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Advice for Pain Relief
Pain is an unpleasant feeling in response to a stimulus. This stimulus could be something that can cause you an injury, an existing injury or an illness. The severity of pain can vary from slight discomfort to leaving a person in absolute distress. Pain as a sensation can be felt anywhere on the body. When deciding on how to deal with pain it is important to know the root cause of the pain and understand what the stimulus is.
Pain can be located in a specific area or it can be felt all over. It can be described in a number of ways such as feeling sharp, dull, throbbing, aching, and pulsating. It can range in severity and it can be different for different people.
Pain can be very useful for helping to diagnose a problem. Without pain, trauma may occur without someone even realising it. Alternatively, a medical condition may remain hidden without the associated pain to help identify it.
The five most common types of pain are:
- Acute pain
- Chronic pain
- Neuropathic pain
- Nociceptive pain
- Radicular pain
Acute Pain
Acute pain means the pain is short in duration, lasting from minutes to about three months (sometimes up to six months). Acute pain also tends to be related to a soft-tissue injury or a temporary illness, so it typically subsides after the injury heals or the illness subsides. Acute pain from an injury may evolve into chronic pain if the injury doesn’t heal correctly or if the pain signals malfunction.
Chronic Pain
Chronic pain is longer in duration. It can be constant or intermittent. For example, headaches can be considered chronic pain when they continue over many months or years – even if the pain isn’t always present. Chronic pain is often due to a health condition, like arthritis, fibromyalgia, or a spine condition.
Longer term chronic pain such as neck or back pain, or frequently recurring intense pain such as migraines, can significantly reduce quality of life, and can lead to poorer mental health and conditions such as depression.
Neuropathic Pain
Neuropathic pain is due to damage to the nerves or other parts of the nervous system. It is often described as shooting, stabbing, or burning pain, or it feels like pins and needles. It can also affect sensitivity to touch and can make someone have difficulty feeling hot or cold sensations. Neuropathic pain is a common type of chronic pain. It may be intermittent, and it can be so severe that it makes performing everyday tasks difficult. Because the pain can interfere with normal movement, it can also lead to mobility issues.
Nociceptive Pain
Nociceptive pain is a type of pain caused by damage to body tissue. People often describe it as being a sharp, achy, or throbbing pain. It’s often caused by an external injury. For example, if you hit your elbow, stub your toe, twist your ankle, or fall and scrape up your knee, you may feel nociceptive pain. This type of pain is often experienced in the joints, muscles, skin, tendons, and bones. It can be both acute and chronic.
Radicular Pain
Radicular pain is a very specific type of pain that can occur when the spinal nerve gets compressed or inflamed. It radiates from the back and hip into the leg(s) by way of the spine and spinal nerve root. People who have radicular pain may experience tingling, numbness, and muscle weakness. Pain that radiates from the back and into the leg is called radiculopathy. It’s commonly known as sciatica because the pain is due to the sciatic nerve being affected. This type of pain is often steady, and people can feel it deep in the leg. Walking, sitting, and some other activities can make sciatica worse. It is one of the most common forms of radicular pain.
Common Examples of Pain
Back pain is an extremely common health problem and the most common form of chronic pain. It isn’t usually caused by anything serious, and often improves within a few weeks or months. But for some, back pain is a long-term, chronic disorder that requires constant management. And for those who have it, back pain can have a huge impact on their ability to work, socialise, exercise and generally live fulfilling lives.
Headache which includes migraines, cluster headaches and tension headaches are examples of primary headaches. These come about through over activity or when there are problems with structures in the head that are pain-sensitive.
Dental pain and in particular tooth pain can have a number of causes, such as a dental abscess, a cracked tooth, and tooth decay. It is most commonly caused by the inflammation of the innermost layer of a tooth, which is very sensitive.
Joint pain is the result of damage to the joints, either through disease or injury. A variety of conditions can lead to joint pain, including; osteoarthritis, rheumatoid arthritis, gout, bursitis, sprains, strains and other injuries.
