Pain is one of the most common human experiences. Yet pain has never been fully accepted as a medical problem.

1. Pain Management
Pain is one of the most common human experiences. Yet pain has never been
fully accepted as a medical problem. One reason may be because pain is a
subjective and highly individualized experience. You can measure pain even
though you can’t touch it, feel it (unless it’s your own), image it or prove its
existence. Even a pinprick creates differing sensations of pain for different people.
Nevertheless, chronic pain affects millions of Americans. Pain is the body’s way of
sending a warning to the brain that something is wrong. Aches are felt when pain
messages, carried by chemicals called neurotransmitters, travel from the nerves
along the spinal cord to the brain. In the brain, pain messages are meshed with
thoughts, emotions and expectations that shape our interpretation and response
to pain.
Both emotions and drugs can change the perception of pain because both affect
neurotransmitter levels. Both emotions and chemicals also alter the amount
ofendorphins, the body’s natural pain relievers, which block the relay of pain
messages to the brain. Depending on your mood and mental state, pain messages
can be slowed, strengthened or stopped entirely. For example, fear, anger and
worry can heighten pain or make you momentarily not notice it, while calming,
positive thoughts can ease it.
There are two main types of pain. Nociceptive pain basically represents pain
associated with a pain receptor. This kind of pain is a signal to the body that it’s
being damaged in some way that needs immediate attention. Trauma, infection
or illness can cause nociceptive pain. Toothaches, sprains, backaches or a broken
bone are other common causes. Although unpleasant, most injuries resulting in
nociceptive pain are short-lived and are easily treated with rest or medications.
Neuropathic pain refers to pain that is not associated with specific pain receptors
and probably represents damage to or sensitization of the nervous system (this is
when pain becomes the disease process itself, rather than representing a
“warning” of underlying pathology). It is constant, often lasting for months after
an injury or trauma, and can be disabling. Examples of neuropathic pain are the

2. chronic pain that can linger after shingles or the pain that people with diabetes
sometimes experience when nerve damage occurs. Diabetic neuropathies can
cause pain, tingling or numbness in the hands, arms, feet and legs and also can
affect other organ systems, including the digestive tract, heart and sex organs.
You may also hear pain referred to as “acute” and “chronic” pain. Acute pain is
short-lived and usually diminishes as your body heals. Chronic pain persists for at
least six months after your body has healed. Sometimes it is difficult to pinpoint
where chronic pain is coming from. Because it persists, chronic pain can interfere
with daily life and lead to depression, anxiety, anger and low self-esteem.
Because pain can be difficult to pinpoint and treat, primary care physicians
increasingly turn to specialists to help those whose pain persists. And health care
professionals also are working to tailor treatments specifically to the individual
and to encourage better self-management of pain.
Diagnosis
It isn’t always easy to talk about pain. Some people think that complaining about
pain is a sign of weakness. Studies on gender differences show that women are
more likely to complain of pain and seek treatment for it than men.
Often, you can successfully treat your pain yourself with common over-the-
counter (OTC) pain-relief medications or by making lifestyle changes.
For example, if you smoke, you should quit or ask your health care professional
for guidance on how to quit. Smoking makes pain worse. Studies, especially for
low back pain, have consistently shown that patients who smoke have a harder
time recovering, regardless of the treatment offered, than nonsmokers and that
smoking can affect the healing of injured discs. Also, there is some evidence from
pharmacological studies that smoking interferes with the absorption and blood
level of various medications, including analgesics.
If you have attempted to treat your pain or tried to make lifestyle changes and
these approaches didn’t relieve your pain or it became worse, you should seek
help from a health care professional. Pain is a message that something is wrong,

3. so don’t wait more than a few days or a week to make an appointment. In fact,
delaying an evaluation and treatment can make many acute pain problems worse.
The American Pain Society endorses the standards set by The Joint Commission
for the assessmentand management of pain, which affect all patients in hospitals,
nursing homes and clinics. Health care facilities must:
Recognize the right of patients to appropriate assessment and management of
pain.
Screen patients for pain during their initial assessment and, when clinically
required, during ongoing, periodic reassessments
Educate patients suffering from pain and their families about pain management
Treatment
Since pain is a complicated combination of emotional, chemical and physical
components, treating and managing it often requires several approaches. Care
may include assistance with self-management, primary care, specialty care, pain
clinics and more. Treatments can include over-the-counter (OTC) or prescription
medications, surgery, physical or rehabilitative therapy, psychological counseling
and lifestyle changes and behavioral interventions, such as quitting smoking.
Other treatments include ice, meditation, self-hypnosis, acupuncture,
chiropractic, electrical stimulation, trigger point injections, nerve blocks, epidural
steroid placement, spinal cord stimulators and intrathecal pumps, which deliver
small doses of pain-relieving medication directly to the pain receptors in the
spinal cords, blocking the message to the brain.
There are many types of pain medications, both prescription and OTC, to help you
manage your pain.
OTC remedies include:
Acetaminophen and most nonsteroidal anti-inflammatory drugs (NSAIDs),
including aspirin, are pain-relief medications available without a prescription.
Tylenol, which contains acetaminophen, reduces pain and fever and is usually safe

