Everybody hurts... sometimes. This is what to do about it. By the GQ Doctor (not REM)
By Dr Nick Knight, GQ
It’s true what they say, pain is, what you say it is. It’s so true that its actually one of the first lessons drilled into any future doctor in medical school. And if you think about it, this makes sense – just ask yourself how you feel if someone questioned you when you said you were in pain. It is subjective. So how else can we define it? Like the march of time and ageing it is also inescapable. Short-term, long-term, planned (well, in a sadomasochistic way), unplanned, it will find its way to us all. For this reason, it doesn’t hurt to be a little clued up on it…
It’s true what they say, pain is, what you say it is. It’s so true that its actually one of the first lessons drilled into any future doctor in medical school. And if you think about it, this makes sense – just ask yourself how you feel if someone questioned you when you said you were in pain. It is subjective. So how else can we define it? Like the march of time and ageing it is also inescapable. Short-term, long-term, planned (well, in a sadomasochistic way), unplanned, it will find its way to us all. For this reason, it doesn’t hurt to be a little clued up on it…
What is pain?
It depends who you ask. Anyone in pain is describing a symptom of something else. It is best thought of as a distressing and unpleasant physical or emotional sensation caused by “actual or potential tissue damage”. The last part of this definition comes from the International Association for the Study of Pain, and is probably the most widely used. Personally, this doesn’t quite cover all types of pain. After all, would you describe the feeling you have with an emotional trauma as pain? I would. That’s not physical. Thus, I revert back to the simpler definition: pain is what you say it is.
Are there different types of pain?
Oh, yes. Let’s focus on the three main types of pain that you’re most likely to come into contact with over the years. Rather than just of academic interest, knowing what causes your pain acts as a guide to know how best to treat it.
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Nociceptive Pain
Throughout your body, are pain receptors called nociceptors. Nociceptive pain is when these receptors are activated due to the presence of harmful intensities of elements that include: thermal (e.g. heat or cold), mechanical (e.g. crushing or tearing), chemical (inflammation from infection). Once activated they inform your brain. This is the most common type of pain.
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Neuropathic Pain
When any part of your nervous system (usually the nerve fibres themselves) is damaged a sensation of pain can be felt. This is neuropathic pain. Symptoms typically are burning, tingling, shooting or electrical in nature. It’s the pain you get when you connect your funny bone with something hard.
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Psychogenic Pain
When we go through an intense or prolonged emotional trauma we can develop physical pain symptoms such as back ache, headache or stomach ache. So too wouldn’t we call distress, sadness or loss, a pain? While naturally open to a lot of debate, it is widely accepted that this is a cause of physical pain. It’s just a bit tricky to prove.
What are the effects of pain?
As with many things in medicine, the effects can be divided it into a biopsychosocial model for pain. The bio part refers to your physical self. Here, pain can remove or hinder the function of a part – or indeed the whole - of your body. The psycho part refers to your psychology. Here, pain can cause symptoms from changes in mood and poor concentration, all the way through to depression and suicide. The social part refers to your social self. Here, pain can strip away your desire to go out, interact and engage in life. This all coalesces into a reduced quality of life for you.
Can you treat pain without drugs?
Absolutely. And while it is the harder route, it has the potential to have more longevity (and less side effects than drugs). Physiotherapy uses not just exercise but water and heat therapies to help alleviate and manage pain. A growing trend is for acupuncture and reflexology for chronic pain and relaxation. Then there’s your electrical stimulus therapy from a TENS machine (Transcutaneous Electrical Nerve Stimulation). Finally, and often overlooked, is psychotherapy. This includes cognitive behavioural therapy and mindfulness, both of which are positive, powerful and underused tools.
If you need drugs, which are best?
Drugs are not without their place. In 1986, The World Health Organisation (WHO) developed a pain ladder, a graduated guide for pain management. And, although originally developed for people with cancer, it is now widely used by doctors around the world as a template of how to manage escalating pain. There are three tiers:
Tier 1: Use non-opioid drugs eg paracetamol or aspirin
Tier 2: Use weak opioid drugs eg codeine-based
Tier 3: Use strong opioid drugs eg morphine-based
Now, alongside each tier you can also add in other adjuvant, supporting drugs which have a specific purpose. For example, non-steroidal anti-inflammatories like Ibuprofen for joint or muscle injuries, or neuropathic pain relief drugs like gabapentin, pregabalin or amitriptyline. And don’t forget all those non-drug therapies can be counted as adjuvant treatments as well - an array of options.
Tier 1: Use non-opioid drugs eg paracetamol or aspirin
Tier 2: Use weak opioid drugs eg codeine-based
Tier 3: Use strong opioid drugs eg morphine-based
Now, alongside each tier you can also add in other adjuvant, supporting drugs which have a specific purpose. For example, non-steroidal anti-inflammatories like Ibuprofen for joint or muscle injuries, or neuropathic pain relief drugs like gabapentin, pregabalin or amitriptyline. And don’t forget all those non-drug therapies can be counted as adjuvant treatments as well - an array of options.
Treat pain holistically
As you can see, pain is a complex business that requires a holistic approach. So, whatever your pain needs, if you feel you’re using more than some occasional paracetamol or ibuprofen, then please do seek advice online from the NHS website, or visit your local pharmacist, practice nurse or GP. Then, once the source - and type – of pain has been identified, your management can be tailor made.