Muscular pain is when stress is caused to the muscles and is very common. They can cause swelling, bruising, weakness, and cramping. This can be from an injury to physical activity such as playing sports. It can also be stimulated by a medical condition such as infections, fibromyalgia, thyroid problems and autoimmune disorders.
At Pharmacinta, we offer a range of prescription treatments for pain relief. Our clinicians can prescribe the anti-inflammatory painkiller Naproxen. This is known as a non-steroidal anti-inflammatory drug (NSAID). It is used to relieve pain in many conditions such as osteoarthritis, gout, lower back pain, and general strains and sprains.
The most common signs and symptoms of acute pain include:
- Sharp pain
- Throbbing
- Burning
- Stabbing pain
- Tingling
- Weakness
- Numbness
The symptoms associated with acute pain are many, as the term by itself is quite broad and vague. Some of the more commonly known symptoms are as follows:
- Fatigue
- Muscle spasms
- Flu-like symptoms
- Insomnia
- Depression
- Weight loss
- Anxiety
- Depression
Chronic pain can range from mild to severe. It can continue day after day or come and go. The pain can feel like:
- A dull ache
- Throbbing
- Burning
- Shooting
- Squeezing
- Stinging
- Soreness
- Stiffness
Sometimes pain is just one of many symptoms, which can also include:
- Feeling very tired or wiped out
- Not feeling hungry
- Trouble sleeping
- Mood changes
- Weakness
- A lack of energy
Many symptoms may be present in the case of neuropathic pain. These symptoms include:
- Shooting, burning, stabbing, or electric shock-like pain; tingling, numbness, or a “pins and needles” feeling.
- Pain brought on by normally non-painful stimuli such as cold, gentle brushing against the skin, pressure, etc.
- An unpleasant, abnormal sensation .
- Trouble sleeping, and emotional problems due to disturbed sleep and pain.
- Pain that may be lessened in response to a normally painful stimulus.
Visceral pain, which is a type of Nociceptive pain, is often linked with:
- Pressure
- Aching
- Squeezing
- Cramping
Moreover, other symptoms reported include:
- Nausea or vomiting
- Changes in body temperature
- Heart rate
- Blood pressure
Symptoms of Radicular pain include:
- Pain in the area around your affected nerve
- Tingling
- Numbness
- Muscle weakness
In rare cases, back pain can be a sign of a serious medical problem. If you experience any of the following symptoms alongside back pain, seek medical help immediately:
- Loss of bowel or bladder control
- Fever
- Onset following trauma, such as a fall or blow to the back
Rare but serious causes of back pain include:
- A broken bone in the spine
- An infection
- Some types of cancer, such as multiple myeloma
Cauda equina syndrome - a condition in which the nerves in the lower back become severely compressed.
Muscle Pain
Many things can cause muscle pain, including:
- Autoimmune diseases
- Infections
- Injuries
- Medications
- Neuromuscular disorders
Joint Pain
There are many possible causes of joint pain. It might be caused by an injury or a longer-lasting problem such as arthritis. Common causes of joint pain and related symptoms.
- Sprain or strain - Pain, swelling or bruising after intense or repetitive exercise
- Osteoarthritis - Over the age of 45, pain worse when walking and stiffness after moving
- Bursitis - Hot, swollen joint that's more painful when you move it or press on it
- Rheumatoid arthritis - Pain and stiffness felt in both sides of your body that's worse after not moving (for example, when you wake up)
- Gout - Hot, swollen toe joint (usually big toe) with very bad pain that comes on suddenly
- Joint infection (septic arthritis) - Hot, swollen joint and a high temperature or feeling hot and shivery
Sprain
A sprain occurs when you overextend or tear a ligament while severely stressing a joint. Sprains often occur in the following circumstances:
- Ankle — Walking or exercising on an uneven surface, landing awkwardly from a jump
- Knee — Pivoting during an athletic activity
- Wrist — Landing on an outstretched hand during a fall
- Thumb — Skiing injury or overextension when playing racquet sports, such as tennis
Back Pain
Usually, back pain is classed as “non-specific”, which means no obvious cause can be identified. In other instances, pain will be classed as “mechanical”. This means the pain originates from the joints, bones or soft tissues in and around the spine.
