Are You Living With Pain?

Pain: What You Need to Know

Analgesics commonly known as pain killers, are the number one medication taken by people around the globe. I'm sure everyone has experienced pain of some sort during their lifetime.

It is important to know that we can't measure pain! Pain is subjective, what is painful to you may not be painful to someone else.

Pain is a common experience that can be caused by a variety of things, such as injury, illness, or surgery. Pain medications that are used to relieve pain work by blocking the pain signals that are sent to the brain. There are many different types of painkillers, and they work in different ways. Since Pain is subjective, sometimes, one painkiller may work for one person but may not work in the same way for the next. It is also because we all have different pain thresholds. A not-so-strong analgesic may be sufficient for a person whose pain threshold is high. This means, that person can tolerate pain better.

In addition to different pain perceptions, there are different types of pain. In order to treat your pain you have to first understand the type of pain you have.

Types of Pain

The familiar way we describe pain could be, a dull ache, throbbing, burning sensation, stinging, pounding, or simply very sore.

The following are 4 main common types of pain:

• Acute pain

• Chronic pain

• Neuropathic pain

• Nociceptive pain

Acute Pain

• Acute pain is described as sudden sharp or intense pain.

• It can be caused by disease, injury, trauma, or surgery. Examples are cuts and bruises, broken bones, muscle damage, menstrual cramps, tissue damage or swelling, muscle contractions, and dental pain.

• Pain duration can be from a few minutes to less than 3 months. It does not last all day and night but can come and go in short bursts.

• You can explain your severity of pain on a scale of 1-10 but as I said before, it is hard to measure pain.

Chronic Pain

• Chronic pain is ongoing pain that lasts longer than 3-6 months.

• Examples are cancer pain, arthritis, lupus, fibromyalgia, and many more.

• It can be very debilitating to your life. It impacts your quality of life.

• It is not easily diagnosed due to different underlying conditions.

• It has a profound effect on sleep, mood and appetite which can result in weight loss.

Neuropathic Pain

Neuropathic pain is a type of pain that is caused by damage to the nerves. The nerves are responsible for carrying messages from the body to the brain, and when they are damaged, they can send incorrect or exaggerated messages to the brain, which is interpreted as pain.

Neuropathic pain can be caused by a variety of things, including:

• Injury: Neuropathic pain can be caused by damage to the nerves, such as from a car accident, a fall, or surgery.

• Disease: Neuropathic pain can be caused by diseases such as diabetes, multiple sclerosis, and HIV/AIDS.

• Medications: Some medications, such as chemotherapy drugs and certain antibiotics, can cause neuropathic pain.

Neuropathic pain can be a very difficult type of pain to treat. There is no one-size-fits-all treatment, and the best treatment for you will depend on the cause of your pain, your individual needs, and your preferences.

Nociceptive Pain

Nociceptive pain is a type of pain that is caused by damage to body tissue. Nociceptors are specialized sensory neurons that detect potentially harmful stimuli, such as extreme temperatures, pressure, or chemicals. When nociceptors are activated, they send signals to the brain, which interprets the signals as pain.

Nociceptive pain can be caused by a variety of things, including injury, inflammation, and disease. It can be acute, meaning it comes on suddenly and lasts for a short period of time, or chronic, meaning it lasts for more than 12 weeks.

Acute nociceptive pain is often a sign that something is wrong and that the body needs to be protected. For example, acute pain is a warning that you have been injured and that you need to rest the injured area. Chronic nociceptive pain, on the other hand, can be debilitating and interfere with a person's quality of life.

How to Treat Different Types of Pain-Choosing a Pain Killer

There are many different types of painkillers available, both over-the-counter and prescription. The type of painkiller that is right for you will depend on the type and severity of your pain, as well as your medical history.

The following are some of the most common categories of painkillers:

• Paracetamol, 500mg tablet or capsule is the first line of treatment as a pain reliever if there is no associated inflammation. It is useful to reduce fever and acute pain.

• Longer-acting paracetamol is available in a 665mg strength with a maximum dosage of 6 tablets/24 hours provided no other types of paracetamol are also taken at the same time. The slow-release mechanism is useful for pain relief around the clock . It is especially useful for chronic pain associated with osteoarthritis.

• For stronger pain, either acute or chronic, you can take paracetamol and ibuprofen combined in the same medicine. It is used when paracetamol or ibuprofen do not provide enough pain relief individually such as in migraine, headache, backache, period pain, dental pain, rheumatic and muscular pain, body aches in cold and flu, sore throats, and fever.

• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs work by blocking the production of prostaglandins, which are chemicals that cause inflammation and pain. Some common NSAIDs such as ibuprofen, naproxen, aspirin, diclofenac are available OTC but higher strengths are available on prescription. These are great pain relievers when used short-term for rheumatic pain, backache, sprains, and strains. It is best to avoid NSAIDS in general ifand you have heart disease, high blood pressure, high cholesterol, diabetes, stroke, blood clot, stomach ulcers or bleeding, liver or kidney disease, Asthma, and if you smoke a lot. Always speak to your healthcare professional if you have any concerns.

