According to the British Pain Society, health professionals use different terms for different types of pain.
Short-term pain is called acute pain – from a sprained ankle, for instance, whilst long-term pain is called persistent or chronic pain – resulting from back trouble or arthritis, for example. Pain that comes and goes is called recurrent or intermittent pain – such as tooth ache.
Many acute pains are like an alarm indicating that something is wrong. Most minor ones are easy to treat; others may be a sign of something more serious. For example the pain of a broken leg will enforce rest until it heals. Here the pain is helping.
Persistent pain often serves no useful purpose. The messages from the warning system linked to long-term conditions like arthritis or back pain are not needed – just annoying. Over time, it may affect what a person can do, their ability to work, and their sleep patterns. It can have a strong negative effect on the sufferer’s family and friends too.
Pain signals use the spinal cord and specialised nerve fibres to travel to the brain. This involves the whole body. It is more than just a network of wires. These fibres also work to process the pain signals. All together they work like a very powerful computer.
Sometimes this computer system can go wrong. The messages get confused and the brain cannot understand the signals properly. It can lead to chronic or persistent pain, which can be very hard to repair.
Part of this process is linked directly with the emotional centres in the brain. This means that how a person is feeling emotionally has an effect on their pain. Therefore anger, depression and anxiety can make pain feel worse. The opposite is also true. If a person is feeling positive and happy, then their pain can seem to be less. It shows that pain is never ‘just in the mind’ or ‘just in the body’ – it is a complex mix involving a person’s whole being and how their brain interprets the signals.
Sometimes, pain can begin in a very small way. But the signals quickly jump along the nerve network.
This is called ‘wind-up’ and is one of the reasons why chronic pain does not go away easily. The pain can last for hours, days or even years. This can lead to a long term, distressing problem which requires skill, time and patience to improve.
The way a pain signal jumps along the nerve system is through the release of a chemical. These are called neurotransmitters, and over one hundred types have been discovered.
There are good neurotransmitters and bad ones. The bad ones make the pain worse; the good ones can help block the pain.
Pain management
Pain management (also called pain medicine) is the medical discipline concerned with the relief of pain.
Pain management generally benefits from a multidisciplinary approach that includes pharmacologic measures (analgesics such as narcotics or NSAIDs and pain modifiers such as tricyclic antidepressants or anticonvulsants), nonpharmacologic measures (such as interventional procedures, physical therapy and physical exercise, application of ice and/or heat), and psychological measures (such as biofeedback and cognitive therapy). The World Health Organization (WHO) recommended a pain ladder for managing analgesia, which was first described for usage in cancer pain, but can be used by medical professionals as a general principle when dealing with analgesia for any type of pain.
Pain management practitioners come from all fields of medicine. Most often, pain fellowship trained physicians are anesthesiologists, neurologists, physiatrists or psychiatrists. Palliative care doctors are also specialists in pain management.
Some practitioners focus more on the pharmacologic management of the patient, while others are very proficient at the interventional management of pain. Interventional procedures – typically used for chronic back pain – include: epidural steroid injections, facet joint injections, neurolytic blocks, spinal cord stimulators and intrathecal drug delivery system implants. Over the last few years, the number of interventional procedures to relieve pain has grown considerably.
As well as medical practitioners, the area of pain management may often benefit from the input of physiotherapists, chiropractors, clinical psychologists and occupational therapists, amongst others. Together the multidisciplinary team can help create a package of care suitable to the patient.