Pain Management

WHAT IS PAIN?

The word ‘pain’ comes from the Latin word “poena” which means a fine or a penalty. In non-professional terms, pain is the physical suffering caused by some disease in the body, an injury to a body part or an internal process that hurts. ^[1] Earlier, the pain was medically treated as physical damage, which led to feelings of distress to the individual, but with working on the definitions of pain, it has changed. Medical researchers suggest that it is not only the physical body which is involved in the distress and suffering. The International Association for the Study of Pain came up with a definition, which suggests new development in the era. According to them, pain is an unpleasant sensory physical and emotional experience. ^[2] This clearly states that pain has been divided into two major parts, and both the parts have an equal effect towards creating the pain in an individual. If we only consider pain as the damage of tissue or an injury, we are skipping an important part of how we feel pain. When we say we have pain, it is the combination of a physical state of damage or injury and emotional aspect of feelings which cause us to feel that the condition we are in is a dangerous situation. The emotional aspect allows us to understand the component of how we suffer from the damage or injury we get on our external or internal parts.

Today, people have pain in ways which were never witnessed before, and therefore, they are not able to specify the pain in any particular category because of lack of knowledge.  On this basis, McCaffrey and Beebe offered a definition where they say that pain is something that the individual experiences and explain by their experience. This definition also focuses on the combination of emotional and sensory pain combined.

THE RELATION BETWEEN THE BRAIN AND PAIN

The brain is again the integral part in the study of pain as it forwards the messages of pain along the peripheral nervous systems and to the spinal cord. There is a gate theory which explains how these pain signals are passed by gates which are located on nerve fibers between the peripheral nerves and the brain. ^[3] We have also seen that at times we feel the pain instantly after the damage while at times we feel the pain after some time. This is due to the priority the brain sets for the pain signal the nerves are getting. It is the pain signal which decides the intensity of our pain after the damage or injury. Gate theory carefully explains how the peripheral nervous systems and spinal cords take a decision on the idea of pain and its intensity. Pain messages, which are required to reach the brain faster, follow a different pathway where the delta fiber is related to the thalamus and cerebral cortex by the spinal cord. On the other hand, the slow pain messages pass by the same path until the spinal cord from where they pass through the hypothalamus and limbic system. The brain also alters the pain by the situation, where you are, what you experience and the surroundings- that is the primary reason of why we feel the intensity of pain go down when we are with people around us.

PAIN MANAGEMENT

Pain is the result of nonetheless every disease or damage, or while fighting a disease and therefore, depending on the intensity, pain has to be treated by doctors and nurses. Pain management is a broad study of the processes through which physicians and nurses reduced the intensity of pain for any individual. The body experiences many different types of diseases, and the pain related to those conditions vary in case of their intensity, the body part and how they will be treated. Understanding the different diseases, various pain types and causes of the pain is again necessary for the study of pain management. Pain can be the cause of many other diseases as well if not treated properly and can create distress in a human’s lifetime. Therefore, medical researchers continuously work on methods of pain management, and to use medications and therapies to reduce the intensity or remove the pain from the body. Pain management can vary from providing a simple medicine or injection to the patient who works on the sensory aspect of pain to working on their mind and providing them with the courage to fight the pain and collaborate with the emotional dimension of the pain.

CLASSIFICATION OF PAIN

To assess and treat pain, one should understand the classification of pain, the pain spectrum and the time course of grief.

BY TYPES

Pain is classified into Nociceptive, Neuropathic, and Inflammatory. Nociceptive is due to injury in some body part like muscles, skin or tendons. These further are classified into Somatic, which is organ injuries, and Visceral, which are muscle injuries. The second type is Neuropathic pain which is due to a disease in the somatosensory nervous system. The examples include the diabetic neuropathy or post-stroke central pain. Lastly, inflammatory pain is due to activation and sensitization of the nociceptive pain by the mediators which are released at a site of tissue inflammation. Examples of this include cancer pain or migraine pain.

BY PAIN SPECTRUM

A pain spectrum is a scale to measure the intensity of pain. There are three methods to measure the pain, being self-report by the patient, observation from the specialist, and subjective data. Self-report is the most trusted method and necessary to be obtained as it is the actual understanding of the pain. If for some reason, self-report cannot be obtained, other methods are used. There is a scale developed by pain managers which divide the pain intensity. The pain from on a scale of 10 is rated where less than 4 is considered mild, 5-6 is considered moderate, and 7 or more than that is considered severe and needs immediate treatment. There are many scales being used and developed by different researchers out of which some famous scales are Wong-Baker FACES Pain Rating Scale; Coloured Analogue Scale, ^[4] FLACC (Face Legs Arms Cry Consolability Scale); Brief Pain Inventory, CHEOPS (Children’s Hospital of Eastern Ontario Pain Scale), ^[5] Visual Analog Scale (VAS); Verbal Numerical Rating Scale (VNRS) and Verbal Descriptor Scale (VDS).