These types of pain are usually affected by physical position and activity. So for example, you may feel better while lying down, and worse when moving around. While it’s common to feel worse while moving, it’s important to remember that you should not avoid physical activity. A sedentary lifestyle can cause muscles in the back to become weaker, which risks making the pain worse.
In cases of mechanical back pain, symptoms can sometimes develop suddenly. While an exact cause is difficult to find, back pain is sometimes the result of poor posture or poor lifting technique - for example bending your back to pick heavy items up off the floor.
A variety of health problems can cause back pain, which is why it’s important that the condition is investigatedholistically. In most cases, medical causes of back pain are usually related to spinal problems including a slipped disc, sciatica, ankylosing spondylitis and spondylolisthesis.
Neuropathic Pain
Nerve pain can be due to problems in the central nervous system (brain and spinal cord), or in the nerves that run from there to the muscles and organs. It is usually caused by disease or injury.
Common causes include:
- an injury to the brain, spine or nerves
- poor blood supply to the nerves
- heavy drinking
- phantom pain after an amputation
- vitamin B12 or thiamine (vitamin B1) deficiency
- certain medicines
Conditions that can cause nerve pain include:
- infections such as shingles and HIV/AIDS
- multiple sclerosis
- diabetes
- stroke
- cancer and its treatment with radiation, surgery or chemotherapy
- trapped nerves, such as in carpal tunnel syndrome
There are other conditions associated with nerve pain including sciatica, fibromyalgia and peripheral neuropathy.
Headaches
The most common reasons are:
- having a cold or flu
- stress
- drinking too much alcohol
- bad posture
- eyesight problems
- not eating regular meals
- not drinking enough fluids (dehydration)
- taking too many painkillers
- having your period or during menopause
If the pain is being caused by an underlying disorder, treating the underlying disorder will also relieve the associated pain. For example, if suffering from a bacterial infection, taking the appropriate course of antibiotics should clear up the infection, which should result in the elimination of the associated pain. If the pain is moderate to severe, it may also be necessary to use analgesics (painkillers), until the underlying cause has been treated. Analgesics are effective at relieving nociceptive pain but aren't effective at combating neuropathic pain.
There are many different ways in which pain is managed including drug and non-drug intervention. Non Steroidal Anti Inflammatory Drugs (NSAIDs) are one of the most common pain-relieving medicines available. Low NSAID doses are effective for treating minor ailments, such as muscle aches, headaches, fever, minor strains and other daily discomforts. Higher doses of NSAIDs will help to relieve more moderate pain, such as joint inflammation.
NSAIDs work on the chemical level by blocking the effects of certain enzymes, specifically the Cox-1 & Cox-2 enzymes. These enzymes play an important role in the production of prostaglandins, which are chemicals like hormones. When the body is injured, the damaged tissue releases prostaglandins, which amplify the pain signals from the nerves, as well as causing the damaged tissue to swell. By blocking the enzymes that produce prostaglandins, NSAIDs will effectively reduce the swelling and decrease the sensations of pain.
In terms of drug intervention, at Pharmacinta, we provide the following:
- Naproxen, which is known as Non Steroidal Anti Inflammatory Drugs (NSAID), is commonly used as effective painkillers to treat pain and inflammation caused by conditions like; arthritis, tendinitis, bursitis, ankylosing spondylitis, gout and period pain. It works at the point of pain to reduce inflammation and chemicals that cause pain. The advantage of using them is they are non addictive painkillers. However, they aren’t suitable for everyone, for example, people with stomach ulcers and poor kidney function.
- Piroxicam Gel is an NSAID that is available in topical form. It is often referred to simply as 'an anti-inflammatory' and works by preventing the production of some natural chemicals in your body which cause pain and inflammation. When piroxicam is applied to the skin as a gel, instead of it having an effect on all of your body, it only works on the area where you have applied it. It is absorbed into your skin and then moves deeper into areas of your body where there is inflammation (for example, your muscle).
