Overview

Many people see pain as a symptom of some underlying problem that they should try to fix. But pain is much more than that.

While we have all experienced pain, the term remains difficult to define. According to the International Association for the Study of Pain, pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

There is no question that pain is a sensation in a part of the body, but it is always unpleasant, making it an emotional experience. All pain is subjective, meaning that the amount of pain each person feels is affected by his or her personal views, experience, or background.

Mayfield Clinic provides only surgical treatment for pain; however, there are numerous organizations that offer additional options. They are listed at the end of this document under Sources & Links.

Types of pain

Acute pain is directly related to tissue damage and has an obvious source; it can last for a moment, such as when a bee stings, or for months, as in the case of a severe burn or surgery. Pain signals are sent to the brain, but they become fewer as healing progresses. Also, acute pain is limited in duration and responds to treatment.

Chronic pain is persistent and harder to find the source. Sometimes after an acute injury has healed, pain signals continue to be sent to the brain. Chronic pain is often present in ongoing conditions such as arthritis or cancer. In some cases the pain comes and goes, or it may be present all the time. In addition to the real sensation of pain, chronic pain sufferers may fall into a cycle of pain, inactivity, sleeplessness, anger, and sadness.

What causes pain?

Pain is commonly caused by an injury, illness, or aging. Pain specialists classify pain as either mechanical, biochemical, or psychogenic. Mechanical pain comes from something obviously wrong in the body, such as an injury, tumors, or spinal stenosis. Biochemical pain can come from herniated discs when the disc material irritates nearby nerves. Psychogenic pain is a pain disorder that is related to mental or emotional problems.

Most common forms of pain:

Headache: tension headache, vascular headache, migraine
Low back pain: sciatica (leg pain due to an irritated nerve in the spine)
Cancer pain: constant pain caused by tumors compressing the spinal nerves, or scarring from previous radiation therapy
Arthritis pain: osteoarthritis, rheumatoid arthritis
Neurogenic pain: trigeminal neuralgia, shingles, amputated “phantom” pain
Psychogenic pain: emotional distress that we cannot express that turns into physical pain

Where to get help

When a person first experiences pain, the family doctor is usually consulted. If pain requires further evaluation, a consultation with a specialist such as a neurologist, physiatrist, or surgeon may be recommended to find and treat the source of pain. If the source of pain cannot be identified or treatment has not provided relief, you may be referred to a pain management specialist.

A doctor who specializes in the treatment of pain may be board certified by the American Board of Anesthesiology, American Board of Pain Medicine, or the American Academy of Pain Management.

What is pain management?

Pain management is an integrated approach to making pain tolerable by learning physical, emotional, intellectual and social skills. This may include exercise, physical therapy, medication, relaxation, acupunture, behavior changes, biofeedback, hypnosis, and counseling. When you use pain management techniques, you stay in control of your own health. These techniques also help the brain produce it’s own pain medications called endorphins, which literally means “morphine within.”

Self care
Stress is the number one obstacle to pain control. Pain increases when you are tense and stressed – leading to emotional feelings of fear and helplessness. Relaxation exercises are one way of reclaiming control of your body. Deep breathing, visualization, and other relaxation techniques can help you to better manage the pain you live with.

Learning to live with chronic pain is not impossible – there are resources to help you. Look beyond your pain to the things that are important in your life. Set small goals for yourself. Choose to focus on what you can do, not what you can’t. Pain does not have to be the center of your life.

Commit to living a healthy lifestyle by:
- getting enough sleep
- maintaining a height and weight that's right for your body
- eating a healthy diet
- refraining from harmful habits such as smoking, drinking alcohol, and drug use.

Exercise / Physical therapy
No matter how much pain you're in, there are always gentle stretches and exercises you can do. Weak muscles feel more pain than toned flexible ones. Regular exercises can strengthen muscles that support your spine, easing pain and preventing further injury. Stretching exercises encourage your muscles to stay flexible. Your doctor can show you how to make modifications to your daily standing, sitting, and sleeping habits. For example, learning how to lift properly or sitting for shorter periods of time (see Coping with Back Pain). Check with your doctor before you begin any new exercise program.