4. to use with other medications if necessary, although caution should be used when
taking with alcohol because of potential for serious liver damage. (Always check
with your health care professional if you are taking other medications.)Ibuprofen
(such as Motrin and Advil) and naproxen sodium (such as Aleve) are examples of
nonprescription NSAIDs that help reduce aches and pains. However, NSAIDs can
cause stomach irritation and affect kidney function. Plus, there is the potential for
cardiovascular events associated with the use of NSAIDS. The longer you use
NSAIDs, the more likely you are to have side effects, and the more serious those
effects can be. Many other drugs cannot be taken with NSAIDs, and these
medications are associated with serious gastrointestinal problems, including
ulcers, bleeding and perforation. NSAIDs should be used with caution in people
over 65 and in those with any history of ulcers or gastrointestinal bleeding,
congestive heart failure, renal insufficiency and hypertension. It’s important to
ask your health care professional for safety information associated with pain
relievers with your personal health history in mind. Higher-strength forms of
ibuprofen (and other NSAIDS) are available by prescription.Aspirin, available as a
generic and in brands including Bayer, Bufferin and Ecotrin, is also an NSAID but is
used primarily for relieving short-term pain.
Prescription pain medications include:
NSAIDs such as ibuprofen or naproxen, which are useful for moderate to severe
pain
 narcotic analgesics (opioids or opiates), a wide range of medications that
are typically used for acute pain after an injury or surgery
 narcotic-like medications, such as tramadol (Ultram)
 antidepressants, medications used to treat depression, which also affect
pain pathways in the brain
 the COX-2 specific inhibitor (cyclooxygenase inhibitor) celecoxib (Celebrex),
a type of NSAID
topical pain relief agents applied directly to the skin, some available without a
prescription

5. Narcotics
Narcotics, such as morphine, are used to treat cancer pain and other types of
moderate to severe pain. Most people who take narcotics as prescribed by their
health care professional for pain do not get high or become addicted to these
drugs. Their bodies may become adapted to the narcotic, however, so they
experience withdrawal if the narcotics are stopped abruptly.
Narcotic analgesics may be taken orally, by injection (intramuscularly), through a
vein (intravenously) or by rectal suppository. There also are other methods of
giving pain medicines for more continuous pain relief. Not all narcotics are
available in each of these forms.
Frequently prescribed narcotic pain relievers include:
 codeine, most commonly prescribed with acetaminophen as Tylenol 3
 fentanyl (Sublimaze, Fentora)
 hydromorphone (Dilaudid)
 methadone (Dolophine)
 oxycodone (OxyContin, Percocet)
 oxymorphone (Opana)
 morphine (AVINza, Kadian, MS Contin)
OxyContin, a form of oxycodone, was approved in 1996 for the treatment of
moderate to severe pain associated with musculoskeletalconditions, and by 2001
it became the most frequently prescribed brand name narcotic medication for
treating moderate to severe pain in the United States. The narcotic has come
under intense scrutiny by the U.S. Food and Drug Administration (FDA) and the
U.S. Drug Enforcement Agency due to widespread abuse. Abusers can bypass the
time-release aspect of the drug by crushing, chewing, snorting or shooting
OxyContin pills to get a quick morphine-like high. The abuse of OxyContin is
associated with serious consequences including addiction, overdose and death.
Therefore, the FDA requires the manufacturer of OxyContin to include the
agency’s highest level of safety warning on the label. The FDA has also
collaborated with the manufacturer to develop and implement a risk

6. management plan to help detect and prevent abuse and diversion of OxyContin.
In addition, an abuse-deterrent form of OxyContin called Remoxy is currently
being reviewed by the FDA.
Because of potential adverse effects, many pain physicians now avoid prescribing
two drugs once commonly used for pain relief: propoxyphene (Darvon) and
meperidine (Demerol).
Antidepressants
Antidepressants affect pain by changing the levels of neurotransmitters (brain
chemicals) and altering the pain messages reaching the brain. When a woman is
depressed and also in pain, these medications can both reduce pain and improve
mood. The tricyclic antidepressants help to restore the body’s normal perception
of pain and may be recommended as a treatment option even when a patient is
not depressed. Drugs that stimulate the feel-good brain chemicals serotonin and
norepinephrine, such as duloxetine (Cymbalta), havebeen shown to improve both
mood and pain.
Nonsteroidal anti-inflammatory drugs (NSAIDS)
Nonsteroidal anti-inflammatory drugs (NSAIDS) help reduce inflammation by
lowering the release of prostaglandins. Prostaglandins are chemicals produced in
the body that lead to pain, inflammation and fever.
A prescription medication in the class of NSAIDS is the COX-2 specific inhibitor
(cyclooxygenase inhibitor) celecoxib (Celebrex). Celebrex is indicated for the relief
of symptoms caused by arthritis, such as inflammation, swelling, stiffness and
joint pain and other types of acute pain. It is designed to cause fewer
gastrointestinal side effects (such as ulcers and bleeding) than other types of
NSAIDs.
Celebrex can increase the risk of heart attack and stroke; discuss these risks with
your health care professional. And if you are currently taking Celebrex and think
you are having an allergic reaction or have other severe or unusual symptoms

7. while taking any NSAID, call your health care professional immediately. For more
information on the risks associated with Celebrex.
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