The table below shows appropriate dosages for OTC pain medications.

• Opioids: When OTC medications are not adequate for severe acute pain, opioids can be prescribed by your doctor if there are no contraindications. Opioids are a class of drugs that are derived from the opium poppy plant. They are very effective at relieving pain, but they can also be addictive and have serious side effects. Opioids are usually only prescribed for short-term use. Some common opioids include codeine, endone, tramadol, and panadeine forte. Opioid use comes with a warning of drowsiness and you should not drive or operate machinery. Consuming alcohol increases drowsiness so alcohol should be avoided when on opioids. Other side effects include constipation, nausea, and vomiting. These medications should be used only as directed by your health professional as they can become habit-forming when misused. Long-term use in higher doses results in less pain relief but more side effects such as dependency. When pain medications don't help is it best to get advice from a pain specialist.

• Anticonvulsant drugs: Pregabalin (Lyrica ),a prescription medication is an anticonvulsant drug used to treat neuropathic pain. Lyrica is indicated for use in the following conditions: neuropathic pain associated with spinal cord injury, diabetic neuropathy, postherpetic neuralgia, fibromyalgia, and peripheral neuropathy. It can become addictive if misused, especially in higher doses. One of the side effects of pregabalin is drowsiness so you should not drive if it makes you drowsy.

• Topical pain relievers: Topical pain relievers are creams, gels, or patches that are applied to the skin. They can be used to relieve pain in a

specific area, such as a muscle or joint. Some common topical pain relievers include capsaicin cream ( Zo rub , Zostrix ) , Arnica cream or gel, diclofenac gel (Voltaren), Nurofen gel, Feldene gel, Deep heat, Dencorub, pain away, lidocaine patches (Nervoderm, Lidocaine) and opioid patches available on prescription such as Norspan. Topical pain relief can be used as an adjunct to oral pain medication to enhance pain relief. Some of these are available here for your convenience.

Heat Patches can be used alone or in combination with pain medication. Heat patches increase blood circulation to the affected area providing more oxygen and nutrients thereby assisting with pain and or movement. Heat also stimulates the skin's sensory receptors, decreasing pain signals to the brain and relieving discomfort.

Other Options for Pain Relief

There are many other options for pain relief besides painkillers. Some of these options include physical therapy, massage therapy, acupuncture, and heat therapy.

Complementary Medicines

Complementary medicines have limited clinical evidence but can be used in conjunction with other medications for added pain relief. They can also be useful if you can't tolerate NSAIDs because of GI side effects.

Curcumin ( from Tumeric ) is the most evidence-based herbal medicine used for inflammation in rheumatoid ( RA ) and osteoarthritis pain ( OA ). Refer to the blog on Curcumin.

Boswellia can be tried for osteoarthritis. A combination of Boswellia-curcumin and Rhuleave -K may help with acute muscle pain and delay muscle soreness.

Omega-3 fish oils can be used for OA joint pain, RA, tension and migraine headaches, menstrual pain, and cramps.

Magnesium has been tried for muscle cramps, helps support muscle relaxation, tension and migraine headaches, and menstrual cramps, and may help reduce neuropathic pain.

Additionally, some studies have shown that Ashwagandha may assist if you are experiencing sleep disturbance and stress due to pain.

If you are taking prescription medications, always check with your healthcare professional for any interactions or send me a message.

Medicinal Cannabis

Lastly, the much-awaited, Medicinal Cannabis. It is derived from the cannabis plant. Unofficially, it has been used recreationally for many years.

Two of the most common cannabinoid compounds used in medicinal cannabis products are THC (delta 9-tetrahydrocannabinol) and CBD (cannabidiol). THC and CBD are used to reduce pain in some medical conditions. While THC can give a feeling of being "high", CBD, on the other hand, does not give this feeling.

Medicinal cannabis is not a first-line of treatment. It can be obtained on a prescription and can be tried for pain relief in certain medical conditions where traditional pain relievers have failed. You need to consult with your treating physician before trying medicinal cannabis.

( I will be writing a special blog about Medicinal Cannabis soon! )

Side Effects

Most medications have side effects, and painkillers are no exception. Some of the common side effects of painkillers include nausea, vomiting, constipation, and drowsiness. In some cases, painkillers can also cause more serious side effects, such as liver damage or kidney failure.

In conclusion, pain is a complex experience that can have a significant impact on our lives. Painkillers can be a helpful way to manage pain, but they are not without risks. It is important to use painkillers wisely and to be aware of the potential side effects.

Use a step-wise approach;

• Use non-drug methods of pain relief whenever possible, such as heat, ice, massage, or relaxation techniques.

• Start with the lowest effective dose of painkillers and take them for the shortest possible time.

• Be aware of the side effects of painkillers and report any concerns to your trusted health professional.

• Do not take more painkillers than prescribed.

• Do not share painkillers with others.