Pain management
Pain management is an aspect of medicine and health care involving relief of pain in various dimensions, from acute and simple to chronic and challenging. Most physicians and other health professionals provide some pain control in the normal course of their practice, and for the more complex instances of pain, they also call on additional help from a specific medical specialty devoted to pain, which is called pain medicine.
Pain management often uses a interdisciplinary approach for easing the suffering and improving the quality of life of anyone experiencing pain, whether acute pain or chronic pain. Relieving pain is typically an acute process, while managing chronic pain involves additional complexities and ideally a interdisciplinary approach.
A typical multidisciplinary pain management team may include: medical practitioners, pharmacists, clinical psychologists, physiotherapists, occupational therapists, recreational therapists, physician assistants, nurses, and dentists. The team may also include other mental health specialists and massage therapists. Pain sometimes resolves quickly once the underlying trauma or pathology has healed, and is treated by one practitioner, with drugs such as pain relievers and occasionally also anxiolytics.
Effective management of chronic pain, however, frequently requires the coordinated efforts of the pain management team. Effective pain management does not always mean total eradication of all pain. Rather, it often means achieving adequate quality of life in the presence of pain, through any combination of lessening the pain and/or better understanding it and being able to live happily despite it. Medicine treats injuries and diseases to support and speed healing. It treats distressing symptoms such as pain and discomfort to reduce any suffering during treatment, healing, and dying.
The task of medicine is to relieve suffering under three circumstances. The first is when a painful injury or pathology is resistant to treatment and persists. The second is when pain persists after the injury or pathology has healed. Finally, the third circumstance is when medical science cannot identify the cause of pain. Treatment approaches to chronic pain include pharmacological measures, such as analgesics, antidepressants, and anticonvulsants; interventional procedures, physical therapy, physical exercise, application of ice or heat; and psychological measures, such as biofeedback and cognitive behavioral therapy.
Defining pain
In the nursing profession, one common definition of pain is any problem that is "whatever the experiencing person says it is, existing whenever the experiencing person says it does".Pain management includes patient and communication about the pain problem. To define the pain problem, a health care provider will likely ask questions such as:
- How intense is the pain?
- How does the pain feel?
- Where is the pain?
- What, if anything, makes the pain lessen?
- What, if anything, makes the pain increase?
- When did the pain start?
- Zero equaling no pain
- One to three equaling mild pain
- Four to six equaling moderate pain
- Seven to 10 equaling severe pain
Adverse effects
There are many types of pain management. Each have their own benefits, drawbacks, and limits.A common challenge in pain management is communication between the health care provider and the person experiencing pain. People experiencing pain may have difficulty recognizing or describing what they feel and how intense it is. Health care providers and patients may have difficulty communicating with each other about how pain responds to treatments. There is a risk in many types of pain management for the patient to take treatment that is less effective than needed or which causes other difficulties and side effects. Some treatments for pain can be harmful if overused. A goal of pain management for the patient and their health care provider is to identify the amount of treatment needed to address the pain without going beyond that limit.
Another problem with pain management is that pain is the body's natural way of communicating a problem. Pain is supposed to resolve as the body heals itself with time and pain management. Sometimes pain management covers a problem, and the patient might be less aware that they need treatment for a deeper problem.
Physical approaches
Physical medicine and rehabilitation
, a medical specialty, uses a range of physical techniques, such as heat and electrotherapy, as well as therapeutic exercises and behavioral therapy in the management of pain. PM&R techniques are usually part of an interdisciplinary program that might also include pharmaceuticals. Spa therapy has shown positive effects in reducing pain among patients with chronic low back pain, but its evidence base is limited. Studies have shown that elastic therapeutic tape can be used to reduce chronic low back pain. The Centers for Disease Control and Prevention recommended that physical therapy and exercise be prescribed as first-line treatments for multiple causes of chronic pain in 2016 guidelines. Applicable disorders include chronic low back pain, osteoarthritis of the hip and knee, and fibromyalgia. Exercise alone or with other rehabilitation disciplines can have a positive effects on pain. Besides improving the experience of pain itself, exercise can also improve individuals' well-being and general health.Manual and joint mobilization therapies are considered safe interventions for low back pain, with manual therapy potentially offering a larger therapeutic effect.
Specifically in chronic low back pain, education about the way the brain processes pain in conjunction with routine physiotherapy interventions may provide short-term relief of disability and pain.
Exercise interventions
Physical activity interventions, such as tai chi, yoga, and pilates, promote harmony of the mind and body through total body awareness. These practices incorporate breathing techniques, meditation, and a wide variety of movements while training the body to perform functionally by increasing strength, flexibility, and range of motion. Physical activity can also benefit people with chronic pain by reducing inflammation and sensitivity and boosting overall energy. Physical activity and exercise may improve chronic pain, and overall quality of life, while minimizing the need for pain medications. More specifically, walking has been effective in improving pain management in chronic low back pain.Transcutaneous electrical nerve stimulation
Transcutaneous electrical nerve stimulation is a self-operated portable device intended to help regulate and control chronic pain via electrical impulses. Limited research has explored the effectiveness of TENS in relation to pain management of multiple sclerosis. MS is a chronic autoimmune neurological disorder, which consists of the demyelination of the nerve axons and the disruption of nerve conduction velocity and efficiency. In one study, electrodes were placed over the lumbar spine, and participants received treatment twice a day and at any time when they experienced a painful episode. This study found that TENS would benefit MS patients with localized or limited symptoms in one limb. The research is mixed with whether or not TENS helps manage pain in MS patients.Transcutaneous electrical nerve stimulation is ineffective for lower back pain, but it may help with diabetic neuropathy.
Transcranial direct current stimulation
Transcranial direct current stimulation is a non-invasive technique of brain stimulation that can modulate activity in specific brain cortex regions, and it involves the application of low-intensity constant direct current to the scalp through electrodes in order to modulate the excitability of large cortical areas. tDCS may have a role in pain assessment by contributing to efforts in distinguishing between somatic and affective aspects of pain experience. Zaghi and colleagues found that the motor cortex, when stimulated with tDCS, increases the threshold for both the perception of non-painful and painful stimuli. Although there is a greater need for research examining the mechanism of electrical stimulation in pain treatment, one theory suggests that the changes in thalamic activity may be due to the influence of motor cortex stimulation on the decrease in pain sensations.Concerning MS, a study found that daily tDCS sessions resulted in an individual's subjective report of pain decreased when compared to a sham condition. In addition, the study found a similar improvement at 1 to 3 days before and after each tDCS session.
Research examining tDCS for pain treatment in fibromyalgia has found initial evidence for pain decreases. Specifically, the stimulation of the primary motor cortex resulted in significantly greater pain improvement in comparison to the control group. However, this effect decreased after treatment ended, but remained significant for three weeks following the extinction of treatment.