Last week, what pain is and how pain can be managed, broadly what are the causes of pain and related issues were deliberated.
Steps in pain control
The first step in managing pain is to do a total pain assessment. Patients are asked to choose a number from 0 to 10 to rank the pain or explain the severity of the pain. The zero (0) is very mild and (10) is the worst possible pain. Keeping in mind three important principles to manage pain, the foremost target is always to treat the pain right away, either completely or partially, based on the root cause of pain or the surrounding scenario. A delay may allow pain to get worse. One should not be afraid of becoming addicted to pain medicine. There is a misnomer that by using pain medicines, one may become addicted to them. if medicines are used in the right way under the close supervision of a qualified physician, it is rarely a problem. It is better to implement the World Health Organization’s step-care approach
Step 1. For mild to moderate pain, it is always safe to start with a non-steroidal anti-inflammatory drug (NSAID) like ibuprofen and other NSAIDs that your healthcare provider may prescribe. Mostly, these are called over-the-counter drugs. An alternative to NSAIDs for step 1 pain is acetaminophen. This may be combined with another medicine to address pain.
Step 2. If pain continues or gets worse, a physician may prescribe an opioid medicine to treat mild to moderate pain. An example is hydrocodone. This type of opioid may be combined with a non-opioid pain reliever.
Step 3. If pain continues or gets worse, your healthcare provider may prescribe a stronger opioid medicine. Examples include morphine and fentanyl. A word of caution when opioid medicines are used. These are a class of strong pain relievers, including drugs like morphine, oxycodone, and fentanyl that work by binding to opioid receptors in the body to block pain signals. They are used for moderate to severe pain but can also be addictive and lead to severe health risks like overdose and death if misused. They are derived from the opium poppy plant or are man-made synthetic variations.
Understanding opioid medicines
Opioid medicines work best for moderate to severe pain. A wide range of opioid medicines is available, and they can be taken in a variety of ways. One drawback of these medicines is that, over time, users are likely to develop a tolerance to the one that is first started and may need higher doses to get the same effect. The treating physician or the pain management specialist closely monitors the patient and decides the suitable dose.
These are common ways in which opioid medicines can be given. These can be taken in pill or liquid form and can be short-acting or long-acting (sustained release). The other way is an adhesive patch, which is applied to the skin to release medicine over time. An example of this is a fentanyl patch.
At times, opioid medicine injections may be given under the skin or into a muscle. Other forms of opioid may be given directly into the blood through an intravenous (IV) line. Opioids can be given through a medicine pump attached to an IV line that is called patient-controlled analgesia. When the pain is hard to control, a pain-control specialist may give an opioid medicine directly into the spinal cord area which is called a spinal injection.
Adjuvant analgesics
These are also called helper medicines. The adjuvant analgesics can help to control pain in certain cases. Commonly used adjuvant medicines include steroids. These are strong anti-inflammatory medicines that may help relieve pain by decreasing inflammation. They may be used along with other pain relievers for nerve, bone, or other types of pain.
Other classes of drugs, such as antidepressants, anticonvulsants, local anaesthetics, muscle relaxants, antianxiety medicines and bisphosphonates are also widely used for different chronic pain management. To explain in detail the antidepressants may also be useful in pain caused by nerve damage. Treating any existing depression can make pain easier to control.
The anticonvulsants are usually used to control seizures, but they can also help to control nerve-related pain.
Pain specialist may inject a local anaesthetic to block pain. Local anaesthetics are medicines that can block pain signals in the body. Muscle relaxants may be used along with pain medicine if pain is aggravated by muscle spasms. If tension or anxiety aggravates pai,n then anti-anxiety medicines may be prescribed along with pain medicine.
Bisphosphonates. Bisphosphonates are a class of drugs used to treat bone diseases like osteoporosis by slowing down bone breakdown. They inhibit bone-resorbing cells, which helps increase bone density and reduce fracture risk. These medications are available as pills or intravenous infusions and are also used for controlling bone pain from cancer. In other words, these medicines are used to prevent fractures in people whose cancer has spread to the bone. They can play a key role in relieving bone injury and pain.
Other pain control strategies
Surgery is often the last thing a patient or pain management specialist would consider at end of life. But at times, surgery can provide pain relief and increase function. The primary goal of surgery can be to ease specific symptoms. For instance, surgery may be recommended to stabilize a hip fracture in someone with advanced cancer. The surgery is not going to treat the cancer or lengthen the patient’s life, but it may be the best way to reduce hip pain and improve mobility. Because surgery involves risk, the treating physician must clearly express treatment goals for both the patient and the patient’s family. Radiation therapy can also be used to ease pain and control symptoms.
For pain control and palliative care, many options are available. One can get help from a pain medicine specialist or a palliative care specialist. Every patient has a right to be free of pain as best possible and there is no reason to let pain decrease the quality of life.
