Pain is a very common condition. At any given time, around one in ten Australians report experiencing acute pain, with one in five reporting that their pain is constant. The occurrence of pain rises as people get older, and women are more likely to experience pain than men.
There are two types of pain. Acute pain is a normal response to tissue injury, which starts suddenly and is usually short-lived. Chronic (ongoing) pain persists beyond the normal time of healing and generally lasts for longer than three months.
Pain may be anything from a dull ache to a sharp stab, and can range from mild to extreme. Pain may be located in one part of the body or it may be widespread.
Studies suggest that a person’s outlook and the way they cope emotionally with long-term (chronic) pain can influence their quality of life. Counselling can help support you to manage the emotional and psychological effects of chronic pain. Understanding the causes of your pain can help reduce your fear and anxiety.
Key pain management strategies include:
• pain-relieving medications
• physical or occupational therapy
• complementary therapies (such as acupuncture and massage)
Causes of pain
The most common causes of pain in adults include:
- medical conditions (such as cancer, arthritis and back problems)
The most commonly reported pains are headache and back pain (although pain involving the limbs, shoulder, neck and head is also common).
How pain affects the body
There are two main types of pain. Acute pain is a normal response to tissue injury, which starts suddenly and is usually short lived. Chronic (ongoing) pain persists beyond the normal time of healing and generally lasts for longer than three months.
Chronic pain is usually the result of an injury (for example, a sports or work accident), illness or other health problem. The cause is unknown in around one third of cases.
Pain receptors are attached to two main types of nerves – one relays messages quickly (resulting in a sharp, acute pain) and the other relays messages slowly (resulting in a dull, throbbing pain).
Some areas of the body have more pain receptors than others. For example, the skin is loaded with receptors that can give specific information on the exact location and type of pain. In contrast, there are relatively few receptors in the gastrointestinal tract (gut), which means that it is harder to pinpoint the precise location of a stomach ache.
The pain message relay
Pain receptors in the body relay the sensation of pain along the nerves to the spinal cord, which sends it to a structure in the brain called the thalamus. The thalamus also contributes to mood and arousal, which helps to explain why our interpretation of pain partly depends on our state of mind. The pain message is then delivered to the brain’s cerebral cortex.
Pain relievers (analgesics) are common medicines that many people use at some time in their lives. There are two broad categories of analgesics:
- non-opioid – such as aspirin and paracetamol, mainly used for mild to moderate pain
- opioid – such as morphine and oxycodone, mainly used for severe pain.
Medications available for the management of pain include:
- aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen – these medicines also reduce inflammation (redness and swelling)
- opioid medications, such as codeine and morphine – these medicines treat moderate to severe pain
- local anaesthetics
- some antidepressants
- anti-epileptic medicines.
How pain-relieving medications work
Pain-relieving medications work in various ways. For example, opioid medications alter pain messages by influencing brain chemistry, which is why these medications can be addictive.
Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) are medications that work by blocking an enzyme in the body needed to create prostaglandins. Prostaglandins are chemicals that trigger physiological changes such as increased temperature and dilation of blood vessels. They also cause an increased sensitivity to pain.
Blocking the action of prostaglandins reduces fever, inflammation and pain. However, prostaglandins also help the stomach lining to resist gastric acid, which is why aspirin and NSAIDs can cause stomach irritation and bleeding in some people.
Choosing the right pain-relieving medication
The right choice of medication for you will depend on your pain. Issues you need to discuss with your doctor include:
- the location, intensity and type of pain
- any activities that ease the pain or make it worse
- the impact your pain has on your lifestyle, such as how it affects your appetite or quality of sleep.
Your other medical conditions and the medicines you take can also determine which pain-relieving medication is right for you. Discuss these with your doctor so that you choose the safest and most effective pain relief option.
Managing your medications effectively
Always follow instructions for taking your medications safely and effectively. By doing so, your pain is more likely to be well managed, you are less likely to take larger doses of medication and you can reduce your risk of side effects.
Medications for chronic pain are best taken regularly. Talk to your doctor or pharmacist if your medicines lose their ability to reduce your pain or are causing you other problems, such as side effects. These are more likely to occur if you are taking pain-relieving medications for a long time.
People can lower their levels of felt pain by learning self-management skills, such as coping with depression and stress. It is important to learn the skills you need to cope with your pain and not rely on medications alone to do this.
Side effects of pain-relieving medicines
Some of the side effects of common pain-relieving medicines include:
- Paracetamol can cause skin rash, liver and kidney damage (if used in large doses for a long time).
- Aspirin can cause stomach irritation, allergic reactions in susceptible people (such as triggering an asthma attack), tinnitus (ringing in the ears), kidney damage (if used in large doses for a long time) and reduced blood-clotting ability.
- Non-steroidal anti-inflammatory drugs (NSAIDs) can cause headache, nausea, stomach irritation and upsets, skin rashes, fatigue and dizziness.
