PAIN

“The hurt means you're alive. It means your body is reacting and willing to fight - both to fight back and fight through it. So rather than running from grief's harsh reality, you may find that in letting it groan and pierce and ache and cry, you begin to exhaust some of its staying power. You expose its secret hiding places. You force it into the open air where it can be more easily outlined and dealt with.”
― Frank Page, Melissa: A Father's Lessons from a Daughter's Suicide

What is the pain really, and is it good or bad?

Well pain is a signal. It tells to the brain that something injured or damaged in the body. Without the pain our “command centre” wouldn’t know there is something happened and we need to act to prevent further damages.

Let say you are walking on the beach you step on a sharp seashell your skin sends the signal to your brain and as reaction you pick up your leg from the sharp object and hopefully prevent a cut and a nasty infection.

For a person who cannot feel pain the situation way more complex and dangerous. There was period of time in my life when I was working with people who lives with high level spinal cord injury. The spinal cord injury (depending of its severity) most of the time means the person loose sensations including pain. It’s because the injury cuts off the “message way” between the body and the brain. These people not necessarily feel the pain or feel different way.

We had cases when our client was sitting too close to the radiator and his knee pushed against to the hot surface. Normally if something too hot we move away quickly and that is it. Well not with the spinal cord injury. In this case the person didn’t feel the pain and stayed there for long period of time. The result was a long lasting G3 burn and deep tissue injury. All because he couldn’t feel the pain…

Picturing this would you say pain is bad? No

So, based on this the pain is good

I know now you are thinking this guy is crazy or a weirdo. Trust me I had some experience with pain and I didn't liked it at all.

Normally I don’t take medications to manage my pain, I use alternative methods (will talk about those later) As a medical person (I am not only a medical massage therapist but also a nurse practicing both professions actively) I learned about loads of sicknesses and thing could and would go wrong in our body. As a person know these things, the first thing goes true in my head, (and I am sure most of those alike me in our profession -nurses, doctors) is the worst-case scenario. Awful diseases ending up death in a horrific way. Than the common-sense kicks in and think about it a minute and close the worst-case scenario thought. But still the pain is a signal so let’s check it out.

My worst ever pain was during a root canal treatment with my dentist. All went well, I got my shots of local anaesthetics (no dentist put a finger into my mouth without numbing me first, no thank you). So, I was numb as numb can be. Then suddenly she did something. Firework exploded in my brain and felt white simmering lighting strike in my head. The pain a bit later turned into a dull pressure feeling which made me constantly move and if I stopped it turned into unbearable. And I thought I can stand pain. LOL…

I drove home and constantly used the steering wheel as a drum kit and singing. If a police car pulls up next to me I am sure they pull me over and run a couple drug and alcohol test on me. Luckily the police were busy elsewhere. As soon as I got home (still under the local anaesthetic) I took the strongest painkiller I could take (Codeine + paracetamol and later Codeine +Ibuprofen) and it gave me peace just long enough to fall asleep. Later the pain subsidized thanks to the good job of my dentist, and I mean it. She is still my dentist and will be in the future.

That is for my worst-case scenario.

I had lower back pain because my own stupidity as lifting heavy weight into my car on a completely inappropriate way. I ended up in pain with sciatica. In that case I used massage therapy to help the pain.

No, I did not massage myself… that’s waste of time. If you need massage you have to go see a therapist, no matter how pro you are.

I visited a colleague of mine and he helped me.

There are loads of different type of pain and we can categories them by different ways. 

The pain could be:

Acute: This kind of pain is generally intense and short-lived. It is the way the body warns a person to an injury or localized tissue damage. Treating the injury normally resolves acute pain.

Chronic: This pain type last way longer than acute pain, and often there isn’t cure. Chronic pain can be mild or severe. It can also be continuous, i.e. in arthritis, or intermittent, i.e. migraine episode. Intermittent pain occurs repeatedly but stops between flares.

With chronic pain the fight of fly reaction fades away and the patient get “use to the pain” as the systematic nervous system adapts to the pain stimulus

How do we describe pain?

There are more specialized ways to describing pain.

1. Neuropathic pain: This pain happens after an injury of peripheral nerves. It could cause feelings like electric shocks, cause tenderness, numbness, discomfort or tingling sensation.

2. Phantom pain: you might hear this terminology from movies or from people who had their limb amputated. The phantom pain originated into the part of the body which is not there anymore.

3. Central pain: This pain often related to infarction, abscesses, tumors, degeneration, or bleeding in central nervous system (brain or spinal cord). Central pain is constant, could ranging between mild to extremely severe. People with central pain might feel burning, aching, and pressing sensations.

