Thursday September 15, 2016
What a Pain!
Pain: what it is, why do different people feel it differently, and what can be done to manage it.
For those of us know don't experience pain regularly, it’s easy to take such a pain-free life for granted. However, it’s thought that approximately 28 million Brits suffer pain on a daily basis – a staggering statistic! Admittedly, modern medicine does not have all of the answers to cure all pains, but in the majority of cases, pain can be effectively managed with help from your private GP.
What is pain?
Pain is the unpleasant physical sensation, often a sign of traumatic injury or disease. There are many different types of pain: acute, chronic, neuropathic and cancer pains. Different types of pain have different sources, and should be managed and treated in different ways.
This is probably the most common type of pain, and something we may experience on a day-to-day basis, but lasting less than 12 weeks. It’s caused by the stimulation of a variety of pain-specific sensors in the skin (nociceptors), which are each activated by a few specific stimuli. The activation of these nociceptors then sends signals to the brain via nerves, which ultimately causes the brain to recognise the sensation of pain. These stimuli can be grouped into the following categories:
- Heat pain – ever splashed yourself with kettle water? Or caught your finger on a hot tray straight from the oven? This pain is thought to set in with interactions with temperatures of 27°C and over.
- Cold pain – well known for anyone who’s tried going for a swim in cold water. Or the shock of a post-sauna plunge pool!
- Irritant pain – Capsaicin is the active ingredients in hot chilli peppers – and essentially causes pain. For some reason, there is a fine line between this kind of pain and pleasure – hence why hot chillies are regularly added to popular spicy foods! But have you every accidentally rubbed your eyes after chopping these kinds of peppers? This sensation is clearly more on the painful than pleasurable side!
- Pressure pain – from a strong force of pressure to the body. Ever inadvertently shut your fingers in a car door? This is a prime example of pain caused by pressure.
Capsaicin is the ingredient responsible for the pain sensation associated with eating hot chilli peppers
What's the point of pain?
Despite the unpleasant sensation caused by the above examples, the resultant pain is also very important in preventing further damage to the body. Once you’ve shut your fingers in a car door once, you’re far less likely to repeat this same mistake again!
In the above examples, pain is a symptom of the traumatic event, not necessarily an illness in itself. The symptom of pain in these examples can usually be relieved fairly simply. Acute traumatic pain from many of the above categories leads to painful inflammation. This pain can be relieved with either paracetamol or an NSAID (non-steroidal anti-inflammatory drug) painkillers: ibuprofen and aspirin.
Ibuprofen is available over-the-counter, without prescription, and is suitable for relief of a variety of pains, from period pain, headache and migraine, to muscle and tendon sprains such as those seen in sports injuries. It’s also available in a variety of forms, such as tablets, liquids, gels, creams and sprays. Ibuprofen is not suitable, however, for pregnant women.
Similarly, aspirin helps to relieve pain, inflammation and fever. It’s also been shown to reduce the risk of heart attack and stroke, when taken regularly in low doses.
Another popular type of NSAID painkiller is diclofenac, the active ingredient in painkilling gels such as Voltarol. Such gels are regularly used for the treatment of more chronic, back pains.
Paracetamol (aka acetaminophen) is another over-the-counter painkiller that can help relieve mild or moderate pain.
Paracetamol, Ibuprofen and Aspirin are all over-the-counter painkillers than can help to effectively manage acute pain
In moderate to severe pain, adults can take ibuprofen at the same time, since they have different mechanisms of action. Ask your Private Doctor or pharmacist for more information on safe, effective use of such painkilling medications.
The RICE protocol – Rest, Ice, Compression, Elevation – is also helpful in relieving pain and swelling, such as that of a twisted ankle or knee, and also helps promote healing.
Resting and applying ice to a swollen joint can help relieve pain and inflammation.
