Pain Medicine & Palliative Care: Pain Medicine
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What causes pain?
Can pain be treated, and how?
Are there different treatments for the elderly and children?
Can they treat substance abusers with pain medication?
What are the goals for pain management at Beth Israel Medical Center?
What types of mechanical aids are useful for people with osteoarthritis?
How can I find a pain specialist?
If you have a question, ask us
and we may post FAQs on the site.
In the simplest case, something dangerous -- heat from the stove, the
cut of a knife, electricity from an outlet, an object colliding with your
toe -- damages or threatens to damage tissue in your body.
Pain receptors, called nociceptors, send signals to your brain via your
spinal column telling you of the danger so you can take measures to protect
yourself or prevent further injury. This type of pain, called nociceptive
pain, is the most common. It is experienced with muscle or bone injuries,
surgery, or pressure from an infection or condition like cancer. It can
be experienced as sharp, dull or aching, in a large or small area, and
generally goes away as the damage to your body heals.
Nociceptive pain can last for months or years when damaged tissues cannot
heal, and chronic inflammation may be involved. Arthritis, some kinds
of neck and back pain, osteoporosis pain, some kinds of cancer pain, and
many other types of chronic pain are nociceptive.
Another type of pain is caused by injured nerves, or other changes in
the nervous system, and is called neuropathic pain. The disturbed nervous
system sends pain signals to the brain even when there is no other ongoing
tissue damage. Neuropathic pain is often experienced as tingling, aching,
or burning and can last for months or years. One example of this type
of pain is phantom limb pain, when a person who has had an arm or leg
removed still experiences pain as if it were coming from the missing limb.
Other types of neuropathic pain include trigeminal neuralgia, peripheral
neuropathy, postherpetic neuralgia, and complex regional pain syndrome
(CRPS).
Some patients have chronic pain, and doctors cannot pinpoint the source.
Often, it is best to refer to this pain as idiopathic -- which means that
the cause is unknown.
All types of pain are subjective and can be measured and reported only
by the person experiencing it. All types of pain are real and can be treated.
Many factors influence the experience of pain, including the mechanisms
in the body that are sustaining the pain, the meaning of the pain, and
psychological factors, such as individual coping styles and emotional
support.
Yes. Pain can be treated safely and effectively. There are many types
of treatments for pain, including medication and non-drug treatments.
It is important to treat pain. Unrelieved pain brings unnecessary suffering.
Living with pain uses up a lot of energy that can be better used to fight
illness or maintain activities of daily living. Pain may cause patients
to:
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feel weak because of disruptions in activity, appetite, and sleep |
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give up hope |
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reject treatment programs |
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feel helpless, anxious, and depressed |
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think about suicide |
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stop enjoying normal activities, such as work, recreation, and
relations with others |
If you are in pain, don't give up! Working with your doctor and other
professionals, you can manage your pain. Sometimes pain relief can be
obtained right away. In other situations, it takes time for treatment
to be tailored to fit the individual and his/her unique condition.
Pain treatment needs to be tailored to the individual. What works for
one person may not work for the next. Pain can be treated through the
use of:
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Drug Therapies
Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs),
such as aspirin, ibuprofen, naproxen, and others; opioids (also
called narcotics); so-called adjuvant analgesics, which are drugs
that are used primarily to treat conditions other than pain but
can relieve some painful conditions. Adjuvant drugs include antidepressants,
anticonvulsants, local anesthetics, and others.
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Rehabilitation Therapies
Physical therapy, occupational therapy, treatments such as heat,
cold, ultrasound, and others.
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Psychological Therapies
Cognitive approaches, such as relaxation training, distraction techniques,
hypnosis, biofeedback, and other behavioral approaches; other types
of psychotherapy.
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Anesthetic Therapies
Nerve blocks, drug infusion into the spine, spinal cord stimulation.
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Neurostimulatory Procedures
Transcutaneous electrical nerve stimulation (TENS), acupuncture,
invasive stimulatory therapies (spinal cord and brain).
