dedicated to "advancing the understanding of the brain and nervous system") estimated that nearly 100 million people in the United States have experienced some sort of chronic pain. Those whose chronic pain is more severe and persistent may find it necessary to explore treatment options. Those afflicted can take comfort in the fact that modern scientists and surgeons are working diligently to alleviate their suffering.
This zealous search for pain relief hasn’t always been the case, however. Indeed, until the 19th century, physicians often thought that pain was indicative of a high chance of recovery. Marcia Meldrum, who holds a doctorate degree in the history of science and medicine and who was a co-investigator on a National Institute of Mental Health grant studying chronic pain in children, quoted a surgeon who, in 1826, stated: "The greater the pain, the greater must be our confidence in the power and energy of life.” Even more primitive cultures believed that pain was evidence of human folly or bad spirits. “Surgeons” would often drill holes in a patient’s skin to try to release their demons. The ancient Greeks took it a step further: The goddess of revenge, Poine, was sent to punish mortal fools who had angered the gods (hence, the origin of the word pain). In modern times, thankfully, doctors are more inclined to believe that “no pain is untreatable” and that “pain is an emergency.”
Physical therapy can play a major role in pain reduction.
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What Is the Source of Your Pain?
Professionals are now armed with a better understanding of the causes of pain, of which there are several types:
Nociceptive pain involves the receptors of sensory neurons that are located in the skin, mucosa or internal organs. Pain arises when these receptors are activated by a possibly damaging stimulus - such as heat or pressure.
Somatic pain originates from conditions within the bones, muscles, and tendons.
Visceral pain stems from distress within the organs.
Neuropathic pain is generated from nerve cell dysfunction. It can prove particularly troublesome in treatment. (Phantom limb syndrome, when the brain still feels pain from an amputated arm or leg, is a form of neuropathic pain.)
For the most part, doctors still determine the extent of pain by asking questions about its duration and intensity. Often, they urge patients to rank their pain on a scale of 1 to 10 (1 being bearable, 10 being the worst pain they’ve ever experienced). For younger children, who might not understand such queries, a scale using facial expressions, ranging from happy to sad, is employed.
The type of pain a person experiences, as well as its severity and duration, may play a large role in determining treatment. In some cases, holistic methods of healing designed to reduce stress can often prove beneficial. The use
of Eastern practices like Reiki (a Japanese-developed "energy healing" technique involving gentle massage and laying on of hands) and acupuncture have become commonplace. Certain relaxation tools and hypnosis are said to help treat problems such as the anxiety and depression that can develop when a patient has to deal with chronic pain. These techniques have also proven helpful when actual pain results from anxiety and depression. Ongoing studies conducted by the National Center for Complementary and Alternative Medicine (an arm of the National Institutes of Health) suggest that treatments such as acupuncture may be effective for certain conditions provided they are performed by a qualified practitioner.
Medical massage and physical therapy, both time-tested methods, are among other non-invasive procedures that have helped many pain sufferers.
Added buoyancy in water is a key component in hydrotherapy’s success.
Looking for Solutions
Those with intense pain that proves impervious to lifestyle or holistic approaches may be forced to consider using prescription drugs, under proper medical supervision, to function. Opioid pain medications - such as codeine, morphine, and oxycodone - are often prescribed to sufferers. They are immensely effective in treating acute pain, and can be effective in treating long-term chronic pain, though use over a prolonged period risks addiction. Additionally, local anesthetics, such as lidocaine and Novocain, and anti-inflammatory drugs such as cortisone, can be injected into nerves and joints, reducing swelling, irritation, and abnormal nerve activity in the affected region.
Despite all efforts, there are cases when drugs and injections still fail. Chronic pain sufferers may be forced to consider surgery. The most common surgery entails inserting implants into the patient’s body. An Intrathecal Pump brings morphine directly to the spinal fluid. This delivery system can be very effective using much smaller doses that oral medication and often without the unpleasant side effects such as loss of appetite, nausea, and constipation. According to Cincinnati’s Mayfield Clinic, one of the largest neurosurgical practices in the world, “The pump is programmed to slowly release medication over a period of time. It can also be programmed to release different amounts of medication. This therapy is completely reversible if you should ever decide to have the pump removed.”
Another minimally invasive surgical alternative is Spinal Cord Stimulation, which involves an implanted device that generates an electrical impulse that alters the patient’s perception of pain. The National Pain Foundation explains the limitations of this method: "An SCS system produces an electrical field over the spinal cord which blocks some, but not all, types of pain. For example, pain from surgery, stomach pain, or tissue injury will not respond to spinal cord stimulation. These are types of nociceptive pain. SCS can only control pain that comes from damage to the nervous system or that is caused by abnormal processes of this system... neuropathic pain."
Prescription medications are effective, but can come with a laundry list of side effects.
Surgical Sympathectomy is the most extreme surgical option. In this procedure, malfunctioning nerves are cut to prevent the flow of pain signals. As with all surgeries, these techniques carry serious risks. Needless to say, it is important to consult your physician (and, perhaps, a second physician) about all treatment options.
The pain we all endure can range from aggravating to crippling. Its arrival can prove a setback in our daily life. More than ever before, however, the issue is being seriously addressed. Physicians are specializing in pain management. The Internet has become a valuable source of information, referrals, and support groups.
Most importantly, science is making continual advances in the field of medical management toward the goal, in the very near future, of permanently easing pain and improving life for millions of people.
Jennifer Wright is a graduate of St. John’s College and now resides in New York City.
What’s Up? does not give medical advice. This material is simply a discussion
of current information, trends, and practices. Please seek the advice of your physician before making any changes to your lifestyle or health routine.
