Pain can be debilitating, or annoying, especially if you cannot find the cause.It can also be difficult to describe accurately.
For some people, pain can be temporary and easily fixed with medications, but for others, it could spell a lifetime of “hell”.
The International Association For The Study Of Pain (IASP) defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage.
“It’s a sensation just like cold or heat, but pain also evokes emotion. Each individual’s experience is different,” says Dr Mary Cardosa, consultant anaesthesiologist and pain specialist.
Pain can generally be categorised as nociceptive pain and neuropathic or nerve pain.
While nociceptive pain is related to the nociceptive sensory nerve, which senses and reacts to external factors that may harm or threaten the body, nerve pain is due to an injury or malfunction of the nervous system.
“The type of pain most people have experienced is acute or short term pain, often associated with tissue injury. It has a protective function, and though unpleasant, you need this kind of pain, or else you won’t know when you injure yourself. It is resolved when the injury is treated or healed,” says Dr Cardosa.
The other kind of pain, which is difficult to understand, is chronic pain as it goes on beyond the healing period, usually more than three months.
Examples include peripheral neuropathy cause by diabetes, chronic back pain and fibromyalgia. Scans and tests come out normal, and doctors cannot find the root cause, leading to frustrated patients.
Dr Cardosa explains, “Chronic pain is called a disease of the pain signalling system or nervous system. In chronic pain, there is no tissue damage or the tissue has already healed, and yet, the pain sensation persists.
“No one knows why chronic pain exists, how it occurs and who are the people in which it occurs. People used to think this group was ‘crazy’ and that the ‘pain is in their head’, but the pain is real! Something has gone wrong.”
When the pain is related to nerves, it is caused by a lesion or disease of the somatosensory nervous system. For example, this could occur after a spinal cord injury, brachial plexus injury or stroke.
“They cannot walk, they cannot feel their legs, but there is pain at the site. This is distressing to the patient.
There is also something called phantom pain where the leg has been amputated but the patient still feels the leg and pain.
“Despite having no limb, the nerves that represent the leg and that part of the leg which is represented in the brain is still there.
“Your brain and spinal cord retains a memory of the leg, and if that memory includes a painful episode before the amputation (i.e. trauma), then the chances of chronic pain are higher.”
According to a 2015 article published in the American Society for Pain Management Nursing, 7.1% of the general Malaysian adult population suffer from chronic pain.
Apart from being a financial burden, prolonged chronic pain can also bring about depression, exhaustion, loss of appetite and mood swings.
More often than not, chronic pain is idiopathic (no known cause), especially when it involves trigeminal neuralgia (pain in the face), says Dr Cardosa, who is also the president of the Malaysian Association For The Study Of Pain and one of the pioneers of the development of clinical services, health workforce education and pain research in Malaysia.
“The shooting electrical sensation is triggered by brushing your teeth or washing your face and it’s a horrible feeling. In some cases, it’s found that the fifth cranial nerve lies very close to an artery that is near that area of the brain.
“It’s thought that the throbbing of the artery disturbs the nerve. Treatment can be surgery where you put a piece of cloth in between the artery and the nerve to try to protect the nerve.”
Sadly, for most cases of neuropathic pain, the damage has already been done and cannot be reversed.
With acute pain, the doctors know where the pain pathway runs, and block it at different points using different drugs, the common one being local anaesthe-tic, nonsteroidal anti-inflammatory drugs and traditional painkillers.
The International Association For The Study Of Pain (IASP) defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage.
“It’s a sensation just like cold or heat, but pain also evokes emotion. Each individual’s experience is different,” says Dr Mary Cardosa, consultant anaesthesiologist and pain specialist.
Pain can generally be categorised as nociceptive pain and neuropathic or nerve pain.
While nociceptive pain is related to the nociceptive sensory nerve, which senses and reacts to external factors that may harm or threaten the body, nerve pain is due to an injury or malfunction of the nervous system.
“The type of pain most people have experienced is acute or short term pain, often associated with tissue injury. It has a protective function, and though unpleasant, you need this kind of pain, or else you won’t know when you injure yourself. It is resolved when the injury is treated or healed,” says Dr Cardosa.