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Surgical Approaches
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Alternative or Complementary Approaches
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The elderly are more likely to experience pain than the general
population and are often undertreated for pain due to myths about their
pain sensitivity, pain tolerance, and ability to benefit from opioid drugs.
If you are an older person experiencing pain, you should take the following
factors into account:
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You may experience more than one source of pain; |
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You may have several medical problems and be taking
a number of medications at once, and this may increase the risk
of analgesic drugs; |
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You run a higher-than-average risk of side effects from all drugs,
including analgesics like nonsteroidal anti-inflammatory drugs.
It is important to report the over-the-counter pain medications
you take to your health care team; |
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Having chronic medical problems and an increased risk of side
effects does not mean than your pain cannot, or should not, be aggressively
treated. You may be a candidate for any of the many pain-relieving
therapies that exist. |
Pain management for children should:
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Be tailored to the child's level of development, including his/her
verbal skills, ability to separate from parents, and understanding
of medical procedures; |
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Take advantage of the child's personality and draw on his/her
emotional and physical resources wherever possible; |
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Respond to issues the child's pain is causing in the family. |
For those with no history of substance dependence, there is
a very low risk of developing addiction -- with its hallmark loss of control,
compulsive drug use, and continued use despite harm. For those who do
have a history of substance abuse, pain management can be more difficult.
Doctors may have a greater tendency to undertreat, and patients may not
be able to benefit from the treatments offered if they are actively abusing,
particularly if the level of abuse is consistent with addiction. In some
cases:
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The doctor may want to work in collaboration with a psychiatrist
or substance abuse specialist. |
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The doctor may want to avoid drugs that can be abused or very
closely monitor those prescribed. It may be best to develop a contract
or agreement between treating physician and patient, defining limits
and acceptable behaviors. |
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The doctor may strongly encourage non-drug therapies to complement
any drugs that are prescribed. |
At Beth Israel Medical Center, our goal is to relieve pain safely and
effectively.
To this end, we strive to:
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Give pain relief high priority. It is important to treat pain;
the effects of unrelieved pain can be devastating; |
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Offer a thorough assessment of each patient, based on the patient's
individual experience of pain; |
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Base treatment on what works for the patient‹not myths,
biases, or unfounded fears about treatment; |
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Take into account the special needs of each individual, including
those who are very young or very old, those with a history of chemical
dependency, and those who are minorities or non-English speakers; |
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Provide access to an interdisciplinary group of professionals
who can implement a broad array of state-of-the-art approaches,
including drug therapies, rehabilitative approaches, psychological
treatments, and interventional pain management approaches. |
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Use the simplest and least invasive treatments first; |
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Encourage patients to be active participants in their treatment,
drawing on non-medical interventions in addition to (not instead
of) medical treatment; |
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Educate patients and their families about pain and its treatment;
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Reassess the treatment plan regularly, responding promptly to
changes in pain or the development of new pain. |
Several types of mechanical aids may be useful for patients
with functional limitations due to osteoarthritis. In patients with knee
osteoarthritis, shock-absorbing footwear may be useful for reducing the
impact of a load on the knee. Heel wedging may improve proprioception
and may reduce pain in knee osteoarthritis.
Walking aids can reduce the stress applied to weight bearing joints and
may improve patient stability during ambulation. Supports, braces, and
corrective devices may relieve pain and improve function of affected joints.
Patellar taping is commonly used for the treatment of anterior knee pain.
Splints are frequently used by occupational therapists to manage osteoarthritis
of the hand. The physical and occupational therapist can provide assessment
these types of devices. There is historical and anecdotal evidence for
their benefit rather than from controlled trials.
There are experts in pain within many fields of medicine.
Please see our Professional Staff Directory or
Find a Physician section
to find a pain specialist. Other organizations can also provide guidance
and referrals to pain specialists in your area. Need assistance? Contact
us.
For more information on our pain practice, please call (212) 844-8930.
To ask a question on pain management please contact us via email at stoppain@chpnet.org.
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