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Managing Pain

What is the most common reason that people seek medical treatment?  Pain. 

Pain affects more people than heart disease, cancer and diabetes combined.  It is also the leading cause of disability and a significant driver of health care spending.  Pain is a byproduct of numerous injuries, diseases and conditions we could potentially experience in our lifetimes.  Pain can have many causes – sometimes those causes can be identified and diagnosed; other times the source of the pain remains a mystery. 

September is Pain Management Awareness Month, a time to raise awareness about the types of pain, the reasons we experience pain, how to recognize when it becomes a serious problem and what we can do to treat it. 

Pain can take on many forms:  dull and aching or sharp and stabbing. It can be pounding and throbbing or burn or sting.  It may be constant or come and go.  No matter the type of pain you experience, it can cause real problems if it persists for a long period of time. 

Because pain affects so many people and can have such a serious impact on a person’s quality of life and productivity, there are physicians who specialize in the treatment of pain.  Pain management specialists are trained in the evaluation, diagnosis and treatment of various types of pain.  Privia Medical Group North Texas has six pain management specialists serving patients across the Metroplex. 

These doctors work with patients suffering from a wide array of conditions, including cancer, migraine headaches, sciatica, lower back pain, fibromyalgia, neck pain and many others. 

Acute Pain

Unpleasant as it is, sometimes pain can be beneficial.  Pain helps us recognize and remember things that are dangerous to our health and safety.  Parents always tell their children never to touch a hot stove – but every now and then, a child just needs to see for himself if Mom and Dad really know what they are talking about.  That child will be much less likely to ever touch a hot stove again after experiencing the painful burn that results. 

Pain also alerts us to the fact that something is wrong.  A painful sunburn reminds you to get out of the sun and wear more sunscreen next time.  An athlete who experiences sudden pain on the field or court is alerted to an injury – and to get rest and treatment before the injury gets even worse. 

Pain that results from a specific illness or injury – and then goes away once the underlying cause is treated – is known as acute pain. 

Chronic Pain

As its name suggests, chronic pain is not temporary – it sticks around for months or sometimes even years.  At least 30% of Americans suffer from chronic pain.  Defined as pain that lasts for three months or longer, chronic pain’s effects can be quite serious.  Chronic pain can limit mobility and impact a person’s ability to do things they want or need to do.  It can lead to feelings of deep frustration and even depression. 

There are many conditions that may cause chronic pain. Some, while they can be treated, cannot ­­­be cured.  Osteoarthritis is one of the most common conditions that fall in this category.  Others include certain autoimmune diseases, such as fibromyalgia and lupus. 

Chronic pain may lead to other health challenges.  For example, someone who finds it painful to move about may increasingly settle into a sedentary lifestyle.  A lack of mobility can contribute to an unhealthy body weight, heart problems, diabetes and hypertension.

Cancer Pain

Pain related to cancer is another major category of pain that requires special medical expertise to manage.  Cancer pain is multifaceted: the cancer itself can cause pain, the cancer may cause complications that result in additional pain and cancer treatments, such as surgery, radiation and chemotherapy, may also result in pain. 

Cancer-related pain is one of the reasons cancer treatments must be individualized for each patient.  Everyone responds differently to both the disease and treatments, so having a pain management specialist working in conjunction with the oncologist is often optimal for effective cancer treatment. 

Determining the Cause of Pain

If you’re experiencing pain, the path to tracking down its root cause starts – and may often end – with your primary care provider

Let’s say you have a pounding headache that won’t go away.  You see your primary care provider and after an examination, it’s determined that you likely have a sinus infection that is causing your headache.  Your doctor may prescribe some medicine to treat the infection and the symptoms – and after several days, you feel better.  In this case, you experienced acute pain caused by the sinus infection and got it diagnosed and treated. 