How the pain Diagnosed:

The pain is a subjective thing, it belongs to you and the only person can explain it is you.

There is no objective method to diagnose pain. Your doctor will rely on you to set up your diagnosis based on your explanation of the pain and the history of your pain. There are different systems to identify pain but it is crucial to have clear communication between your doctor/therapist and you.

Your doctor or therapist will ask you questions about your pain experience like:

· The character of your pain, is it burning, stinging, or stabbing?

· Where do you feel the pain, what it feels like, and does it spread and if it is than how far?

· Is there something worsen or relieve the pain?

· Is there a specific time during the day when the pain occurs or a specific activity?

· Is the pain distract you from your daily activities?

How to measuring pain:

There are several different ways to measure the level of pain.

• The most common is the numeric scale (this is a scale between 1 to 10 where the 1 is the lowest and the 10 is the strongest pain).
• Sometimes the Verbal descriptor scale being used this could be helpful with people has difficulties to understanding the numeric system (i.e. people with cognitive impairments, older adults, autistic people, and those with dyslexia) in this case the doctor ask describing questions regarding their pain.
• Faces scale method is when the doctor shows the person in pain a range of expressive faces from distressed to happy. This method mainly use with children, has also shown effective responses from people with autism.
• There is one more method likely to be used which is the Brief pain inventory. This is a more detailed questionnaire asking you to explain how the pain interrupt your everyday life like sleeping pattern, personal interactions, your relationship, is it impacting your mood and it will also contain a time line to map your pain pattern.
• McGill Pain Questionnaire: it’s a quite complex way to measure pain. It’s uses of 78 pain adjectives arranged into 20 groups further arranged into sets of words describing sensory aspects of the quality of pain). Very widely used questionnaire.

Other indicators of pain when the objective signs of pain could be observed. 

This mostly used in cases where the patient cannot accurately describe their pain because of cognitive impairments.

These are the following observations:

restlessness, moaning and groaning, grimacing, resistance to care, reduced social interactions, increased wandering, crying, not eating/ reduced appetite, sleeping problems

Treatment and management of pain:

Doctors will treat different types of pain in different ways. A treatment that is effective against one type of pain may not relieve another simply because different people has different underlying conditions. Your doctor should treat your pain individually based on your assessment.

Taking an over the counter painkiller might suppress your pain but might and most likely will not treat the origin of your pain.

Acute pain treatment

Treating acute pain often involves taking medication:

• Acetaminophen (also known as paracetamol): belongs to a group of medicines known as analgesics, or painkillers. It is used to relieve mild-to-moderate pain such as headaches, muscle aches, menstrual pain and toothache. When taken in higher doses, acetaminophen can cause serious liver damage. People should never exceed the recommended dosage.
• Non-steroidal anti-inflammatory drugs (NSAIDs): are medicines that are widely used to relieve pain, reduce inflammation, and bring down a high temperature. Experts say that taking NSAIDs for a short time at the lowest effective dose is generally safe. However, people should never exceed the recommended dosage.
• Opioids: Doctors prescribe these drugs for the most extreme acute pains, such as those that result from surgery, burns, cancer, and bone fractures. Opioids are highly addictive, cause withdrawal symptoms, and lose effectiveness over time. They require a prescription.

Chronic pain treatment options:

A range of nondrug therapies can help relieve pain. These alternatives to medication may be more suitable for people experiencing chronic pain and sometimes could reduced the amount of medicines needed. These options could be parallel to your medications and always should discuss with your doctor. These mentioned therapies also could give you different result on individual bases and cannot say this or that will work for you.

Alternative options:

· Acupuncture,

· Nerve blocks,

· Psychotherapy,

· Transcutaneous electrical nerve stimulation (TENS),

· Surgery (surgeries on the nerves, brain, and spine are possible for treating chronic pain),

· Biofeedback (Through this mind-body technique where the person could use of biofeedback in pain management),

· Relaxation therapies (These might include therapies of controlled relaxation routines, hypnosis, yoga, meditation, massage therapy , distraction techniques, tai chi, or a combination of these practices),

· Physical manipulation (A physiotherapist or chiropractor or massage therapist sometimes can help relieve pain by manipulating the tension from a person’s back),

· Physical therapy (exercises can improve mobility and may help to reduce chronic pain),

· Heat and cold (Using hot and cold packs, alternating between heat therapy and cold sometimes more effective),

· Rest (if the pain indicating damage or injury, the best way to support the body is to rest and to reduce the workload on the tissues)