Every person experiences pain almost every day. Medically, pain is defined as an unpleasant sensory and emotional experience that is linked to actual or potential tissue damage.
It has a very important warning function and is intended to protect the body from harmful or dangerous influences. A distinction is made between acute and chronic pain.
It can be triggered by external factors such as cold, heat or injuries as well as internal complaints, e.g. B. inflammation or disorders of the nervous system.
Almost everywhere in the body there are nerve fibers that can perceive different stimuli (e.g. temperature, pressure, injuries or stretching) using special receptors and transmit them to the brain. The brain itself has no pain receptors and is therefore insensitive to pain.
Pain is a subjective sensation that everyone can perceive in very different ways. You don’t necessarily have to have a physical cause. Chronic pain, for example, is an independent disease and has lost its warning function. Emotional stress can also lead to physical pain (psychosomatic pain).
The mental state plays an important role in individual pain perception: grief or depression can increase the sensitivity to pain, but positive feelings can reduce it. Between 100 and 150 million people in the USA suffer from this chronic issue.
The most common conditions include back, muscle and headache, joint (arthritis), rheumatoid arthritis, nerve and tumor pain. Many patients are still not adequately treated.On average, it takes about 10 years for a patient to be treated in a practice or clinic that specializes in therapy.
It is also estimated that more patients with chronic pain would need strong medication (stage III opioids), but only about every 10th person actually receives the required medication.
Here is the info graphic showing statistics shared by Pathways
As a rule, external injuries or internal inflammation trigger acute pain. In these cases, it is a sign of actually existing disorders. These include, for example:
Pain occurs when mechanical (e.g. fall), thermal (e.g. heat or cold), chemical or electrical stimuli exceed a certain threshold. The damaged tissue then releases signal substances that bind to special pain receptors, the so-called nociceptors.
These are free nerve endings. These nerve endings specialize in the perception and transmission of painful stimuli, but can also absorb other sensory stimuli, such as heat or cold.
Nociceptors are located in the skin, muscles, bones, joints and internal organs and report the pain absorbed to the spinal cord. The nerve fibers differ in their diameter and in the speed at which they transmit the pain stimulus: the thin C fibers transmit pain signals at a speed of approx. 1.5 meters per second.
In contrast, the A fiber conducted the pain at 15 meters per second and triggered a reflex in response to the pain, for example pulling your hand away from a hot stove.
The impulse is transmitted from the spinal cord to the brain via ascending nerve fibers. The nerve tracts cross in the spinal cord, which means that a pain signal that comes from the left hand is passed on to the right hemisphere and vice versa.
Information is processed in the brain where and how intensely it hurts. The brain evaluates sensations through a link with the limb system, which is involved, among other things, in the development of emotions. For this reason, it is generally felt uncomfortable.
After a pain signal reaches the brain, it triggers a defense reaction against the cause of the pain within a very short time. In addition, the body’s own pain-relieving system is set in motion when the situation requires an organism that can act, for example after an accident. This is how the hypothalamus stimulates the release of noradrenaline. It accelerates the heartbeat, blood pressure rises and sweat production is boosted – the body is put on high alert by the pain signal.
Pain can also be alleviated or completely eliminated by the body’s own inhibitors. These so-called endorphins inhibit the transmission of pain signals and change the sensation of pain. They only work for a short time and are released during heavy physical exertion or dangerous situations. As a result, pain is only perceived when the body has come to rest or the danger has passed, e.g.after an accident.
“Chronic” is a situation that lasts longer than 6 months, although the pain may have become chronic at an earlier point in time. Pain can become an independent clinical picture over time.
The most common causes of chronic pain in adults are signs of wear of the musculoskeletal system (arthrosis), due to vascular diseases (e.g. peripheral arterial occlusive disease), neuropathic (e.g. after stroke, diabetic polyneuropathy) and tumor.
On the one hand there are so-called primarily chronic pain diseases, in which the pain occurs periodically – one example is migraine. Pain physicians also assume that acute pain can become chronic, since any pain stimulus in the nervous system can cause permanent changes.
As a result, the pain threshold can be lowered so much that even harmless external stimuli such as light touch are perceived as painful. Sometimes the pain fibers are active even when there is no stimulus at all.
