Pain management
Pain management is an aspect of medicine and health care involving relief of pain (pain relief, analgesia, pain control) in various dimensions, from acute and simple to chronic and challenging. Most physicians and other health professionals provide some pain control in the normal course of their practice, and for the more complex instances of pain, they also call on additional help from a specific medical specialty devoted to pain, which is called pain medicine.
This article is about pain management across medicine. For cancer-related pain management specifically, see Cancer pain. For the album by Bubba Sparxxx, see Pain Management (album).Occupation
Physician
- Doctor of Medicine (M.D.)
- Doctor of Osteopathic medicine (D.O.)
- Bachelor of Medicine, Bachelor of Surgery (M.B.B.S.)
- Bachelor of Medicine, Bachelor of Surgery (MBChB)
Pain management often uses a multidisciplinary approach for easing the suffering and improving the quality of life of anyone experiencing pain,[2] whether acute pain or chronic pain. Relief of pain in general (analgesia) is often an acute affair, whereas managing chronic pain requires additional dimensions.
A typical multidisciplinary pain management team may include: medical practitioners, pharmacists, clinical psychologists, physiotherapists, occupational therapists, recreational therapists, physician assistants, nurses, and dentists.[3] The team may also include other mental health specialists and massage therapists. Pain sometimes resolves quickly once the underlying trauma or pathology has healed, and is treated by one practitioner, with drugs such as pain relievers (analgesics) and occasionally also anxiolytics.
Effective management of chronic (long-term) pain, however, frequently requires the coordinated efforts of the pain management team.[4] Effective pain management does not always mean total eradication of all pain. Rather, it often means achieving adequate quality of life in the presence of pain, through any combination of lessening the pain and/or better understanding it and being able to live happily despite it. Medicine treats injuries and diseases to support and speed healing. It treats distressing symptoms such as pain and discomfort to reduce any suffering during treatment, healing, and dying.
The task of medicine is to relieve suffering under three circumstances. The first is when a painful injury or pathology is resistant to treatment and persists. The second is when pain persists after the injury or pathology has healed. Finally, the third circumstance is when medical science cannot identify the cause of pain. Treatment approaches to chronic pain include pharmacological measures, such as analgesics (pain killer drugs), antidepressants, and anticonvulsants; interventional procedures, physical therapy, physical exercise, application of ice or heat; and psychological measures, such as biofeedback and cognitive behavioral therapy.
In the nursing profession, one common definition of pain is any problem that is "whatever the experiencing person says it is, existing whenever the experiencing person says it does".[5]
Pain management includes patient and communication about the pain problem.[6] To define the pain problem, a health care provider will likely ask questions such as:[6]
After asking such questions, the health care provider will have a description of the pain.[6] Pain management will then be used to address that pain.[6]
Adverse effects[edit]
There are many types of pain management. Each have their own benefits, drawbacks, and limits.[6]
A common challenge in pain management is communication between the health care provider and the person experiencing pain.[6] People experiencing pain may have difficulty recognizing or describing what they feel and how intense it is.[6] Health care providers and patients may have difficulty communicating with each other about how pain responds to treatments.[6] There is a risk in many types of pain management for the patient to take treatment that is less effective than needed or which causes other difficulties and side effects.[6] Some treatments for pain can be harmful if overused.[6] A goal of pain management for the patient and their health care provider is to identify the amount of treatment needed to address the pain without going beyond that limit.[6]
Another problem with pain management is that pain is the body's natural way of communicating a problem.[6] Pain is supposed to resolve as the body heals itself with time and pain management.[6] Sometimes pain management covers a problem, and the patient might be less aware that they need treatment for a deeper problem.[6]
Physical approach[edit]
Physical medicine and rehabilitation[edit]
Physical medicine and rehabilitation uses a range of physical techniques such as heat and electrotherapy, as well as therapeutic exercises and behavioral therapy. These techniques are usually part of an interdisciplinary or multidisciplinary program that might also include pharmaceutical medicines.[7] Spa therapy has showed positive effects in reducing pain among patients with chronic low back pain. However, there are limited studies looking at this approach.[8] Studies have shown that kinesiotape could be used on individuals with chronic low back pain to reduce pain.[9] The Center for Disease Control recommends that physical therapy and exercise can be prescribed as a positive alternative to opioids for decreasing one's pain in multiple injuries, illnesses, or diseases.[10] This can include chronic low back pain, osteoarthritis of the hip and knee, or fibromyalgia.[10] Exercise alone or with other rehabilitation disciplines (such as psychologically based approaches) can have a positive effect on reducing pain.[10] In addition to improving pain, exercise also can improve one's well-being and general health.[10]
Manipulative and mobilization therapy are safe interventions that likely reduce pain for patients with chronic low back pain. However, manipulation produces a larger effect than mobilization.[11]
Specifically in chronic low back pain, education about the way the brain processes pain in conjunction with routine physiotherapy interventions may provide short term relief of disability and pain.[12]
Self-management[edit]
Self-management of chronic pain has been described as the individual's ability to manage various aspects of their chronic pain.[86] Self-management can include building self-efficacy, monitoring one's own symptoms, goal setting and action planning. It also includes patient-physician shared decision-making, among others.[86] The benefits of self-management vary depending on self-management techniques used. They only have marginal benefits in management of chronic musculoskeletal pain.[87] Some research has shown that self-management of pain can use different approaches. Those approaches can range from different therapies such as yoga, acupuncture, exercise and other relaxation techniques. Patients could also take a more natural approach by taking different minerals, vitamins or herbs. However, research has shown there is a difference between rural patients and non-rural patients having more access to different self-management approaches. Physicians in these areas may be readily prescribing more pain medication in these rural cities due to being less experienced with pain management. Simply put, it is sometimes easier for rural patients to get a prescription that insurance pays for instead of natural approaches that cost more money than they can afford to spend on their pain management. Self-management may be a more expensive alternative.[88]