Pain: Common and Difficult to Treat
Pain often indicates that something is wrong with us. Pain can appear suddenly or can come about slowly. Feelings of pain can range from mild and occasional to severe and constant. Pain is often classified as acute or chronic. Acute pain lasts only hours or days—and goes away once the original cause has cleared up. Chronic pain lasts months or years and continues even when the initial problem has been resolved. Chronic pain is itself considered a disease because it reflects pathology in the brain and nervous system —which transmits pain—that persists and affects all aspects of life functioning.
What Is Acute Pain?
Acute pain begins suddenly and is usually sharp. It warns us of disease, an injury or onset of a condition that needs attention (like a toothache). Acute pain might be mild and short in duration, or it might be severe and last longer. Acute pain is usually resolved when whatever caused it has been treated or healed. Causes of acute pain can include surgery, dental work, labor and childbirth, and injuries like broken bones, burns, cuts, bruises and sprains.
How Is Acute Pain Treated?
Mild acute pain can often be treated with over-the-counter medications like naproxen or ibuprofen until the problem causing the pain can be addressed. Extreme acute pain can be treated with narcotic medication under a doctor’s supervision.
Does Pain Medication Completely Eliminate Pain?
Complete pain elimination is often not possible because of the side effects of many pain-relieving drugs, many of which can cause sedation. You and your doctor can discuss the benefits and drawbacks of different treatments for acute pain and decide what is right for you.
When Should You Seek Emergency Treatment for Pain?
It can be hard to know whether your pain is “bad enough” to go to the emergency room or an urgent care facility, or whether you should wait until you have an appointment with your doctor or dentist. Chest pain should definitely prompt a visit to the emergency room. Generally, doctors advise against trying to ‘tough it out’ with severe acute pain, since it can become chronic if not treated. (Read more at When Should You Go to the Doctor?)
What Should You Do if You Are Concerned about Pain during Surgery or Childbirth?
Talk to your doctor and anesthesiologist about pain management. Ask explicitly, “What do you think is appropriate pain management?” and make sure you and your doctors are on the same page. Ensure that one of the doctors or the nursing staff will regularly evaluate your pain to make sure you are comfortable. Also talk to your doctors about any medications you are taking, especially if you are already taking pain medication and may have developed a tolerance.
What Are Some Treatments for Pain?*
Pain can be treated in a number of ways, depending upon its severity and cause. Treatment options might include one or more of the following:
- Non-steroidal anti-inflammatory drugs (NSAIDs), a specific type of painkiller such as Motrin® or Aleve®
- Acetaminophen (such as Tylenol®)
- Narcotics (such as morphine or codeine)
- Localized anesthetic (a shot of a pain killer medicine into the area of the pain)
- Nerve blocks (the blocking of a group of nerves with local anesthetics)
- Electrical stimulation
- Physical therapy
- Psychotherapy (talk therapy)
- Relaxation techniques such as deep breathing
- Biofeedback (treatment technique in which people are trained to improve their health by using signals from their own bodies)
- Behavior modification
Some pain medicines are more effective in fighting pain when they are combined with other methods of treatment. Patients might need to try various methods to maintain maximum pain relief.
*This section was adapted from information provided by the Cleveland Clinic Foundation.
Can You Treat Acute Pain at Home?
Most acute pain is not serious and can be handled with home care methods. Some advice from Dr. Kenneth Goldschneider, director of pain management at Cincinnati Children’s Hospital:
For minor injuries, use a cold pack but for no longer than 20 minutes, he suggests.
For sore throats, gargle with salt water— the only advice that has changed since grandma’s time is that aspirin is no longer used for children or adolescents. Use children’s ibuprofen or acetaminophen instead, he says.
He adds that for infants under six months, sugar water has been found to have a short-term analgesic effect: In many hospitals it is now used for giving shots and placing IV’s and other procedures that produce brief, acute pain. It doesn’t work for older children or adults, however.
For a toothache, Manhattan dentist Dennis Bohlin says that when you cannot immediately get to a dentist, use an NSAID drug like ibuprofen or naproxen that has anti-inflammatory properties, since inflammation is often a big part of the problem.
What Is Chronic Pain?
Chronic pain is one of the most difficult—and common—medical conditions. Estimated to affect 76 million Americans—more than diabetes, cancer and heart disease combined—it accompanies illnesses and injuries ranging from cancer to various forms of arthritis, multiple sclerosis and physical trauma.
Pain is defined as chronic when it persists after an injury or illness has otherwise healed, or when it lasts three months or longer.
Who Can Help if You Have Chronic Pain?
The first step to deal with chronic pain is to find a physician or medical team who can accurately diagnose your condition and work with you to lessen pain. Start with your primary care physician or ask for a referral to pain management specialist. A doctor with at least a year long certification in pain management is ideal.
How Is Chronic Pain Treated?
Experts agree that comprehensive care—which can involve medications, exercise, psychological therapy, massage, physical therapy, injections and complementary treatments, depending on the patient and condition—is essential to treat long lasting pain. Chronic pain involves the whole person, their physical and emotional state.
Are Opioids Safe to Take for Chronic Pain?
Opioids, like Oxycontin and morphine, are some of the most effective drugs for chronic pain. Both doctors and patients tend to fear these drugs because of concerns about addiction and overdose. A small number of people who take opioids will become addicted to them. Symptoms of opioid addiction include craving the drug, suffering negative consequences such as losing a job or relationships, having a reduced ability to function and having compulsive drug-related behavior.
Virtually everyone who takes opioids on a daily basis will become physically dependent on their medications; however, they will suffer withdrawal if they quit taking them and the drugs are not slowly tapered off.
How Do You Discuss Needing More Help for Pain with Your Doctor?
Because doctors can lose their licenses or go to prison if they don’t detect addicts who fake pain in order to get access to drugs, patients find themselves in a difficult position when they want to discuss taking opioid medications. Asking for a drug by name, for example, which might be fine with other conditions, is seen as a “red flag.”
Talk to your doctor about seeking relief and explain clearly how chronic pain affects your day-to-day life. If you are prescribed opioids, it’s your responsibility to safely store them, preferably in a locked box. Many people who abuse and overdose on these medications get them from friends and relatives who do not secure them.
What Is Palliative Care?
Palliative care's goal is to manage pain and relieve symptoms in order to improve the quality of life. Though many people associate palliative care with hospice care, it is not only for those in late stages of an illness. It is for any person, of any age, at any time in their illness. Care is usually provided by a health team with doctors, nurses and social workers in the hospital; however, some programs are offering community based outpatient palliative care and home services.
- Medline Plus offered through the National Library of Medicine/National Institutes of Health has information on palliative care.
- The Center to Advance Palliative Care provides health care resources and information about palliative care.
- The American Society of Clinical Oncology (ASCO) has a variety of resources to help patients and their families talk about advanced cancer and identify the best, individualized treatment plan for each patient.
- The Hospice and Palliative Care Nursing Association has a list of Patient/Family Teaching Sheets on Palliative Care. Many documents are in English, Spanish and Mandarin.
- The National Institute of Nursing Research has a brochure titled "Palliative Care: Improving quality of life when you're seriously ill."
More information on palliative care is provided in create this section the BaPP What Is Palliative Care?
Resources reviewed June 2013
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