The constant flood of signals from a damaged region of the body may sensitize the brain via nerve pathways that are normally not used. Pain relievers can also be a possible cause of the development of chronic pain. Severe childhood pain is another risk factor for the development of chronic pain.
That is why special care is taken today in children to avoid pain as much as possible during medical interventions. The children receive local anesthesia with a local anesthetic before taking blood or spinal cord puncture.
Different forms of pain you should never ignore
Attack-like shooting pain (e.g. trigeminal neuralgia) Burning, dull pain (e.g. due to nerve injuries) Deep piercing pain (e.g. caused by swelling such as in Sudeck’s disease) Dull pain that tends to radiate and is accompanied by vegetative symptoms (e.g. headache, muscle cramps).
Nociceptor pain is based on tissue damage due to external influences (e.g. blow, burn, bruising), inflammation, tumors or colic.
With colic, the muscles of internal organs contract excessively, which causes direct excitation of pain receptors. For example, nociceptor pain includes inflammatory diseases such as rheumatoid arthritis, sore or toothache.
In neuropathic pain, peripheral or central nerve fibers themselves are damaged. In this case, the pain does not report tissue damage, but rather its own malfunction. Everyday symptoms include severe pain, often described as razor-sharp or burning. They can appear briefly as a attack or can be felt as long-lasting and dull.
Examples include: Post-zoster neuralgia, central pain after stroke, phantom pain, herniated disc, pain after spinal cord injury. Reflective pain can result from incorrect regulation or incorrect posture. It also include migraines, tension headaches, back pain or Sudeck’s disease, a disease in which injuries trigger a complex disease of the connective and nervous tissue.
Psychosomatic pain can also be triggered primarily by emotional stress. An example is a headache. Since pain is also a major emotional burden, both can intensify, so that cause and effect can often no longer be clearly distinguished.
Visceral pain is a situation that comes from internal organs. It is dull and difficult to locate. These pains are assigned to specific skin (nematode) or muscle areas (myotome) by the brain. These areas on the body surface are also referred to as Head’s zones.
Their position is generally approximately the same as the organ concerned, e.g. chest pain in heart attack. In some cases, the Head zone and the actual origin of the pain are far apart. The gallbladder has a Head zone in the right shoulder area.
Somatic pain is divided into deep pain and surface pain: deep pain comes from bones, muscles, joints, connective tissue. It is rather dull, often radiates and is accompanied by vegetative symptoms (e.g. nausea, tremors, sweating).
In contrast, surface pain occurs in the skin or mucous membrane and are e.g. B. attributed to skin irritation from inflammation or injury. They are easy to locate and quickly fade away when the triggering stimulus has disappeared.
Acute pain is directly related to a triggering event. For example, immediately after a painful injury, a light, sharp and easy to localize pain is perceived, the so-called first pain.
Chronic pain, which persists for a longer period, lacks vegetative symptoms such as sweating, palpitations and increased blood pressure.
Severe or long-lasting acute pain harbors the risk that the pain will persist even without an identifiable cause. Inadequate therapy for acute pain can make pain chronic. In contrast to acute pain, chronic pain is often difficult to treat.
If the chronification is already well advanced, treatment can often no longer completely eliminate the pain, but can only reduce it to an acceptable level.
Chronic pain that is not adequately treated can induce those affected to take painkillers out of fear of the recurring, the effect of which sets in quickly and quickly subsides.
Many patients therefore prematurely stop their therapy if their pain is not treated satisfactorily – frustration and conflicts with the treating doctor are inevitable.
Pain relievers (analgesics) are by far at the top of the most commonly prescribed drugs. Many pain relievers not only have a pain-relieving effect, they also dampen the sensations in the pain-evaluating areas of the limbic system.
They are divided into strong pain relievers and weak to moderate pain relievers. The stage plan of the World Health Organization (WHO) is the basis of drug pain therapy: weak to moderately effective pain relievers are the means of the 1st stage.
Pain relievers of the second stage are the weak opioid analgesics, pain relievers of the third stage are the opioids. The doctor must select the analgesics and supportive medication according to the type of pain.