The other kind of pain, which is difficult to understand, is chronic pain as it goes on beyond the healing period, usually more than three months.
Examples include peripheral neuropathy cause by diabetes, chronic back pain and fibromyalgia. Scans and tests come out normal, and doctors cannot find the root cause, leading to frustrated patients.
Dr Cardosa explains, “Chronic pain is called a disease of the pain signalling system or nervous system. In chronic pain, there is no tissue damage or the tissue has already healed, and yet, the pain sensation persists.
“No one knows why chronic pain exists, how it occurs and who are the people in which it occurs. People used to think this group was ‘crazy’ and that the ‘pain is in their head’, but the pain is real! Something has gone wrong.”
When the pain is related to nerves, it is caused by a lesion or disease of the somatosensory nervous system. For example, this could occur after a spinal cord injury, brachial plexus injury or stroke.
“They cannot walk, they cannot feel their legs, but there is pain at the site. This is distressing to the patient.
There is also something called phantom pain where the leg has been amputated but the patient still feels the leg and pain.
“Despite having no limb, the nerves that represent the leg and that part of the leg which is represented in the brain is still there.
“Your brain and spinal cord retains a memory of the leg, and if that memory includes a painful episode before the amputation (i.e. trauma), then the chances of chronic pain are higher.”
According to a 2015 article published in the American Society for Pain Management Nursing, 7.1% of the general Malaysian adult population suffer from chronic pain.
Apart from being a financial burden, prolonged chronic pain can also bring about depression, exhaustion, loss of appetite and mood swings.
More often than not, chronic pain is idiopathic (no known cause), especially when it involves trigeminal neuralgia (pain in the face), says Dr Cardosa, who is also the president of the Malaysian Association For The Study Of Pain and one of the pioneers of the development of clinical services, health workforce education and pain research in Malaysia.
“The shooting electrical sensation is triggered by brushing your teeth or washing your face and it’s a horrible feeling. In some cases, it’s found that the fifth cranial nerve lies very close to an artery that is near that area of the brain.
“It’s thought that the throbbing of the artery disturbs the nerve. Treatment can be surgery where you put a piece of cloth in between the artery and the nerve to try to protect the nerve.”
Sadly, for most cases of neuropathic pain, the damage has already been done and cannot be reversed.
With acute pain, the doctors know where the pain pathway runs, and block it at different points using different drugs, the common one being local anaesthe-tic, nonsteroidal anti-inflammatory drugs and traditional painkillers.
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| Mayo Clinic researchers found that 1 in 4 patients prescribed an opioid painkiller for the first time progressed to long-term prescriptions. Photo: TNS |
“Unfortunately, all these drugs don’t work for neuropathic pain, only for nociceptive pain. Opioids may work, but we usually give anti-neuropathic agents,” says Dr Cardosa.
All of us have the ability to modulate pain signals. In an emergency, we can run into a burning house to rescue a loved one but only feel pain once we get to safety or the fire has been extinguished.
Dr Cardosa explains, “Our brain has the ability to block pain signals. If a person is very anxious, the pain can increase.
“It’s got to do with what I call a chemical balance. Not all drugs work for everybody. It’s a bit of trial and error; we always try to achieve a balance between the side effects and benefits.”
All these drugs may cause drowsiness, so the dosage needs to be adjusted accordingly. The benefits don’t come immediately as it takes a while to change the chemical balance.
Pain is indeed complicated, and when it becomes chronic, environmental, social and emotional factors need to be taken into account.
Dr Cardosa says, “Pain can go on and on and on; patients cannot function, get depressed, lose jobs, families get upset, etc. So, we use a more holistic approach to treat chronic pain. Patients have to understand what is going on and learn self-management. We found that we can improve function without reducing pain.”
It’s only natural for patients, young and old, to start avoiding certain things because pain increases during those activities.
“When you become less active and stop doing certain things, you become less fit and more stiff, and then you get more pain.
“A vicious cycle is set up. By the time we see these patients, we don’t know how far along the path they are. And it’s a downward spiral they go into.
