| Pain control has become regarded by the medical profession as
a patient right, and an important quality of life measurement.
While over the counter pain remedies are sufficient for most types
of minor and temporary pain, chronic or severe pain may require
more intensive treatment. Non-narcotic treatments such as non-steroidal
anti-inflammatories or muscle relaxants are usually the first medications
to be tried. Often an additional, or adjuvant, treatment will be
used for chronic pain to minimize the amount of pain medication
necessary. If non-narcotic medication and an adjuvant therapy are
ineffective, or if the pain is temporary and severe, narcotic pain
medication will then be tried. Narcotic treatments may also be combined
with an adjuvant therapy, like a low-dose antidepressant, to reduce
the amount of pain treatment required.
It's always best to reduce the need for analgesics (pain medication)
by pursuing therapy for the cause of a condition, but this doesn't
mean that pain is better left untreated. Rather, all analgesics
can have undesirable side effects if taken too frequently, or for
long periods of time. As these side effects can include liver or
kidney damage, gastrointestinal bleeding, physical dependence, or
drug tolerance, it is in the best interests of the patient to look
into non-analgesic methods for pain reduction and prevention.
As there are many methods used to control pain, your doctor's recommendation
and your own choice will need to depend on unique personal factors.
The cause of the pain, the expected duration, and your medical history
will all affect the type of treatment your doctor will suggest.
Injury or Surgical Recovery
While the recovery time may vary depending on the severity of the
injury or surgical incision, this type of pain will typically recede
as the wound heals. Usually individuals return to a pain free state
on healing, though there may be some tightness in the affected area,
and it may take some months for all pain to disappear in certain
cases.
In cases of sprains or other muscle injuries, a course of muscle
relaxants alternated with an NSAID and physical inactivity is often
prescribed for as long as necessary. Usually within a few weeks
enough healing has taken place that activity can be resumed, but
only as recommended by your doctor or physical therapist. Sometimes
prescription narcotic treatment may be alternated with muscle relaxants
to provide additional relief for acute pain, but these medications
should not be taken at the same time or oversedation or drug overdose
are possible.
Surgical wounds usually have predictable recovery times depending
on the depth of the incision. Your care providers will often provide
narcotic pain medication during any in-patient stay, and supervise
your level of physical activity in person.
For outpatient care after surgery, a rotating schedule of narcotic
pain medication and an NSAID may be prescribed. If physical therapy
or certain activity levels are suggested, try to follow them as
best you can. Adhere carefully to the medication schedule recommended
by your doctor. Avoid taking double doses of medication, or taking
doses more closely together than recommended by your doctor. Avoid
mixing your treatment with any other pain medication, even over
the counter analgesics, as it may increase the risk of side effects.
Using pain relief medication to immediately resume your normal
activities may lead to serious or lasting injury. Always follow
your doctor or physical therapists' advice about rest and activity
levels after an injury to ensure complete and speedy recovery.
Chronic Muscle Pain
Chronic muscle aches that don't completely respond to physical
therapy and are not caused by any apparent injury are commonly associated
with fibromyalgia, myofascial pain syndrome, and chronic fatigue
syndrome. In recent years the medical community has come to recognize
the necessity of treating chronic pain as a serious condition, and
aiding sufferers to have a more comfortable and normal everyday
life.
This type of pain may be referred to in some medical literature
as psychogenic pain, which means that there is no known cause for
it, and that it may be partly psychological. However, the number
of disorders described as psychogenic has decreased through the
years as medical science has discovered physical causes and effective
treatments for many of them. Many cases of severe abdominal and
menstrual cramping that would once have been ascribed to 'hysteria'
now result in treatment for endometriosis. It is true, though, that
mental and emotional well-being are recognized to play positive
roles in the treatment of serious disorders such as heart disease
and cancer.
The most common medications prescribed for this type of pain are
muscle relaxants, low dose antidepressants, NSAIDs, benzodiazepines,
or sedatives. Prescription sleep aids of various types may be suggested,
as improving sleep quality can have a beneficial effect on muscle
tension. Narcotic pain medication is prescribed less frequently
due to the risk of dependence, but for some individuals it may be
the only source of relief. Even in cases where narcotic medications
are prescribed, it is usually in combination with another medication
or pain relief therapy.
One important thing to note about the use of low dose antidepressants
for chronic pain is that it doesn't mean your pain is caused by
depression. Often these medications adjust levels of neurotransmitters
responsible for the body's perception of pain, mildly reducing sensitivity
to unpleasant sensations.
Try to find a pain reduction strategy as well, since most types
of chronic pain will respond to bodywork therapy of some kind. Even
if medication is necessary to provide relief, physical therapy,
massage, acupuncture, meditiation, postural improvement, and stress
management techniques may all decrease your level of pain. Some
moderate exercise and stretching are also important, and a physical
therapist can help you create an activity plan that doesn't cause
further pain. Inactivity can worsen muscle pain and tension even
in healthy people. Dehydration may also worsen muscle pain, sometimes
caused by a build up of toxins, and drinking extra water can help
the body remove undesirable substances. Taking care of yourself
in this way can also add a sense of comfort and well-being to your
life, making it easier to manage the stress of chronic pain.