There are various other types of drugs that are also used in pain management, however the above are the main types used in management of common pain symptoms. For certain types of joint and muscle pain, topical treatments such as NSAIDs and Piroxicam gel are effective.
Opioids
These drugs are powerful painkillers that work on pain receptors both at the site of pain and in the central nervous system. They can cause drowsiness, can cause dependency and sometimes nausea and vomiting in patients. Therefore, these drugs are not given unless completely appropriate. Examples of opioids are morphine, codeine, tramadol, oxycodone.
Anticonvulsants
Anticonvulsants are a group of medicines used to treat seizure disorders, but can, in some cases, be used for pain-relief. This is because anticonvulsants will also act as an adjuvant analgesic, which means it can inhibit certain types of nerve transmissions. This action will lead to a reduction of neuropathic pain sensations, such as those caused by diabetic neuropathy or trigeminal neuralgia. Examples of anticonvulsants commonly used as pain relief include: Gabapentin, Pregabalin and Carbamazepine.
Antidepressants
Antidepressants can also act as an adjuvant analgesics. Although they aren't specifically formulated as a pain relief medication, they have proven effective at treating certain types of chronic pain. Antidepressants are believed to control chronic pain in two ways. Firstly, they alter the manner in which pain is perceived from the spinal cord to the brain. Secondly, they help to reduce anxiety, which will help to improve and regulate sleep. Antidepressants have proven effective at treating neuropathic pain and chronic headaches, such as tension headaches or migraines. Examples of antidepressants commonly used as pain relief include Amitriptyline, Citalopram, Fluoxetine and Duloxetine.
Transcutaneous Electrical Nerve Stimulation (TENS)
Transcutaneous electrical nerve stimulation (TENS) is a method of relieving pain by using mild electrical currents. It delivers mild electrical impulses through electrodes to the affected area(s) of the body. These electrical signals are designed to reduce the pain signals being sent to the spinal cord and brain, which should dull the pain sensations, as well as relaxing the surrounding muscles. TENS stimulation can also stimulate the production of endorphins, which act as the bodys natural painkillers. TENS machines are a popular method of pain relief that can be used on a wide variety of conditions, including back pain, neck pain, knee Pain etc.
Nerve Blocks
Nerve blocks are typically used to help treat neuropathic pain. There are groups of nerves, called a plexus or ganglion, which can often cause pain to specific regions of the body. These nerves can be blocked by injecting medicine directly into the affected area, numbing the nerves and blocking the pain signals sent to the central nervous system.
Surgery
If your pain is so severe a mixture of first-line treatments don’t help, your doctor may refer you to a surgeon to see whether your condition has a medical cause specific enough to treat with an operation.
Acupuncture
This ancient Chinese practice is a widely popular therapeutic or preventative practice whereby fine needles are inserted into the skin at key points. Acupuncture has very real positive effects, and is often used in many NHS GP practices as a complementary medicine. By stimulating sensory nerves at specific points under the skin, acupuncture prompts the body to produce more naturally-pain-relieving endorphins. The treatment is most commonly used to relieve chronic tension-type headaches and migraines, as well as other musculoskeletal conditions such as joint or neck pain.
Massage Therapy
Massage has been shown to be effective at relieving chronic back pain, acutely damaged skeletal muscles, and even chronic tension headaches. In addition, massage therapy can be used as a complementary treatment for depression, stress, anxiety and poor quality sleep. This holistic treatment is great for improving circulation, posture and flexibility, and reducing inflammation and stiffness.
Cognitive Behavioural Therapy
Cognitive Behavioural Therapy (CBT) can be used as a psychological treatment for chronic pain, aiming to reduce the negative impact chronic pain has on a person's mental health. CBT is particularly good at reducing feelings of anxiety or depression that has come as a result of chronic pain.
Yoga
This practice is a method of relaxing, strengthening and keeping the body flexible through performing specific poses that stretch different areas of the body. There have been mixed conclusions from studies investigating the effectiveness of yoga as a physical pain relief method, but it does help individuals to cope with their pain, and many report feeling more in control of how their pain affects their daily life.