The exact cause of the pain (eg burnt or crushed fingers, chilli in eyes) is usually self-limiting, meaning it will heal itself in time, not necessarily requiring medical intervention. If the pain doesn’t seem to be subsiding as you might expect, it might be time to seek medical advice to ensure there’s no serious underlying cause for it. If you finger’s still really hurting a few days after slamming it in the car door, are you sure it’s not broken? Maybe you should pop in for a same day doctor appointment.
This is defined as pain lasting over 12 weeks, and can persist for months to years. It can be mild or excruciating, constant or come and go in episodes. For example, arthritis is an example of a chronic pain, as is carpal tunnel syndrome and plantar fasciitis. Chronic pain can also be the result of trauma, such as residual neck pain from a whip-lash injury sustained during a car accident, or from long-term wear-and-tear.
Whiplash, as the result of a car accident, is a common cause of chronic pain
Otherwise known as neuralgia, this is one of the most difficult types of pain to treat, since the source is essentially problems in the nerves themselves. There is no obvious trauma to skin, nerves, or muscles – and yet the pain receptors in the skin just keep firing, stimulating the feeling of pain. After thorough investigation, such as blood tests and physical exams, if no physical source for the pain can be found, patients would generally be referred onto a neurologist for further investigation.
Traditional pain relief, such as paracetamol, NSAID anti-inflammatories and codeine do not usually effectively relieve this pain. A specialist referral to another private clinic in London may be required.
This is another excruciating type of pain associated with many types of cancer. It’s often caused by cancerous tumours pressing on bones, nerves or internal organs. Sometimes, cancer pain can refer to pain caused by the actual cancer treatment itself. It can range from mild to excruciating, and can be difficult to manage with painkillers. Again, like with neuropathic pain, this is usually best managed by specialist Oncologists.
Why do people experience pain differently?
Different people have different pain thresholds, simply meaning different levels to which they can tolerate pain. This may depend partially on genetics, and also on conditioning.
Research also suggests that those who live with a form of chronic pain, experience a phenomenon called Central Sensitization. This means, that they have a heightened sensitivity to pain and touch, known as allodynia and hyperalgesia. So, someone who suffers from chronic back pain, is more sensitive to other kinds of pains too. This means, they will have a more painful experience to a pain stimulus such as a pin-prick, than someone who does not suffer from chronic pain.
Life without pain!
A painfree life may initially seem appealing, but actually it’s really not. People with poorly controlled diabetes often suffer from neuropathy – damage to the nerve endings in the peripheries (fingers and toes!) due to fluctuating glucose levels. This leads to a myriad of extremely harmful complications, such as undetected cuts which can become severely infected before the sufferer even notices them. This can lead to long, painful episodes of deep tissue infections, and the possibility of life-threatening sepsis, blood poisoning.
Some people are also born with the inability to feel pain. This condition is known as Congenital Insensitivity to Pain. Lucky them? Definitely not! These people are at risk of seriously harm, without even noticing - such as internal damage or broken bones. Every little knock or bump may need to be followed up with an X-ray of the affected area, to check for damage. If a bone was to be broken, it could go undetected without the clear alarm bell of pain sensation, to alert you to the damage. Then persistent use of a limb with a broken bone can cause much more internal harm – severed nerves, arteries, damaged muscles etc – not to mention heal incorrectly leading to a deformation in the eventually-healed limb.
If you couldn't feel pain, how would you know if you'd broken a bone?
Long story short, as horrible as the sensation of pain is, it’s usually necessary to alert the sufferer to injury and prevent further damage. In the short-term it’s acutely unpleasant, but in the long-term it can be devastating. It can also have a significant impact on many other aspects of your life, impacting your social interactions between family, friends and colleagues, even leading to anxiety and depression. For some people, chronic pain leads to disability resulting in the sufferer being unable to work.
But in modern medicine, patients don’t need to suffer unnecessarily. There is a vast range of effective treatment options – not just medications, but lifestyle tips and advice that you may have never realized! So if you’re struggling with any kind of pain, don’t suffer in silence. Book in today for a 15-minute GP appointment with one of our private GP’s, and we’re confident that together we’ll be able to work out a better way to help manage and relieve your pain.
By Keira Heslin-Davies