“People tend to think that pain means damage and it’s understandable to react that way. You could have chronic back pain and the doctor tells you it’s due to a degenerative spine or from wear and tear, part of ageing. But, how do you reduce wear and tear? If you don’t move your muscles in chronic pain and keep resting, it’s only going to get worse,” she points out.
Patients need to be convinced they can move again. Because they have been deconditioned, they have to start slow and pace themselves. Exercise is one of the modalities used, along with cognitive behaviour therapy and relaxation.
However, those with chronic pain may tend to overdo things.
“These people have good days and bad days. On bad days, they rest, and on good days, they overdo. Then the pain increases, and they get into cycle, so we tell them to pace their activities and set goals. They cannot run a marathon overnight!
“These methods must be used together, it comes in a package, and it must be constantly practised. If you’re lucky, sometimes drugs alone will work. Central to all this is the patient’s sense of understanding and their control over the situation.”
Unfortunately, a lot of healthcare providers still understand pain using the acute pain model, so they look for a source of the pain.
“If you go to the surgeon enough times, they may eventually offer you surgery, and if you are desperate enough, you will take it. But, chronic pain will not go away. Other doctors may ask you about your pain, so we have to tell our patients how to deal with other doctors.
“Very often patients say pain controls their life. It’s tough. I tell patients their pain is a result of a wrong signal – don’t pay attention to it. It’s like a fire alarm going off and there is no fire.”
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All of us have the ability to modulate pain signals. In an emergency, we can run into a burning house to rescue a loved one but only feel pain once we get to safety or the fire has been extinguished.
Dr Cardosa explains, “Our brain has the ability to block pain signals. If a person is very anxious, the pain can increase.
“It’s got to do with what I call a chemical balance. Not all drugs work for everybody. It’s a bit of trial and error; we always try to achieve a balance between the side effects and benefits.”
All these drugs may cause drowsiness, so the dosage needs to be adjusted accordingly. The benefits don’t come immediately as it takes a while to change the chemical balance.
Pain is indeed complicated, and when it becomes chronic, environmental, social and emotional factors need to be taken into account.
Dr Cardosa says, “Pain can go on and on and on; patients cannot function, get depressed, lose jobs, families get upset, etc. So, we use a more holistic approach to treat chronic pain. Patients have to understand what is going on and learn self-management. We found that we can improve function without reducing pain.”
It’s only natural for patients, young and old, to start avoiding certain things because pain increases during those activities.
“When you become less active and stop doing certain things, you become less fit and more stiff, and then you get more pain.
“A vicious cycle is set up. By the time we see these patients, we don’t know how far along the path they are. And it’s a downward spiral they go into.
“People tend to think that pain means damage and it’s understandable to react that way. You could have chronic back pain and the doctor tells you it’s due to a degenerative spine or from wear and tear, part of ageing. But, how do you reduce wear and tear? If you don’t move your muscles in chronic pain and keep resting, it’s only going to get worse,” she points out.
Patients need to be convinced they can move again. Because they have been deconditioned, they have to start slow and pace themselves. Exercise is one of the modalities used, along with cognitive behaviour therapy and relaxation.
However, those with chronic pain may tend to overdo things.
“These people have good days and bad days. On bad days, they rest, and on good days, they overdo. Then the pain increases, and they get into cycle, so we tell them to pace their activities and set goals. They cannot run a marathon overnight!
“These methods must be used together, it comes in a package, and it must be constantly practised. If you’re lucky, sometimes drugs alone will work. Central to all this is the patient’s sense of understanding and their control over the situation.”
Unfortunately, a lot of healthcare providers still understand pain using the acute pain model, so they look for a source of the pain.
“If you go to the surgeon enough times, they may eventually offer you surgery, and if you are desperate enough, you will take it. But, chronic pain will not go away. Other doctors may ask you about your pain, so we have to tell our patients how to deal with other doctors.
“Very often patients say pain controls their life. It’s tough. I tell patients their pain is a result of a wrong signal – don’t pay attention to it. It’s like a fire alarm going off and there is no fire.”
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