These are non- opioid analgesics. They have an analgesic and anti-inflammatory effect by inhibiting the formation of prostaglandin, an endogenous substance that is involved in the development of pain, fever and inflammation.
They also seem to use other mechanisms to normalize the increased sensitivity of nerve endings (nociceptors).
Salicylic acid derivatives (e.g. acetylsalicylic acid)
They act very quickly against pain, but often cause stomach problems, heartburn and gastric mucosal bleeding. In addition, dizziness, ringing in the ears, nausea and vomiting can occur if they are taken in high doses over a longer period.
Anillin derivatives (e.g. paracetamol or phenacetin)
Paracetamol and phenacetin only have a mild analgesic and anti-inflammatory effect.
Paracetamol has a quick antipyretic effect and is better tolerated than phenacetin. It is therefore also contained in “fever juices” for children.
However, at high doses it can damage the liver. Therefore, no more than 6 to 8 tablets with 500 milligrams of paracetamol should be taken per day. It can also be used over a long period Paracetamol and phenacetin are over-the-counter pain relievers.
Since April 2009, paracetamol can only be sold up to an active ingredient amount of 10 grams without a prescription, which corresponds to a pack of 20 tablets of 500 milligrams each.
Pyrazole derivatives (metamizole, propyphenazone & phenylbutazone)
Metamizole has a strong effect and also has a strong analgesic effect. It also has anti-inflammatory and muscle-relaxing (spasmodic) effects. It is therefore particularly suitable for the treatment of severe acute pain (e.g. after operations, gout) or in tumor therapy for the treatment of pain attacks.
A very rare but serious side effect is the so-called agranulocytosis, in which the number of white blood cells drops dramatically. In addition, allergic skin reactions must be expected. The other substances in this group of pain relievers also have a strong antipyretic, analgesic and anti-inflammatory effect. Because of possible side effects, they must be prescribed by the doctor.
Non-steroidal anti-inflammatory drugs (e.g. diclofenac, indomethacin, ibuprofen, naproxen, piroxicam)
They have an analgesic and anti-inflammatory effect, but not an antipyretic. They are used to treating inflammatory and rheumatic diseases of the joints. Important side effects of non-steroidal anti-inflammatory drugs include damage to the gastrointestinal mucosa, which can lead to stomach ulcers and, in rare cases, gastric bleeding. They can also trigger cardiovascular diseases or asthma and disrupt the fluid and salt balance. Cyclo-oxygenase-2 inhibitors (COX-2 inhibitors, e.g. Celecoxib, Etoricoxib) COX-2 inhibitors suppress the formation of cyclo-oxygenase-2 – an enzyme that promotes the formation of prostaglandins in the event of inflammation or injury.
This prevents both inflammatory reactions and the development of pain signals. COX2 inhibitors differ from traditional non-steroidal anti-inflammatory drugs such as ibuprofen or diclofenac in that they are better tolerated by the stomach. However, they can increase the risk of cardiovascular diseases and should therefore not be taken by cardiac patients.
The so-called antiepileptics anticonvulsants – are particularly effective in the treatment of neuropathic pain of a shooting nature (e.g. trigeminal neuralgia, shingles), example: carbamazepine.
They inhibit nerve cells that continuously send out signals and can thus interrupt the transmission of pain signals.
Gabapentin or pregabalin can also be used in pain patients.
Corticosteroids work against inflammation and reduce swelling.
This reduces the pressure on the surrounding tissue and thus reduces the pain. You can apply it to inflammation and tumours or if nerves are pinched or pressed in the spinal cord (e.g. in the case of a herniated disc).
If possible, they should not be combined with non-steroidal anti-inflammatory drugs, as these increase the risk of gastric ulcer.
Bisphosphonates inhibit the bone-degrading cells (osteoclasts) and thus strengthen the bones. Regardless of this, they also reduce bone pain and are therefore used for osteoporosis, bone cancer or Sudeck’s disease.
Flupirtine differs from the other analgesics in structure and effect. The analgesic effectiveness is comparable to that of weakly effective opioids. It also relaxes the muscles.
That is why it is also used for tension pain. Possible side effects are fatigue, a dry mouth and difficulty concentrating.
