Addressing Pain

The Origins of Managing Pain

Historically, pain was actually considered a good thing. Before there were pain medications, it was thought that pain was the body driving away disease. It was felt that the physiological effects associated with pain, including increased blood pressure and heart rate, would help a patient recover from injury or illness.

With the advent of narcotic pain medications, pain began to be seen as only a bad thing that should always be treated. Due to a combination of pharmaceutical company marketing efforts and the desire of physicians and nurses to see their patients happy and comfortable, pain medications began to be heavily prescribed. At the time, we were unaware of the dangers associated with narcotic medication, although in retrospect, this should have been obvious. These medications are all opioid derived, similar to heroin, one of the most addictive substances known to man. Not only are opioids addictive, but the body’s natural response to ongoing opioid treatment is to increase its sensitivity to painful stimuli. This results in patients needing higher and higher doses of narcotics to maintain a stable level of pain control. Not surprisingly, there is little to no evidence that long term narcotic usage actually provides long term pain relief.

How We Treat Pain Today

Fortunately, there has been significant research and development in the area of pain. We now understand that pain is truly multi factorial and we have returned to the belief that pain in and of itself is not bad. Pain is essentially the conscious interpretation of nerve signals suggesting that there is a problem in the painful area. Without pain we would be faced with constant risk of serious injury because we would not have the protection that pain provides. In addition, we would not know when something is truly wrong.

However, it should be noted that pain, like any other sensation, is part of life. The focus of pain control has shifted from one of eliminating pain to one of making pain manageable and not restrictive. New are non-narcotic medications which are being used for pain focus on affecting the central nervous system’s response to painful stimuli or decreasing dinner logic input of the painful stimuli instead of focusing on sedating the patient and purely blocking the pain. There has also been significant progress in non-medical pain management. Techniques used include biofeedback manipulation massage local measures.

Perhaps the most under-appreciated form of pain control is exercise. Exercise produces natural endorphins substances which interact with nerves in a manner somewhat similar to narcotic pain medications. This helps decrease pain in the entire body. In addition, aerobic exercise stimulates tissue regeneration and healing which ultimately helps reduce pain.

With the more specific example of surgery, it is expected that surgery will be painful. The goal of pain management around the time of surgery is to keep this pain from being severe, to get the pain to a level where the patient can function and recover and is not restricted by the pain. The goal is not to eliminate the pain. To do so would require significant sedation which has a great deal of risk associated with it.

Where does neck pain come from?

Neck pain is very common problem and one of the top reasons that people visit physicians. Neck pain is not unusual in any stage in life but peaks in midlife and is often associated with stiffness or muscle spasm. The majority of neck pain can be treated conservatively often with simple home measures.

Frequently the pain is self-limited, and time alone provides relief. Over the counter medications such as anti-inflammatory medications or Tylenol will oftentimes provide relief. In addition, topical measures such as ice and heat may be beneficial.

With necks it is important to continue movement. A natural response to pain is to hold the neck still and stiff. This eventually makes movement harder and painful. After a minor injury, such as a whiplash injury that causes neck pain, or with neck pain that begins spontaneously it is important to maintain motion and work to return to normal neck motion as soon as possible. Doing so will decrease the overall duration of symptoms.

Sometimes neck pain can indicate a more severe problem. Pain that does not resolve with simple home measures or persists despite normal treatments or pain that is associated with other symptoms such as radiating pain into the arm, numbness, weakness, loss of coordination or balance, fever or chills or pain that get significantly worse with rest or at night are all reasons to consult a physician. Neck pain alone is rarely an indication for surgical intervention But there are other non-surgical treatment options which frequently will provide relief.

The Most Common Form of Pain

Back pain is almost ubiquitous and nearly every personal experience back pain at some point in her life. It is believed to be the #1 reason for physician visits in the United States. Similar to neck pain back pain typically peaks in mid life. Sometimes patients experience a single episode of pain and sometimes the pain becomes recurrent. Patients with recurrent back pain typically experience an acute severe onset of pain with associated muscle spasm that will often last for several days and gradually improve.

Typical treatments include a short period of rest followed by early return to stretching and return to normal activities as soon as possible, use of ice and heat. There is significant evidence that early return to activity provides more rapid resolution of symptoms than prolonged rest. The mainstay of preventative medicine for backs his regular exercise including aerobic fitness and core strengthening. With recurrent back pain or acute episodes of back pain following minor trauma there is significant evidence that more quickly physical therapy protocols are initiated quickly the symptoms will resolve and they lower the rate of symptom recurrence.

Sometimes back pain can indicate more severe problems. Acute back pain after minor trauma in patients with osteoporosis is often a symptom of compression fractures. If pain after minor trauma in a patient with a known history of osteoporosis persists x-rays should be done to rule out fracture. Pain that is associated with other symptoms such as fevers chills pain at night or pain that does not improve over time with basic conservative measures merits a medical workup. Sometimes it is difficult to discern between typical run-of-the-mill back pain and a more serious problem. In these cases medical advice should be sought.

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