In another scenario, you find yourself experiencing persistent lower back pain, another common condition.  There are many possible causes of this type of pain.  It could be a strained muscle.  It may also be related to a urinary tract infection.  Or is it caused by degenerative disk disease, a spinal condition that results from wear and tear on the body as we age?  Perhaps the pain is caused by something else entirely, like a not-yet diagnosed underlying condition?

Your doctor may be able to learn a lot about the possible causes of pain simply by talking with you.  Does the pain worsen or improve with movement?  Is it more severe early in the morning or as the day goes on?  Do you ever feel pain in any other parts of your body? This type of information is helpful to narrow the list of possible causes. 

Diagnostic tests, conducted through physical examinations, imaging and lab tests help to identify – and rule out – causes of pain. 

Treating Pain

Pain management specialists have a variety of strategies available to reduce their patients’ pain.  Medication is one of the most common treatments for pain.  Medicine cannot always eliminate pain, but it may reduce its severity and frequency. 

Pain management specialists carefully evaluate medication options, balancing the efficacy of combating pain with any potential side effects.  For example, some over-the-counter medications can be effective at alleviating muscle aches and back pain, but prolonged use can have harmful side effects on the digestive system. 

In certain situations, opioids have a useful role to play in pain management.  For patients battling cancer, an opioid may be necessary to make the pain manageable.  In the wake of a severe injury or surgery that is causing acute pain, an opioid prescription for a limited amount of time may be the most appropriate remedy. 

However, because they are highly addictive, opioids are dangerous to take for an extended length of time.  While effective at reducing pain, opioids also create feelings of euphoria.  Additionally, when people take opioids on a long-term basis, a resistance to the drug may develop.  This resistance can lead to the urge to take even more of the opioid to feel a meaningful effect, creating a dangerous cycle that may lead to an overdose.  Therefore, even though opiate drugs can be quite effective at reducing or eliminating pain, physicians are careful about prescribing them because they are so addictive.    Tragically, opioid overdose deaths have steadily climbed in the United States, topping 75,000 annually in the most recent data available from the U.S. Centers for Disease Control and Prevention. 

There are several other strategies a pain management specialist may use to help manage pain.  Some examples include:

  • Steroid injections into the area of the body where the pain originates, reducing inflammation and pain
  • Injection of a local anesthetic, numbing the pain temporarily
  • Blocking the peripheral nerves that are responsible for the feeling of pain
  • Radiofrequency ablation, a minimally invasive procedure that destroys the nerves causing the pain
  • Spinal cord stimulation, which may help mitigate lower back pain
  • Exercise:  Exercises that improve posture, strength and flexibility may be effective at reducing pain.  This includes cardio exercises like walking and swimming, as well as Pilates, tai chi and yoga. 
  • Lifestyle changes: As with many other conditions, basic lifestyle adjustments can have a positive impact on pain.  This includes getting enough sleep, drinking plenty of water, maintaining a good diet and keeping a lid on stress. 

Another strategy is to help the patient better cope with pain.  For example, cognitive behavioral therapy helps the patient understand how he or she reacts to pain.  This program aims to refocus the patient’s thoughts and energies, reducing the pain’s effect on their lives. 

Physical and occupational therapy is often an important part of a pain management treatment plan, depending on the cause of the illness or injury.  Particularly for someone with an orthopedic injury, getting stronger and learning how to move in a way that does not exacerbate the pain is essential. 

Life Shouldn’t Be Painful

If you’re one of the 50 million Americans who suffers from chronic pain, remember: you are not alone and your pain does not have to define or limit your life.  Even if your pain cannot be completely cured, pain management specialists – working with your primary care provider and other specialists – can help you mitigate and manage your pain so it does not interfere with your life unnecessarily. 

This article has been reviewed and approved by a panel of Privia Medical Group North Texas physicians. 

This article contains information sourced from:

The U.S. Centers for Disease Control and Prevention

The American Society of Regional Anesthesia and Pain Medicine

The Mayo Clinic

The National Institutes of Health

Cleaveland Clinic

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