Pain Management Overview
Pain occurs as a result of a physiological (i.e., related to body function) series of events in the body. Pain receptors are bare nerve endings that are widely distributed throughout the body in the skin, mucous membranes, and tissue (e.g., bone, muscle). When pain receptors are triggered by mechanical, chemical, or thermal stimuli, the pain signal is transmitted through the nerves to the spinal cord and then to the brain.
Pain is subjectivenot perceived by anyone but the patientand the patient's experience provides the most important information for evaluating pain. The concept of pain includes not only the patient's perception of uncomfortable stimuli, but also his or her response.
Muscle pain often is described as a dull or throbbing ache or tenderness and nerve pain often is described as burning, shooting, stabbing, or searing. Health care providers often use pain rating scales to measure pain.
Pain can be mild or severe and acute (sudden) or chronic (long-lasting, persistent). Acute pain often produces physiological signs such as grimacing, rapid heart rate, sweating, and rapid breathing. Patients who have chronic pain (e.g., lasting more than 3 months) often do not display physiological signs. Chronic pain may be more difficult to treat than acute pain and it is often under-treated.
Persistent pain can affect all aspects of daily life. In many cases, this type of pain is treated by a pain management team, which may include the following:
- Alternative health care providers (e.g., naturopathic doctor, acupuncturist)
- Nurses and nurse practitioners
- Occupational therapists
- Physicians (e.g., physiatrist, psychiatrist, internist, pediatrician, neurologist, anesthesiologist, oncologist) and physician assistants (PAs)
- Physical therapists
- Social workers
Communication and trust between the patient and the pain management team is necessary to help ensure an effective pain treatment plan. An initial pain evaluation (usually conducted by a physician, physician assistant [PA], or nurse practitioner) involves taking a personal and family medical history, performing a complete physical examination, and completing a pain assessment. In some cases, laboratory tests (e.g., blood tests, x-rays) also are performed.
A pain assessment provides information about the location, onset, and severity of the pain and other important information (e.g., factors that improve or worsen the pain, how the pain affects sleep and activity levels).
For more information about working with a pain management team, including questions to ask your health care providers, please see our Patient Information section.
Pain treatment plans are tailored to meet individual needs of the patient. When developing a plan, health care providers consider many factors, including the patient's overall health and his or her personal preferences. Just as each person responds differently to pain, each person also responds differently to pain treatments. Creating an effective treatment plan requires patients and their pain management team to work together.
Goals of the pain treatment plan often include the following:
- Reduce or eliminate pain
- Maximize the patient's ability to function
- Improve the patient's quality of life
Pain medications are often the first course of treatment in pain management. Recently, there has been a rapid increase in the number and types of pain medications and there is a wide range of medicines available to treat the various types, intensities, and categories of pain.
In most cases, pain management plans involve different types of treatment methods. One or more of the following therapies may be used to supplement a pain treatment plan that may also include pain medications:
- Anesthetic pain management (Anesthesia, which previously had been used only to control pain during surgery or childbirth, is now being used to manage other types of pain.)
- Behavior methods of pain control (e.g., hypnosis; these treatment methods focus on modifying the entire effect of pain on the patient, including thoughts and behavior.)
- Chiropractic treatment (focuses on the alignment of the spine, and soft tissues, nerves, and blood vessels to promote healing using less invasive methods)
- Cryotherapy (uses freezing temperatures to reduce inflammation)
- Diathermy (uses high-frequency electrical current to heat deep tissue)
- Neurostimulatory procedures (block pain signals to the brain using a device that uses tiny electrical impulses to stimulate the nerves or spinal cord)
- Neurosurgical pain management (e.g., nerve or spine surgery)
- Physical therapy (e.g., therapeutic exercise and massage, electric stimulation, joint manipulation, heat/cold therapy, ultrasound, cold laser therapy, alternative treatments [acupuncture, naturopathic medicine], nutrition to reduce inflammation)
- Psychotherapy (can help reduce stress and help patients cope with pain)