- Combination analgesics such as preparations that contain paracetamol and codeine can cause nausea, vomiting, constipation, dizziness, liver and kidney damage (if used in large doses for a long time).
- Opioid analgesics such as morphine, oxycodone and codeine can cause nausea, vomiting, constipation, drowsiness, and reduced physical coordination and balance.
Managing pain without medicines
Many non-pharmacological treatments (treatments other than medicines) are available to help you manage your pain. A combination of treatments and therapies is often more effective than just one. Understanding the causes of your pain can help reduce your fear and anxiety. Ask your doctor to suggest other pain-management strategies that might work for you and complement your current pain-management regimen.
Some non-pharmacological pain-management strategies include:
- heat or cold – heat packs can aid relief of chronic musculoskeletal injuries and associated pain. An icepack can be used to help reduce swelling immediately after an injury
- physical therapies – walking, as well as stretching and strengthening or aerobic exercises, may help relieve pain, depending on the cause. Physical activity can also help you maintain your mobility and improve your mood. Ask a physiotherapist or osteopath to design a program specifically for your pain condition
- massage – this is better suited to soft tissue injuries and should be avoided if the pain originates in the joints
- acupuncture – a component of traditional Chinese medicine. Acupuncture involves the insertion of thin needles into specific points on the skin and is believed to restore balance, encourage the body to heal itself and release natural pain-relieving compounds (endorphins)
- relaxation and stress management techniques – including meditation and yoga
- transcutaneous electrical nerve stimulation (TENS) therapy – a minute electrical current is passed through the skin via electrodes, prompting a pain-relieving response from the body
- cognitive behaviour therapy (CBT) – this form of therapy can help you learn to change how you think and, in turn, how you feel and behave about pain. This is a valuable strategy for learning to self-manage chronic pain.
Always be guided by your doctor or other healthcare professional and follow their instructions carefully to avoid making your pain worse.
Managing pain that cannot be relieved
Sometimes pain will persist and cannot be relieved. Some suggestions for how to emotionally handle this difficult and distressing situation include:
- If all medical avenues have been exhausted, it may not be helpful to continue to raise false hopes by searching fruitlessly for a cure. Accept that your pain may not go away and that flare-ups may occur. Talk yourself through these times.
- Find out as much as you can about your condition so that you don't fret or worry unnecessarily about the pain.
- Enlist the support of family and friends. Let them know what support you need, find new ways to stay in touch that are less painful for you, and maintain healthy relationships with people in your social networks who may be able to support you.
- Take steps to prevent or ease depression by any means that work for you, including talking to friends or professionals.
- If pain-relieving medications can't ease the pain, talk to your doctor or pharmacist first about what you should do. Increasing your dose may not help your pain and might cause you harm.
- Improve your physical fitness, eat healthy foods and make sure you get all the rest you need.
- Try not to allow the pain to stop you living your life the way you want to. If you miss activities you used to do before the pain, try reintroducing those activities in a gently paced way. You may need to cut back on some activities if pain flare-ups occur, but it may be possible to increase slowly again as you did before.
- Concentrate on finding fun and rewarding activities that don't make your pain worse.
- Seek advice on new coping strategies and skills from a healthcare professional such as an occupational therapist or psychologist.
Precautions when taking pain-relieving medications
Over-the-counter pain-relieving medications need to be treated with respect and caution, just like any other medication. It’s always a good idea to discuss any medication with your doctor.
General suggestions include:
- Don’t self-medicate with analgesics during pregnancy – some medications can reach the fetus through the placenta and potentially cause harm.
- Take care if you are elderly or caring for an older person. Older people have an increased risk of unwanted side effects. For example, taking aspirin regularly for chronic pain (such as arthritis) can cause a dangerous bleeding stomach ulcer.
- Always tell your pharmacist about any prescription and complementary medicines you are taking so they can help you choose a safe analgesic. Over-the-counter medicines can interact with other medicines, sometimes dangerously – for example by stopping them from working correctly.
- Don’t take more than one over-the-counter medicine at a time without consulting your doctor or pharmacist, or you may unintentionally take an overdose. For example, many ‘cold and flu’ tablets already contain paracetamol, so it is important not to take any other paracetamol-containing medicine to avoid an overdose.
- See your doctor or healthcare professional for proper treatment for sport injuries. Don’t use pain-relieving medications to ‘tough it out’.
- Consult your doctor or pharmacist before using any over-the-counter medicine if you have a chronic physical condition, such as heart disease or diabetes.
Where to get help
- Your doctor
- NURSE-ON-CALL. Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)
- Medicines Line (Australia). Tel. 1300 MEDICINE (1300 633 424) – for information on prescription, over-the-counter and complementary medicines
- Adverse Medicine Events Line. Tel. 1300 134 237
- Austin Pain Management – Outpatient Services Tel. (03) 9496 2211
- Occupational therapist
- Counsellor or psychologist
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