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What is pain?

Through our past experiences of injury, we all learn the meaning of ‘pain’. Our pain experiences are influenced by our awareness, mood, and beliefs. Pain is a physical (sensory) and emotional experience because the sensation felt is unpleasant, and is associated with actual or potential tissue damage. Because pain is based on an individual’s pain perception, it will therefore be different from everyone else’s pain.

Pain is a frequent symptom of many medical conditions. It can range from mild discomfort to unbearable, and be either localised to one area of the body or widespread throughout the body. Pain can be divided into acute pain and chronic pain:

Acute pain occurs over the short term and is generally considered to last for less than 3 months. It may be caused by trauma, surgery, a medical disease, or childbirth.
Chronic pain continues over a long period of time, lasting 6 months and beyond, and may be caused by long-term medical conditions.

Pain, particularly that which is chronic, significantly affects an individual’s quality of life, impacting on their overall functioning, social and family life, and on their work capability.

What causes pain?

Pain arises from different circumstances. Commonly, pain results from touching a harmful stimulus (nociceptive pain) such as something hot and acts to make the person withdraw from the harmful source and protect the injured tissue. Pain may also result from inflammation (inflammatory pain) arising from injured tissues or infection, as cells of the immune system set to heal the wound or fight the infection. Another cause of the pain may stem from damage (neuropathic pain) or abnormal functioning (dysfunctional pain) of the body’s nervous system.

How is pain felt?

Specialised sensory receptors or nerve endings detect unpleasant stimuli and transform them into electrical impulses. These impulses are then transmitted via nerves to the central nervous system (the brain and spinal cord). Several nerve cells are involved in relaying the information along the nerve pathway within the spinal cord to the brain where they are ‘interpreted’ as pain and processed for action.

How is pain assessed?

Adequate assessment of pain is vital for successful pain management. Acute pain is generally assessed by determining its location, intensity, time span, and possible cause. Scales may be used to attain a patient’s subjective feeling of the intensity of pain at that moment or during the last 24 hours or last week. Commonly, a patient is asked to rate their pain on a visual analogue scale (rating pain from 0 to 100), or a numerical rating scale (0 to 10) is used whereby 0 equals no pain and 100 or 10 equals worst possible pain. Assessing long-lasting pain is usually more difficult and may require reporting details of the pain (as for acute pain), a physical examination, pain questionnaires (that include physical and emotional functioning), and specific diagnostic tests.

How is pain treated?

Pain is a complex phenomenon and so many treatments are available for its management, including medicines, surgery, and alternative/complementary therapies. Acute pain is generally easier to treat than chronic pain, which may require input from a pain management team of doctors, nurses, and different therapists.

Pain is treated beginning with the weakest analgesic medicines, working up to the strongest. Thus, treatment starts with paracetamol or a non-steroidal anti-inflammatory drug (NSAID; e.g., aspirin, ibuprofen, and naproxen). These medications are usually effective in treating mild or acute pain for injuries and infection as they reduce inflammation. For moderate pain, weak opioids such as codeine are prescribed, while strong opioids, including morphine, hydrocodone, oxycodone, and fentanyl are taken for severe pain. Opioids work by interfering with impulse transmission. These stronger analgesics are generally used in cases of chronic pain and may be used alongside medications for mild pain.

Medicines used for treating other disorders may also relieve pain. Anti-epileptic drugs, antidepressants, and anaesthetics can be used for treating neuropathic pain. Other medicines reduce inflammation and thus alleviate pain, e.g., corticosteroids, while yet others may be used to calm a person’s fear and anxiety, such as antipsychotics, anxiolytics, psychostimulants, and muscle relaxants.

All medicines should be taken as your doctor has prescribed, which is usually at regular intervals over the treatment period. The type of analgesic and the dose will be prescribed according to the intensity of pain as assessed on a pain scale. Particularly if you are prescribed a strong opioid, your doctor will want to monitor your condition and treatment.

Alternative approaches to pain management include surgery to release pressure on a nerve, chiropractic to manipulate joints to ease a compressed nerve, TENS (transcutaneous electrical nerve stimulation), massage for muscle spasms, acupuncture, hot and cold compresses to reduce inflammation, and cognitive behavioural therapy to help a person better manage their pain.

PLEASE NOTE THAT THE ONLINE CLINIC NO LONGER PRESCRIBES OPIOID MEDICATIONS.

Opioid medications require careful supervision and we do not recommend that patients access these products online. There have been documented cases of members of the public buying opioid medications online, resulting in their death. Regulations have been tightened but there are still unscrupulous websites selling addictive medications to vulnerable members of the public. If you feel that you may be dependent on opioid medications, we strongly recommend that you speak to your GP.

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