It may be best to tackle this question by breaking it down into each of its components…
What is pain?
Pain, medically speaking, is an unpleasant physical feeling or sensation that can occur as a result of a disease, injury, infection, and/or inflammation. Sensory receptors in our body sense the pain and transmit the signal to our brain to perceive the pain via different nerve fibers referred to as A-delta and C fibers. Although initially physical, the pain may have an emotional component for many people that can impact how the pain is perceived.
Are there different types of pain?
Pain is often broken down into different categories to help doctors determine how to manage it more effectively. The most common categories to consider are acute pain and chronic pain.
Acute pain is generally the result of an injury or surgery. There is a direct cause and effect. This category of pain tends to be short term and resolution can be linked to healing. Acute pain tends to last a few days but less than 6 months.
Chronic pain lasts longer, generally beyond 6 months. This can be longer than anticipated based on slow healing after an injury or surgery, or the result of an underlying and ongoing condition.
What are the causes of acute and chronic pain?
Causes for acute and chronic pain can include nociceptive pain, neuropathic pain, inflammatory pain, and functional pain.
Nociceptive pain is the most common type of pain and the one most people are familiar with. This type of pain can be somatic, visceral, or radicular. An injury such as getting your finger caught in a drawer would be an example of a somatic form of nociceptive pain as the injury occurs in the skin or musculoskeletal system. Having a stomach ache can trigger visceral nociceptive pain as this type occurs in our organs. If you have ever experienced pain from a pinched nerve this is a form of radicular nociceptive pain as it involves a nerve root and radiates down the nerves.
Neuropathic pain relates to nerve injury or inflammation. The root neuro- references ‘nerve’. If a nerve is injured, damaged, trapped, or inflamed, it can set off signals in the nerve to the brain to sense discomfort, abnormal sensations, shooting or stabbing sensations, tingling, etc. Examples of neuropathic pain include injuries that involve the nerve affected, shingles-related neuropathy, cancers that involve or invade nerves, or carpal tunnel syndrome.
Inflammatory pain is the result of inflammation drawn to the tissue that can trigger pain by its presence and/or from mediators released from inflammatory cells. The inflammation can be from a surgery or injury in addition to one of the more common triggers, arthritis.
And, lastly, functional pain is a bit of a frustrating category left for pain as a result of an unknown or unclear trigger. There is not an obvious source of pain. Fibromyalgia and irritable bowel syndrome tend to fall into this category.
How do medications for pain play a role in the management of these types of pain?
As a part of the treatment or management of some health conditions, the role that pain can play in healing cannot be overlooked. Pain can impact the quality of life, ability to recover quickly, ability to work, and poorly impact emotional and mental health. For example, after surgery for a hip replacement, there can be significant pain associated with the site as a result of the procedure itself. However, functionally it may not be unreasonable to initiate physical therapy to speed recovery and avoid the risk of becoming sedentary. If the pain is managed appropriately, there can be a hastened chance of recovery, return to family and work, and a better quality of life.
What types of pain medications are available?
Traditionally, the main categories for pain medications include NSAIDs, non NSAIDs, and opioid analgesics.
NSAIDs, NonSteroidal Anti Inflammatory Drugs, include both prescription and nonprescription options. They are referred to as ‘nonsteroidal’ because they work as a steroid but are not a steroid. They block your cell’s ability to produce certain mediators in inflammation. This reduces the risk of adverse effects traditionally seen with steroid medications.
Acetominophen is a non-NSAID pain reliever found over the counter.
Opioid analgesics are available by prescription for pain management. They have been referred to as narcotic analgesics as the pain relief is accompanied by a sense of euphoria and risk of addiction. These are covered in more detail in our post “What are Opioids?”
Which NSAIDs are available?
Name of MedicationName BrandRx and/or nonRx
What does the terms mild, moderate, and severe pain refer to?
Categorizing pain by severity is based on a subjective evaluation of pain with the patient reporting how the pain feels.
Pain scales used to categorize this require the doctor to ask “on a scale of 1 to 10, how bad is your pain?”
Mild pain is considered a 0-2
Moderate pain a 3-5
Severe pain = 6-10
How do the categories of pain and severity of pain affect how pain is managed?
The acute vs chronic nature of pain in addition to the severity of pain are factors that the doctor will consider in determining a management plan. There are times when OTC options are highly effective and reasonable and may require a routine to help control pain during the course of recovery. That being said, there may also be situations where opioid analgesics can play a role in helping patients navigate pain while also being mindful to reduce the chances of addiction and diversion.
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