About pain
Pain is one of the most common human experiences, and mild, short-lived pains, like headaches, minor injuries and musculoskeletal aches and pains are a feature of everyday life.
The experience of pain is affected by many things including mood, past experience and concerns of the cause, and these can magnify or reduce the suffering itself.
Pain can be due to a wide variety of causes and last for a variable amount of time.
In healthcare, a number of terms are often added to help describe the pain better and direct to specific treatments. Often common words are used with specialist meaning which can cause confusion.
Common terms include:
| Acute/Chronic pain |
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These two terms are used to describe how long a pain is lasting, not its severity. Acute describes a pain, usually lasting for less than 3 months, and Chronic for more than 3 months. Sometimes 6 months is used as a cut-off. Although these terms refer to time, they may give some indication as to the treatment options. Other terms used may refer to the underlying cause: |
| Nociceptive |
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This means there is some tissue damage, which is the most common cause of pain. e.g., broken bone, skin burn, infection, toothache, etc. These types of pain are usually acute (short-lasting) and settle with the normal healing process. This does not always happen. |
| Neuropathic pain |
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This means there is direct damage to some part of the nervous system e.g., brain, spine, nerves (large and small). These pains are often associated with ‘strange’ unpleasant sensations and are more commonly associated with chronic (long-term) pain. The damage may be a relative short-term event but healing in the nervous system is slow and unpredictable. Examples include diabetic neuropathy, post-amputation pain, post-shingles pain, post-stroke pain and sciatica |
| Nociplastic/Central Sensitisation |
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| These terms are used to describe the apparent changing quality or severity of a pain, not associated with any obvious change in the underlying cause. It is assumed to be related to changes in how the nervous system responds to persistent pain. |
| Cancer pain |
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| is a term often used to describe the complex mix of the above types of pain; both in terms of time, cause and how they vary over the course of the condition. |
Treatments
Healthcare initially focuses on the reason for a pain; investigating its cause (e.g., X-rays, blood tests etc), applying treatments (e.g., medicines, surgery) focused on the cause. The pain is often managed as a parallel issue – anticipated to settle as the problem is cured.
But what if the pain doesn’t settle or no cause is discovered?
For some pain problems when serious, sinister or progressive conditions have been ruled out as a cause, we might not find out what is causing the pain. It is in these cases where holistic pain management is helpful in managing the pain as the disease, when we are unable to determine the cause of the pain.
Many long-term pain problems do not respond well or at all to medications, including opioids, and other strategies may be far more helpful. These can include physiotherapy to help improve general activity and improved muscle support for painful areas (especially for spinal and joint pains), coping strategies to understand the nature of pain and develop skills such as relaxation, mindfulness, pacing, goal setting to avoid over- and under-activity cycling. Occasionally focused injections may be considered. Some people gain benefit from ‘alternative’ treatments such as acupuncture or a TENS machine.