Medications
Pain medications vary considerably. Specific types and causes of pain may respond better to one kind of pain medication than to another kind. Also, each person is slightly different in the way they respond to a pain medication. Chronic pain suffers who are on medication may have breakthrough pain. These are uncontrolled severe flares of pain that “break through” the medication. Medications used to treat pain include:

• Analgesics, such as acetaminophen (Tylenol) and tramadol (Ultram), can relieve pain but don't have the anti-inflammatory effects of NSAIDs.

• Nonsteroidal anti-inflammatory drugs (NSAIDs) - aspirin, ibuprofen (Motrin, Nuprin, Advil), naproxen (Naprosyn), and celecoxib (Celebrex) are examples of nonsteroidal anti-inflammatory drugs used to reduce inflammation and relieve pain. Long-term use of analgesics and NSAIDs may cause stomach ulcers as well as kidney and liver problems.

• Muscle relaxants such as diazepam (Valium), clonazepam (Klonopin), cyclobenzaprine (Flexeril), and baclofen (Liorisol) can be used to treat pain associated with muscle spasms and spasticity.

• Anticonvulsants such as phenytoin (Dilantin) and carbamazepine (Tegretol), gabapentin (Neurontin) can be used to relieve nerve pain as in trigeminal neuralgia.

• Steroids can be used to reduce the swelling and inflammation of the nerves. They are taken orally (as a Medrol dose pack) in a tapering dosage over a 5-day period. They have the advantage of providing pain relief within a 24-hour period. Steroid injections into the area of your pain may be prescribed if your pain is severe.
  
  Epidural steroid injections. This procedure, usually performed under fluoroscopy, involves an injection of steroids and an analgesic numbing agent into the epidural space of the spine to reduce the swelling and inflammation of the nerves. About 50% of patients will notice relief after an epidural injection, although the results tend to be temporary. This procedure is usually done in a series of three, at 2-week intervals, to obtain the best results in the shortest time. If the injections are helpful, the series can be done up to three times a year.
  
  Facet injections are used for patients with low back pain stemming from inflammation or irritation of the facet joint. They may be performed using a fluoroscope (X-ray), which directs a needle through the skin and muscles to the path of the sensory nerves located in the facet joints. At that point, a mixture of numbing medicine and cortisone is injected into the facet joint.

• Narcotics (opioids) are very powerful pain relievers that actually deaden a person’s perception of pain. They are used for a short period (2 to 4 weeks) after an acute injury or surgery. Common narcotics include codeine (Tylenol 3), meperidine (Demerol), propoxyphene (Darvocet), hydrocodone (Vicodin), and oxycodone (Percocet, Oxycontin). Sumatriptan (Imitrex) and naratriptan (Amerge) are used to relieve migraine headache. Narcotic medications cause impaired mental function, drowsiness, nausea, constipation, and sometimes addiction.

Surgical treatments
Surgery is considered once all appropriate nonsurgical and medical treatments have been explored. Because surgery involves cutting or interrupting the nerves that carry the pain signals, you may lose sensation in that area of your body.

• Spinal cord stimulation uses a small generator, implanted in your back or abdomen that transmits an electrical current to your spinal cord. The result is a tingling sensation instead of pain.

• Intrathecal pain pumps use a small pump that is surgically placed under the skin of your abdomen and delivers pain medication through a catheter directly to the area around your spinal cord.

• Intradiscal Electrothermal Therapy (IDET) uses heat delivered directly within the spinal discs to shrink the tears and fissures in the annulus and thermo-coagulate nerves to overcome discogenic lower back pain.

• Percutaneous Stereotactic Rhizotomy (PSR) uses a heating current to destroy the part of the nerve that causes pain. Most often used to relieve neuralgia (nerve pain).

Sources & links

If you have more questions, please contact the Mayfield Spine Institute at 800-325-7787 or 513-221-1100. While Mayfield Clinic does not offer pain management as a service, the following organizations can help you find a pain care specialist in your area.

Associations & organizations
Academy of Medicine of Cincinnati www.academyofmedicine.org
American Chronic Pain Association www.theacpa.org
American Pain Foundation www.painfoundation.org
American Academy of Pain Management www.aapainmanage.org
American Pain Society www.ampainsoc.org

Other sources
The Mayday Pain Project www.painandhealth.org
WebMD my.webmd.com
National Library of Medicine, www.nlm.nih.gov/medlineplus/pain.html
Pain.com www.pain.com
Psychology Information Online www.psychologyinfo.com/treatment/pain.html

updated: 6.2004
reviewed by: Theresa Greenwald, RN