Pain Management

Pain management (also called pain medicine; algiatry) is a branch of medicine employing an interdisciplinary approach for easing the suffering and improving the quality of life of those living with pain. The typical pain management team includes medical practitioners, clinical psychologists, physiotherapists, occupational therapists, and nurse practitioners. Pain sometimes resolves promptly once the underlying trauma or pathology has healed, and is treated by one practitioner, with drugs such as analgesics and (occasionally) anxiolytics. Effective management of long term pain, however, frequently requires the coordinated efforts of the management team.

Medicine treats injury and pathology to support and speed healing; and treats distressing symptoms such as pain to relieve suffering during treatment and healing. When a painful injury or pathology is resistant to treatment and persists, when pain persists after the injury or pathology has healed, and when medical science cannot identify the cause of pain, the task of medicine is to relieve suffering. Treatment approaches to long term pain include pharmacologic measures, such as analgesics, tricyclic antidepressants and anticonvulsants, interventional procedures, physical therapy, physical exercise, application of ice and/or heat, and psychological measures, such as biofeedback and cognitive behavioral therapy.
There are many causes of acute or chronic back pain such as back strain, spinal stenosis, and osteoarthritis. But how is back pain treated? What happens if pain doesn't go away? To help answer those questions and others, this article provides information about many aspects of pain management including:
• Different types of pain
• The role of the pain management specialist
• Diagnosis; determining the cause of pain
• Pain relieving treatments
• Pain control improves lives

Different Types of Pain

Most often, pain is classified as being either acute or chronic. Broader definitions and examples follow.
Acute pain may begin suddenly and is often described as feeling sharp. It is likened to the body's warning system signaling something is wrong. Most times, acute pain is quickly resolved, although by definition it may last 3 to 6 months. Patterns of recovery from acute pain are usually predictable and aid in developing a treatment plan.

Pain specialists realize it is important to control acute pain to prevent it from becoming chronic. Causes of acute pain include:
• Broken bones (spinal vertebral fracture)
• Burns or cuts
• Certain diseases
• Dental work
• Labor and childbirth
• Soft tissue injury, such as whiplash
• Surgical pain (post-operative pain)

Chronic pain is defined as lasting longer than 6 months, is persistent and may be severe. Chronic pain is more difficult to treat. A multi-disciplinary approach, involving several specialists who offer treatment separately or simultaneously, has become a standard of care. Such specialists include physiatrists and anesthesiologists.

Chronic pain affects people physically and emotionally. Physical symptoms include muscle tension, loss of mobility, lack of energy and appetite. The emotional affects can be similarly devastating and include depression, anger, and anxiety. Causes of chronic pain can include:
• Arthritis (osteoarthritis)
• Cancer
• Degenerative disc disease and other spinal disorders
• Nerve dysfunction (with or without nerve damage)
• Soft tissue injury, such as trauma from a fall or motor vehicle accident
• Unresolved disease or injury (psychogenic pain)

There are many kinds of pain that can be described as acute or chronic. Some include:

Myofascial pain is caused by painful trigger points that develop in a muscle or a group of muscles. A trigger point is a locally sensitive and tender area in a muscle or where a muscle and fascia (band-like tissue encasing muscle) meet.

Myofascial pain may cause "referred pain" because when a trigger point is pressed the pain may be felt elsewhere. This pain may be chronic and described as nagging, burning, aching, or stabbing.

Psychogenic pain presents as real physical pain caused by a psychological problem. This means the pain is caused by the patient's mental or emotional issues.

Radicular pain, or radiculitis, is caused by inflammation of a spinal nerve root. Other associated terms are "cervical radiculitis" or "lumbar radiculitis" meaning the pain originates from a cervical (neck) or lumbar (low back) spinal nerve.

Sciatica is a commonly used term to describe pain that descends into the leg. Different disorders can cause spinal nerve compression, inflammation, and pain. A spinal tumor or cyst, disc herniation, spinal stenosis, and osteoarthritis can cause radiculitis.

Somatic pain is caused by bodily injury or other event affecting the pain receptors in the skin, ligaments, muscles, bones, or joints. This pain may be chronic and is sometimes associated with cancer.
Visceral pain is caused by internal organs that are damaged or injured.