Pain management

Pain management is the use of medicines and other approaches to prevent, reduce, or stop pain sensations.

Pain has the important role of alerting the brain to potential or actual damage to the body, from injury, disease, or other causes. But after the brain receives and processes the message, further pain can be a nuisance and can actually interfere with recovery from illness or injury. Unrelieved pain can become a syndrome in its own right and cause a downward spiral in a person's health and outlook. Managing pain properly speeds recovery, prevents additional health complications, and improves a person's of life.

Finding and treating the cause of the pain is the first step in managing it.Injuries must be repaired and diseases must be diagnosed and treated. But treating the cause doesn't always relieve the pain. Pain-relieving drugs and other treatments are often necessary.

Pain-relieving drugs, otherwise called analgesics, include nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, narcotics, antidepressants, anticonvulsants, and others. NSAIDs and acetaminophen are available as over-the-counter and prescription medications, and are frequently the first treatment for pain. These drugs can also be used along with other drugs that may require a doctor's prescription.

NSAIDs include aspirin, ibuprofen (Motrin, Advil, Nuprin), naproxen sodium (Aleve), and ketoprofen (Orudis KT). These drugs are used to treat pain from inflammation. Acetaminophen is also effective against pain, but its ability toreduce inflammation is limited.

NSAIDs and acetaminophen are effective for most forms of acute (sharp, but not long-lasting) pain, but moderate and severe pain may require stronger medication. Narcotics handle intense pain effectively, and are used for cancer pain and acute pain that does not respond to milder drugs. This drug class includes drugs such as oxycodon, methadone, and meperidine (Demerol). Narcotics may be ineffective against some forms of chronic pain. In addition, they are not recommended for long-term use because the body develops a tolerance to thedrugs, making them less effective over time.

Although antidepressant drugs were developed to treat depression, they are also effective in combating chronic headaches, cancer pain, and pain associated with nerve damage. Antidepressants that have been shown to have analgesic (pain reducing) properties include amitriptyline (Elavil), trazodone (Desyrel), and imipramine (Tofranil). Anticonvulsant drugs share asimilar background with antidepressants. Developed to treat epilepsy, anticonvulsants were found to relieve pain as well. Drugs such as phenytoin (Dilantin) and carbamazepine (Tegretol) are prescribed to treat the pain associatedwith nerve damage.

Other prescription drugs are used to treat specific types of pain or specificpain syndromes. For example, corticosteroids are very effective against paincaused by inflammation and swelling, and sumatriptan (Imitrex) was developedto treat migraine headaches.

Some drugs for pain can be taken by mouth. Others are not absorbed very wellfrom the stomach and must be injected into muscles or veins. Following surgery and other medical procedures, patients may have the option of controlling the pain medication themselves. By pressing a button, they can release a set dose of medication into a solution that flows into the body through a needle inserted in a vein. Another mode of administration involves implanted tubes that deliver pain medication directly to the spinal cord. Delivering drugs in this way can reduce side effects and increase the effectiveness of the drug.

Pain treatment options that do not use drugs are often used in addition to drug therapy. Non-drug therapies help some people gain a greater sense of control over their pain. Relaxation techniques, such as yoga and meditation, are used to decrease muscle tension and reduce stress. Tension and stress can alsobe reduced through biofeedback, in which a person consciously attempts to modify skin temperature, muscle tension, blood pressure, and heart rate.

Participating in normal activities and exercising can also help control pain.Through physical therapy, a person can learn exercises for reducing stress,strengthening muscles, and staying fit. Regular exercise has been linked to production of endorphins, the body's natural pain killers.

Acupuncture involves the inserting of small needles into the skin at key points. Acupressure uses these same key points, but involves applying pressure rather than inserting needles. Both of these methods may work by prompting thebody to release endorphins. Applying heat or being massaged are very relaxingand help reduce stress. Transcutaneous electrical nerve stimulation (TENS) applies a small electric current to certain parts of nerves, potentially interrupting pain signals and inducing release of endorphins. To be effective, useof TENS should be medically supervised.

If other treatment methods are not effective in reducing pain, surgery may bean option. Some types of surgery are designed to relieve pressure on a nerve. Another type of surgical procedure is neurolysis, also called a nerve block, which involves destroying a portion of a nerve that is transmitting a painsignal. A third approach is to electrically stimulate or directly apply drugsto nerves that are transmitting pain signals. Electrical stimulation works on the same principle as TENS. But instead of applying the current across theskin, electrodes are implanted to stimulate nerves. Finally, a surgeon may cut a nerve and disconnect it from the central nervous system. However, this does not always relieve the pain, so the technique is not widely used.

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