Joint Pain
There are many disorders that can cause painful joints, including
rheumatoid and osteoarthritis, gout, bursitis, fibromyalgia, Sjogren's
syndorme, ankylosing spondylitis, and others. Debilitating pain
and restricted movement often result, leading to severe disability
in advanced cases.
Common medical treatment for joint pain of various types usually
begins with non-steroidal anti-inflammatories (NSAIDs), over the
counter pain medication, and sometimes opioids for very severe cases.
Immunosupressive treatments are being investigated for the autoimmune
condition in rheumatoid arthritis, but this treatment is at an early
stage and may have other complications. Surgery can be required
in advanced cases where joints have deteriorated to the point of
needing replacement, or where bone spurs have formed in major joints,
but this is relatively infrequent.
There are few therapies for joint pain that amount to more than
symptom control, though some types may be related to activity levels
or diet and responsive to mild lifestyle changes. Poor muscle tone
can contribute significantly to pain and stiffness in the joints,
and exercise may alleviate what can seem like an escalating cycle
of pain and inactivity. While extreme overuse can damage any part
of the body, inactivity is a far more likely hazard. Also, some
individuals with joint pain can be very sensitive to certain foods,
particularly the nightshade vegetables (eggplant, peppers, tomatoes,
white potatoes), and may find that they feel better when these are
removed from the diet.
Your treatment will depend heavily on the type of joint pain or
arthritis you have, and you and your doctor may end up trying several
types of therapy before finding one that suits you over the long
term.
Chronic Headaches
Few types of pain are as unnerving as headaches. It's hard to get
comfortable, hard to think, and very hard to ignore the sensation.
But there are different types, and they may have different causes.
If you suffer frequent headaches you should explore your options
for reducing their frequency as well as relieving the pain during
an attack.
You may also want to look into your medication use if headaches
become a more frequent part of your life. Many of the medications
used to treat headaches can cause them if used too often. Even medications
like oral contraceptives and SSRIs can increase your risk of headache,
so you should look into potential medical causes of your pain.
Tension Headaches: These headaches are most frequently caused
by stress and muscle tension in the head, neck, or shoulders. Some
individuals can experience this type of headache in connection with
caffeine withdrawal; the so-called 'sunday morning headache' that
occurs when you haven't had your usual cup of coffee. Other causes
may be dehydration, constipation, allergy, eye strain, stuffed-up
sinuses, tooth-grinding, high blood pressure, and spinal misalignment.
NSAIDs are usually sufficient to ease a tension headache.
Reducing the frequency of tension headaches can usually be accomplished
with massage, acupuncture, relaxation therapy, meditation, chiropractic
therapy, or various stress management techniques. Frequent headaches
that don't respond to relaxation therapy may have another health
problem as the cause, and the potential conditions mentioned above
should all be investigated.
Migraine or Cluster Headaches: These vascular headaches
appear to have a hereditary component, and there is no cure for
the condition, or any deep understanding of the cause. It seems
that there is a susceptibility to migraine or cluster headache present
in some people, and attacks will then be set off by an unknown mechanism.
While stress may play a part in triggering migraine or cluster headaches,
allergies, food triggers, unstable blood sugar, sleep disorders,
neurotransmitter imbalances, as well as the possible health causes
of tension headaches, have all been identified as potential causes
for some attacks.
There are prescription pain therapies for vascular headaches which
don't work for any other type of pain. The barbiturate/analgesic
combinations Fioricet
and Fiorinal are examples.
There are also the triptan medications; Amerge
(naratriptan), Imitrex
(sumatriptan), Maxalt (rizatriptan), and Zomig (zolmitriptan),
designed to stop the pain of an attack without causing drowsiness.
The ergotamine derivatives Cafergot, DHE 45 injections, Ergostat,
or Migranal nasal spray may also be used for migraine, and may be
especially helpful with cluster headaches.
The more generic types of pain medication, such as narcotics, NSAIDs,
or combinations of the two, may be effective for some attacks, but
not all. They may also have side effects that can become more pronounced
with frequent use. Also, the use of pain medication more than 2-3
times per week can cause rebound headaches in individuals with vascular
headache. Even pain medications specifically designed to treat migraine
or cluster headache may have this effect, so a prevention therapy
is often suggested.
Vascular headache prevention can take the form of the same stress
reduction therapies useful to treat tension headache, but more is
often necessary. Sometimes a low dose antidepressant therapy is
effective over time, and may also be arranged to improve sleep quality.
Treating the sleep quality can be a useful option on its own, and
might be accomplished either through prescription or sleep hygiene
therapy.
A digestive disturbance is frequently linked to vascular headache,
though the cause varies among individuals. Investigating potential
food triggers can often be rewarded with reduced frequency of attack.
Try to find effective combination therapies for
controlling your pain, so that you don't end up relying entirely
on medication that can be hard on the rest of your body. At the
same time, don't allow pain to keep you from enjoying your life.
Pain control is a patient right, and an important dimension of health
and well-being.
References:
This document is provided for information only; it is not intended
to diagnose symptoms, prescribe treatment, or to substitute for
consultation with a physician. While we have made every effort to
ensure that this information is accurate and extensive, only your
doctor can tell you if a medication, or drug combination, is safe
for you. Information intended for US residents only. |
