Pain

What is pain?

Almost everyone experiences pain at some point. It might feel stabbing, jolting, aching, throbbing, pinching, pulsating, or burning — but there is little doubt that it is pain.

Early on we learn that certain actions, like falling and scraping a knee, will cause pain. This type of pain, acute pain, usually doesn't last long. While acute pain is uncomfortable, it has a purpose. It warns you when something is wrong with your body and prompts you to take action. Acute pain can also help healing by reminding you not to touch a wound or use a joint on the mend.

Unfortunately, for many people pain can linger and interfere with the ability to enjoy life, and make it hard to carry out daily activities. Pain that lasts beyond three months is known as chronic pain. Chronic pain can be hard on your body and on your mental health.

What is nociceptive pain?

Nociceptive pain is related to an injury (such as a cut, burn, sprain, or broken bone) or inflammation (for example, an infection or injury). The sensation of pain is sent to the brain through specialized nerve receptors called nociceptors (pronounced no-seh-SEP-ters). A pain-sensitive area of the body such as your fingertip or tongue has thousands of nociceptors. The skin is full of nociceptors. Nociceptors transmits pain signals from the muscles, joints, and internal organs as well.

What is organ pain?

Organ pain can feel like aching or squeezing and can be sharp or dull. It can be hard to tell exactly what is causing organ pain, so don't try to guess. Report this pain to your doctor. For example, the location of kidney pain is usually felt in the middle of your back. If it is caused by a kidney stone, pain comes in waves. If pain in that area occurs with a fever, it could be a kidney infection. The location of liver pain can be on the right side, just beneath the ribcage. That's where your liver is. But problems with the liver can also cause generalized abdominal pain.

What causes nerve pain?

Neuropathic pain, or nerve pain, occurs when nerve fibers are damaged or no longer work correctly. As a result, they process pain signals and sensations abnormally. It's also commonly called nerve pain. Many conditions and injuries can cause nerve pain: for example, diabetes, multiple sclerosis, a spinal cord injury, a stroke, infection, or entrapment of a nerve. Common examples or neuropathic pain include the excruciating pain that can linger in the face, neck, chest, or trunk after an attack of shingles; the pain, tingling, and numbness in the feet and legs that afflict some people with diabetes (diabetic neuropathy); or the wrist pain associated with carpal tunnel syndrome.

Nerve pain typically feels different from nociceptive pain — it may be burning or shooting, or cause an uncomfortable sensation of "pins and needles." It can even be triggered by sensations that are not typically painful, such as the waistband of your pants rubbing against your back.

Neuropathic pain can last a long time and can be hard to treat. Certain medications can help provide nerve pain relief.

One type of neuropathic pain, called centralized pain, can be especially troublesome. With most pain, an electrical impulse shoots to the brain, which registers and processes the pain signals. But some people develop centralized pain, which seems to occur out of the blue, with no obvious injury. Experts believe that this happens when certain medical conditions damage the central nervous system in ways that cause the brain to generate pain sensations in various parts of the body without any obvious cause. There is growing evidence that dysfunction in the central nervous system may contribute to the development and persistence of chronic pain.

What is pain management?

Pain management includes a wide range of approaches to provide pain relief and improve your ability to function. The best ways to relieve pain depend on the type of pain and how it impacts your life.

Even if it seems that your pain has gotten the best of you, be aware that you have more options, including nondrug and nonsurgical approaches, than ever before. Keep in mind that you may need a combination of therapies to achieve the good relief, and it may take some trial and error.

A good place to start is with your primary care doctor. In the case of particularly stubborn pain, a pain management clinic may be a reasonable next step.

The first and most important thing is to rule out serious conditions that could be causing your pain. The next task is figure out the cause of the pain, but that's not always easy. Even if pain is located in one specific area, the problem causing the pain may actually be somewhere else.

Pain management often involves a holistic approach, for example correcting poor posture and misalignments that contribute to pain, and learning mind-body techniques to control and cope with pain. It is also important to improve mood and sleep symptoms that have developed in response to the pain.

Common pain medications

Medications can help, but how well they work depends on the person and the nature of pain.

Analgesics (painkillers) are the most common pain medications. Acetaminophen (Tylenol and other brands) interferes with pain messages. Nonsteroidal anti-inflammatory drugs like aspirin and ibuprofen (Advil, Motrin, and others) interfere with pain messages. They also reduce inflammation — the swelling and irritation that can make pain worse. Topical pain relievers (such as lidocaine patches or creams) may ease pain by numbing the area, reducing inflammation, or causing a form of skin irritation that "distracts" the brain from focusing on pain.

Narcotic pain relievers, such as morphine and codeine, are the most powerful pain treatments. They have serious side effects and can be addictive. Doctors prescribe these for the most serious pain, at the lowest dose that is effective, and for the shortest time possible.

Other drugs such as anesthetics, antidepressants, anticonvulsants, and corticosteroids may work against certain types of pain. Sometimes medications are injected directly into the region of pain or near a nerve, to interrupt the pain signal.

Non-drug treatments for pain include:

• acupuncture
• massage therapy
• relaxation
• psychotherapy
• transcutaneous electrical nerve stimulation (TENS), which uses electrical impulses to stimulate the nerve endings at or near the site of pain.

What causes muscle pain?

There are many types and causes of muscle pain. The most common types of muscle pain are muscle strains, muscle cramps, and overuse injuries.

Your doctor will want to know what type of activity triggered your muscle pain, and whether there was a pop in the muscle at the time of injury. They will ask about other symptoms that might suggest a more serious medical problem — for example: any muscle weakness or difficulty moving, recent fever, weight loss, leg numbness, urinary or bladder problems.

A muscle strain occurs when muscle fibers are stretched or torn. Most of the time muscle strains happen when the muscle has been stretched beyond its limits or it has been forced to contract too strongly. In mild cases, only a few muscle fibers are stretched or torn, and the muscle remains intact and strong. In severe cases, however, the strained muscle may be torn and unable to function properly.

Although the risk of muscle strain is especially high during sports activities, you also can strain a muscle by lifting a heavy carton or by simply stepping off a curb.

Minor strains usually gets better with RICE.

• Rest the injured muscle (and take a temporary break from sports activities).
• Ice the injured area to reduce swelling.
• Compress the muscle with an elastic bandage.
• Elevate the injured area.

Acetaminophen (Tylenol and others) or a nonsteroidal anti-inflammatory drug such as ibuprofen (Advil, Motrin, and others) can help relieve pain.

Muscle cramps are involuntary muscle contractions that often strike unexpectedly, whether it's a charley horse in the middle of the night or a back spasm as you reach for an everyday object. Common causes of muscle cramps include:

• exercising with "cold" muscles
• certain nutritional deficiencies (for example, too little magnesium or potassium in your diet)
• reduced blood flow to muscles.

Muscle relaxers are not necessary for everyday muscle cramps, but are sometimes prescribed for severe muscle spasms. Massage therapy can help some painful conditions. It may ease pain by relaxing painful muscles, tendons, and joints; relieving stress and anxiety; and stimulating competing nerve fibers that can interfere with pain messages.