The two faces of pain: acute and chronic What is pain? The International Association for the Study of Pain defines it as: An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. It is useful to distinguish between two basic types of pain, acute and chronic, and they differ greatly. Acute pain, for the most part, results from disease, inflammation, or injury to tissues. This type of pain generally comes on suddenly, for example, after trauma or surgery, and may be accompanied by anxiety or emotional distress. The cause of acute pain can usually be diagnosed and treated, and the pain is self-limiting, that is, it is confined to a given period of time and severity. In some rare instances, it can become chronic. Chronic pain is widely believed to represent disease itself. It can be made much worse by environmental and psychological factors. Chronic pain persists over a longer period of time than acute pain and is resistant to most medical treatments. It can-and often does-cause severe problems for patients.

How is pain treated : The goal of pain management is to improve function, enabling individuals to work, attend school, or participate in other day-to-day activities. Patients and their physicians have a number of options for the treatment of pain; some are more effective than others. Sometimes, relaxation and the use of imagery as a distraction provide relief. These methods can be powerful and effective, according to those who advocate their use. Whatever the treatment regime, it is important to remember that pain is treatable. The following treatments are among the most common. Acetaminophen is the basic ingredient found in Tylenol and its many generic equivalents. It is sold over the counter, in a prescription-strength preparation, and in combination with codeine. Analgesic refers to the class of drugs that includes most painkillers, such as aspirin, acetaminophen, and ibuprofen. The word analgesic is derived from ancient Greek and means to reduce or stop pain. Nonprescription or over-the-counter pain relievers are generally used for mild to moderate pain. Prescription pain relievers, sold through a pharmacy under the direction of a physician, are used for more moderate to severe pain. Anticonvulsants are used for the treatment of seizure disorders but are also sometimes prescribed for the treatment of pain. Carbamazepine in particular is used to treat a number of painful conditions, including trigeminal neuralgia. Another antiepileptic drug, gabapentin, is being studied for its pain-relieving properties, especially as a treatment for neuropathic pain. Antidepressants are sometimes used for the treatment of pain and, along with neuroleptics and lithium, belong to a category of drugs called psychotropic drugs. In addition, anti-anxiety drugs called benzodiazepines also act as muscle relaxants and are sometimes used as pain relievers. Physicians usually try to treat the condition with analgesics before prescribing these drugs. Antimigraine drugs include the triptans- sumatriptan (Imitrex), naratriptan (Amerge), and zolmitriptan (Zomig)-and are used specifically for migraine headaches. They can have serious side effects in some people and therefore, as with all prescription medicines, should be used only under a doctor's care. Biofeedback is used for the treatment of many common pain problems, most notably headache and back pain. Using a special electronic machine, the patient is trained to become aware of, to follow, and to gain control over certain bodily functions, including muscle tension, heart rate, and skin temperature. The individual can then learn to effect a change in his or her responses to pain, for example, by using relaxation techniques. Biofeedback is often used in combination with other treatment methods, generally without side effects. Similarly, the use of relaxation techniques in the treatment of pain can increase the patient's feeling of well-being. Capsaicin is a chemical found in chili peppers that is also a primary ingredient in pain-relieving creams. Chemonucleolysis is a treatment in which an enzyme, chymopapain, is injected directly into a herniated lumbar disc in an effort to dissolve material around the disc, thus reducing pressure and pain. The procedure's use is extremely limited, in part because some patients may have a life-threatening allergic reaction to chymopapain. Chiropractic refers to hand manipulation of the spine, usually for relief of back pain, and is a treatment option that continues to grow in popularity among many people who simply seek relief from back disorders. It has never been without controversy, however. Chiropractic's usefulness as a treatment for back pain is, for the most part, restricted to a select group of individuals with uncomplicated acute low back pain who may derive relief from the massage component of the therapy.

Chronic pain medicines - Information : Many medicines can help pain, including the ones listed in this handout. Each one may have side effects. Some side effects can be serious. It is important to listen to your family doctor carefully when he or she tells you how to use your pain medicine. If you have questions about side effects or about how much medicine to take, ask your doctor or your pharmacist. Acetaminophen (one brand name: Tylenol) helps many kinds of chronic pain. Remember, many over-the-counter and prescription pain medicines have acetaminophen in them. If you are not careful, you could take more acetaminophen than is good for you. Taking too much acetaminophen can cause liver damage. If you often have to take more than two acetaminophen pills a day, tell your doctor. Nonsteroidal Anti-inflammatory Medicines - Other medicines that help with pain are called nonsteroidal anti-inflammatory medicines. Examples include ibuprofen (two brand names: Motrin, Advil) and naproxen (two brand names: Aleve [over-the-counter], and Naprosyn [prescription]). You can take these medicines just when you need them, or you can take them every day. When you take these medicines regularly, they build up in your blood to fight the pain of inflammation (swelling) and give general pain relief. Many of these medicines are available in low-dose forms without a prescription. You need to tell your doctor if you are taking any of these medicines regularly. If your doctor wants you to take one of these medicines, always take it with food or a glass of milk, because the most common side effects are related to the stomach. If you already are taking other pain medicines, do not take these medicines without talking to your doctor first.

Chronic pain treatment : One of the most serious problems in modern medicine is the undertreatment of patients in chronic pain. More than 30 million patients suffer from chronic pain, and seven million of them cannot relieve their pain without opioids (narcotics), but only few doctors in the country are willing to prescribe them, according to the National Chronic Pain Outreach Association. Today's massive denial of pain medication is a consequence of the social, regulatory and law enforcement climate created by the War on Drugs. Doctors can suffer loss of license or even incarceration, when the inevitable mistake of providing medicine to a dishonest patient who may be misusing or diverting medication occurs. The climate has led to a situation in which most physicians are incorrectly trained in pain management and under- or non-treatment of pain is the norm. Doctors who treat pain correctly typically must exceed the usual prescribed dosages, and in so doing draw the scrutiny of state medical boards and the U.S. Drug Enforcement Administration (DEA). The DEA demands that doctors and pharmacies regularly provide them with records of every prescription for controlled substances that is written or filled. The fate of pain patients in the "police state of medicine" is grim. Day after day of constant torment drives many to depression or even suicide. Many patients receive enough medicine to provide relief for four hours out of the day, and have to decide which 20 hours of the day they will spend in extreme pain. Frightened doctors sometimes "fire" patients, cutting them off from pain meds suddenly, thereby putting them at risk for shock or withdrawal. And those patients receiving adequate prescriptions live in fear that their doctors could be put out of business by the government or frightened into cutting them off. Former addicts as well as former prisoners are in the worst situation of all, being automatically suspect -- but pain patients from these backgrounds need and deserve proper treatment nonetheless.