Frequently Asked Questions
Pain is a sensation triggered by the nervous system, usually as a response to an injury or illness. The pain sensation is unpleasant; it hurts and causes discomfort, and perhaps even agony. Pain can be experienced in a variety of ways; from short and sharp, to dull and constant.
Acute pain is usually directly related to soft tissue damage, such as a cut or a strain, broken bones, surgery etc. It is typically sharp in quality and acts as a warning of disease or injury to the body. As the injured tissue heals, the associated pain should gradually resolve. Acute pain can be mild and brief, or alternatively, it can be severe and last for weeks.
Chronic pain describes the type of pain that persists long after the instigating injury or illness has healed. In a lot of cases, chronic pain will have originated from a past trauma or infection. Common examples of chronic pain include: Headache, Back pain, Arthritis pain, Cancer pain, Neurogenic pain
Analgesics are medicines that are designed to relieve the symptoms of pain. Analgesics can be grouped into three main categories: Simple analgesics – such as Paracetamol; NSAIDs - which include; Ibuprofen, Aspirin, Naproxen; Opioid analgesics – which include Morphine, Pethidine, Oxycodone, Tramadol.
Different painkillers may work well for one person but not another. Generally, paracetamol is the first painkiller people are advised to take. For more severe pain strong NSAIDs like Naproxen, or a weak opioid like codeine, may be prescribed. Generally, very strong painkillers like morphine and oxycodone are only prescribed by your doctor if your pain is very severe.
Certain medicines that are used to treat depression can also be effective at treating certain types of pain. Specifically, pain caused by damaged or sensitive nerves, such as shingles or sciatica. You don’t have to be depressed for these treatments to work. An example of an antidepressant commonly used for pain relief is Amitriptyline. Gabapentin is an antiepileptic medicine, which is also an effective treatment for pain relief.
It is advised to go and speak to your doctor should your pain last longer than is reasonably expected. This time frame will vary depending on the type of illness or injury that initially caused the pain. If you are suffering from any form of unexplained pain, where the cause is unknown, then it is recommended you speak to your doctor.
Your choice of pain relief will depend on the type of pain you have. If the pain is mild to moderate with associated inflammation, for example; mild back pain or headaches, then Paracetamol or NSAIDs will be a suitable choice. If however, the pain is being caused by damaged or sensitive nerves, then Amitriptyline or Gabapentin would be a better choice.
Your choice of pain relief will depend on the type of pain you have. If the pain is mild to moderate with associated inflammation, for example; mild back pain or headaches, then Paracetamol or NSAIDs will be a suitable choice. If however, the pain is being caused by damaged or sensitive nerves, then Amitriptyline or Gabapentin would be a better choice.
It is safe to take paracetamol and ibuprofen together if required. The doses can either be taken simultaneously or spaced apart, depending on the level of distress. Children under sixteen should not take paracetamol and ibuprofen at the same time. However, the doses can be staggered should it be necessary.
If you’re pregnant, Paracetamol is generally safe to take. It has been routinely used during all stages of pregnancy. As with most medicines, it is advised to take the lowest effective dose for the shortest possible time. Alternative pain relief may be possible should paracetamol prove ineffective. However, in these cases, it is recommended to speak to your doctor, midwife, or pharmacist prior to choosing an alternative, as certain treatments can carry potential risks to the unborn baby.
Naproxen is safe with certain other painkillers. These include paracetamol, co-codamol and other opioid only type medicines such as tramadol, codeine or morphine. They do not interact with each other or increase the likelihood of adverse side effects.
Drinking alcohol is fine while taking Naproxen at moderate quantities. Alcohol can irritate the stomach, adding to the NSAID effect of Naproxen.
Tramadol and codeine are very similar in terms of how strong they are. However, in the UK, tramadol is prescribed in higher strengths than codeine. It is also only available on prescription, so many people consider it to be stronger than codeine because codeine is available to buy from a pharmacy.
Ibuprofen, naproxen, diclofenac, and aspirin are all types of NSAIDs. They are often used for their anti-inflammatory effects.
No, paracetamol is not an NSAID. However, paracetamol can be an effective painkiller and is suitable for most people to take.