There are lots of pain relievers I mentioned before, but trying herbal ones can help you against any side effects.
These are usually the ingredients from plants that can pain relieve. These include
Arnica is applied to the skin as a tincture or ointment. The ingredients have an analgesic and anti-inflammatory effect. Arnica helps with bruises, sprains, muscle and joint problems (e.g. rheumatism). One should not arnica in allergy apply against cruciferous and never apply to open wounds (risk of erysipelas). Skin allergies to arnica are relatively common.
Comfrey is applied to the skin during inflammation and promotes wound healing. Pastes, vegetable juice and ointments are used. Comfrey helps with painful bruises, strains, sprains. It should not be applied to open skin areas as well as during pregnancy, breastfeeding and in children. Comfrey should also not be used for more than 4 to 6 weeks per year.
When used externally, camphor has a cooling effect and thus increases the blood circulation in the skin. Camphor is used for rheumatic diseases of the muscles.
Spruce needle oil promotes blood circulation to the skin and can be used as an ointment or bath additive for muscle and nerve pain.
Clove oil has an analgesic effect and is used externally in dentistry as a light anesthetic. There are special tooth drops that contain up to 30% essential oil.
Gingko improves blood circulation and can increase the pain-free walking distance in patients with peripheral arterial occlusive disease (PAD, “shop window disease “). Various ginkgo preparations are available on the market.
Hay flowers are used externally as hot, moist compresses. They increase the blood flow to the skin and relieve pain in rheumatic diseases and degenerative joint diseases (arthrosis). In the case of acute rheumatism attacks and inflammation of the skin, the application is not recommended.
The oil promotes blood circulation. It can be used for rheumatic complaints or nerve pain.
Poplar extracts contain salicylates and therefore have an analgesic and anti-inflammatory effect. They are drunk as tea.
When used externally, chilli and cayenne pepper extract relieve pain. Their ingredient capsaicin is particularly helpful for neuralgic pain such in diabetic neuropathy, post-zoster neuralgia, lumbago (lumbago) or tennis elbow.
However, capsaicin only works after prolonged use. First, it intensifies the pain by permanently activating the nerve endings and thereby causing a sustained release of the neurotransmitters.
As a result, the supply of neurotransmitters is exhausted. Treatment must be continued so that this supply cannot be replenished.
Peppermint oil acts externally rubbed against headaches (tension headaches).
External application in the form of ointments, creams, bath additives, rosemary spirit to rub. Rosemary leaves are suitable for the supportive treatment of rheumatic diseases.
The ingredients have an analgesic and anti-inflammatory effect. Porridge envelopes are used for external use in soft tissue rheumatism and degenerative joint diseases (arthrosis).
The ingredients have an analgesic effect. As a dosage form, tea or finished medicinal products are available for selection. It can be used for back pain due to arthrosis, spinal disc damage, inflammatory rheumatic diseases, headaches and neuralgia.
The ingredients have anti-inflammatory, antipyretic and analgesic effects. The most important ingredient is salicin – a relative of salicylic acid. Willow bark can be taken as a tea.
In principle, both severe acute pain and chronic pain should be treated early in order to prevent the development of a chronic pain disease. Advice such as “clenching teeth” and “an Indian knows no pain” is wrong and, in the worst case, can cause pain to become chronic.
Therefore, ask a doctor for advice if you have severe or prolonged pain and have it treated. Be open to your doctor and tell them in detail about your pain and how it affects your life. A common pain ailment is a headache. These are often related to lifestyle.
If you have to sit predominantly in your profession, you should firmly incorporate muscle relaxation exercises into your daily schedule. Make sure you get enough sleep and don’t drink alcohol.
Regular exercise, in turn, can protect against the pain that can be attributed to age-related signs of wear, such as osteoarthritis. This also applies to back pain, because strong muscles relieve the spine.
Optimal pain treatment should enable you to take an active part in life again and not perceive pain as a determining factor in your everyday life.
However, it can only be successful if you have pain treated early and consistently.
I hope, you like this detailed post on pain , its treatment and medicines.
Sophia have studied at Medical University in Michigan and have good experience in the field of human behavior and psychiatry. She is also working as a researcher in well know medical industry.