Most of us have experienced physical pain at some point in life. Pain can be important to health, by warning of potential damage so that we can avoid it, and should not be ignored. Different types of pain need to be managed in different ways. This information explains the different types and causes of pain and how to manage them most effectively to maintain quality of life.
Most of us have experienced pain - an unpleasant physical sensation, generally caused by illness or injury, which can also result in health problems such as anxiety if not well managed.
Pain occurs when receptors on the ends of nerves pick up information about possible damage, and this is passed along the nerves to the brain. From very early age, the brain makes a ‘map’ of the body to detect where messages come from. It usually does this accurately for the skin and muscles, but less accurately for internal organs.
Damage to the nerves themselves can give rise to a different type of pain, called neuropathic pain. Any changes to the nervous system itself can change the way pain is experienced. For example, spina bifida can prevent some of the messages passing from the body to the brain, and may mean the ‘map’ is not complete. One major risk of this is that skin damage, particularly to the feet and legs, may not be felt early enough to prevent damage to the tissues.
Chronic pain can develop after long episodes of pain, and can be difficult to understand and manage. Different types of pain need managing in different ways.
‘Nocioceptive’ pain receptors are those which sense pain in the skin and tissues. They detect damage by burning, cutting or chemicals. In our internal organs, stretching (such as bloating), lack of blood supply, or inflammation can be picked up, but may be interpreted by the brain as a problem in another part of the body which uses the same nerve. This is called referred pain. Most pain of this type can be controlled using traditional analgesic (pain killing) medicines, like paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs). They prevent the nerve endings detecting damage, so the brain is not aware of something painful happening.
Painkillers which act on the brain, to reduce the pain you feel, include morphine, tramadol and pethidine. Severe, longstanding inflammation can sometimes be treated with steroids, creams, tablets or injections into the affected area. When the tissue has healed, the pain usually stops. Some tissues like tendons and ligaments can take a long time to heal, so strains and sprains can be painful for a long time.
This type of pain is caused by problems with the nerves themselves. It includes sciatica and other trapped nerve problems, and phantom limb pain that many people have after amputation. (Some people have intense pain on being touched lightly on the area, or painful pins and needles.) Neuropathic pain also includes some severe head pain experienced by people with hydrocephalus.
Around 10% of people with hydrocephalus suffer severe headaches even when their shunt is working properly. Traditional painkillers may not help much. Some medicines, like amitriptyline, gabapentin and lamotrigine, can be very effective in reducing neuropathic pain, although they are more usually prescribed for depression or epilepsy. (Do not be concerned if you are prescribed these – it does not mean that your doctor thinks your pain is caused by depression or epilepsy.)
If pain lasts a long time, new pathways in the brain can open up. This process is called neuroplasticity, meaning that the brain can change in response to our experiences. This is chronic pain.
Children are particularly at risk of this; where at all possible, children should be kept pain-free when they are injured or ill to prevent this happening.
This change is important as our brain then tells us we are in pain even when the original injury has healed. This change to the brain is permanent. It is not the same as imagining pain.
Overuse of some painkillers can cause ‘rebound’ pain, especially headache. Without careful management, it is possible to end up with ‘layers’ of drugs building up – various drugs being used to overcome side effects from others. In addition, with chronic pain, our brain seems to produce less of our ‘feel-good’ chemicals (endorphins) than in acute pain – so we have fewer chemicals to help reduce the pain we feel. Also, when we expect something to hurt, for example during injections, it can result in more pain being felt than usual.
How we experience pain can vary according to our emotions and what else is going on in our lives.
Anxiety can make our experience of pain worse. This is important, as we may be anxious about what is causing the pain, or worry that professionals have ‘missed’ an important cause, such as a shunt blockage, causing more anxiety, pain and so on.
If you are feeling bad about other aspects of your life, such as relationships, this can also make pain worse. Chronic pain may interfere with your concentration and sleep, reducing quality of life and your ability to cope with life in pain even more.
Managing chronic pain often means managing your whole life, and learning how to live your life with pain. It may not be possible to get rid of the pain completely, but the goal of most management programmes is to help you find ways of getting on with your ordinary activities, rather than pain dominating everything.
Managing anxiety and setting goals regarding your everyday life will probably play as large a part in your treatment as medicines. Most dedicated Pain Management Services will have a Psychologist; referral to one does not mean your doctor thinks you are imagining your pain.
Therapies such as myofascial release (a physiotherapy massage technique), acupuncture and hypnotherapy are widely used too. It can be helpful to keep an open mind.
Seek medical help to get the cause of the pain investigated. Once serious or dangerous causes have been ruled out, it is helpful if you can accept this. Not all pain will have an obvious treatable cause, and anxiety or catastrophising (often thinking something awful will happen) about what is wrong can make pain worse.
If you have back pain, then kidney stones, trapped nerves, muscle strain, arthritis, constipation, or gynaecological problems (for females) may all be possible causes.
Physiotherapy may help if it is muscular pain or problems with your posture. Don’t put up with pain quietly without seeking help; give yourself a chance to get pain under control before it converts to ‘chronic’ pain and gets harder to deal with.
If painkillers don’t seem to be working anymore, try to get referred to a Pain Clinic where specialists can address the cocktail of medicines that you are prescribed.
Understand the role of your thoughts and emotions in your pain. Look at your relationships, finances, social life, lifestyle. Psychological services are an important part of services for pain. It doesn’t mean you’re imagining your pain. Pain management often focuses on trying to keep you in control of your life, rather than pain overshadowing all aspects of it.
Find what works for you - hypnosis, acupuncture, myofascial release may all help. Mindfulness techniques are also being used for pain management. Anything that helps you relax will probably help chronic pain.