BY COURSE OF TIME

Pain is also classified according to the time course of the pain where, if the pain is not long term, it is known as acute pain, while if the pain is long term, it is called chronic pain. ^[6] While acute pain is just a small feeling or sensation of pain which ends in some weeks with proper medication or treatment, chronic pain lasts more than at least 12 weeks. Acute pain is one which occurs due to damage to soft tissue and the pain releases as the injury heals. Chronic pain is due to a long-term illness or an unfortunate internal damage. Chronic pain can also be caused due to fatigue, less sleep, or behavioral reasons.

WHY DO DIFFERENT PEOPLE EXPERIENCE PAIN DIFFERENTLY?

You would have come across many individuals who have a particularly sharp pain often while some who take pain quite casually and have the courage to work along with the pain they are experiencing. There are two major factors because of which different individuals experience the intensity of pain differently. One is due to the brain while the other is due to their past experiences.

Until the last decade, we had no evidence of whether the person claiming to be in pain is speaking the truth since only the symptoms of the disease could have explained the pain. However, after the invention of MRI (Magnetic Response Imaging), we can view when the pain starts, when it ends and the intensity of pain in different individuals. Brain Imaging has confirmed that some people do experience more pain for the same disease or injury than the other person. Wake Forest University Baptist Medical Center carried forward a study in 2003, by Robert C. Coghill, Ph.D., lead investigator, where 17 healthy volunteers were taken and given a sensation of apparent pain while their brains were recorded. This study led to show us that the individuals who said the pain was intense had the parts of the brain being largely activated while those who felt mild pain had areas of brain slightly activated. The activation was shown by primary somatosensory cortex which makes the perception of the painful stimulus of where the pain is located and how bad it is- the anterior cingulate cortex which passes the feeling of pain to the brain. The study also confirmed that while to the spinal cord pain is similar, but once the pain reaches the brain, the intensity of pain changes and that is where the individuals start experiencing pain differently. This study was an excellent addition to learning pain management for different people. ^[7]

Additionally, the different experience of pain is also due to the cognitive factors including experience with pain in the past, your emotional state of mind when you experience the pain, the people you are surrounded by when you experience the pain, and an individual’s expectation of grief.

Other important factors which are gaining hype in the perception of pain are genetics, mood, and age. ^[8] The nervous system is built from the instructions from the genetic code. Hence, genes make you feel pain differently. Age and mood again can be considered the cognitive factors we were talking about earlier. Researchers are working on these three factors and their importance in the perception of pain.

CLINICAL APPROACH TO PAIN

When a patient enters with a complaint of pain, one needs to understand the procedure used clinically to work with the patient. The first step in the clinical process is to get the history of the patient which explains which major and minor diseases the patient has gone through in the past. Moreover, the patient is allowed to account for the experience of pain and the part of the body he is feeling the pain. The body part and the experience help us to decide on the possible reasons for grief. The second step is to provide pharmacologic treatment to the patient. The first choice of doctors is acetaminophen nonsteroidal anti-inflammatory drug (NSAID) for mild-to-moderate pain in the body. The selection of the two drugs is made based on the side effects of both the drugs. These side effects can be known by asking the patient about the other diseases one have or by looking at the history books if you have them. If the patient is taking cyclooxygenase-2 selective NSAIDs, he should not have any cardiovascular diseases. If the patient has more than mild pain, an acetaminophen/opioid combination can work best for the patient. At any case, these medications are given under careful consideration of the diseases the patient has or had in the past. The medication also differs when the type of pain is different. The pain can be acute pain, chronic pain, labor pain or cancer pain, these being the main categories of much more various situations. Someone with severe acute pain can also be provided with potent opioids. ^[9] Doctors should also guide the patient about the usage of the medication and how often the patient can pursue the medication. Usually, if the patient has a mild headache and that gets handled by medicine, the patient will take the same medicine over and over again every time he has a minor headache, and this can be regularly. At times, these habits can be harmful to the patient, and it is the responsibility of the doctor or nurse to explain the usage and dose of the medicine for future use as well.

Medical students need to understand that acute and chronic pains can be due to psychological effect the pain leaves on an individual. A survey suggested that the people who had a particular chronic pain would have different chronic pain in the coming week as well.

WAYS TO REDUCE PAIN

Pain is complex due to various classifications of types, intensity and time course, and due to many a different science behind every area of the body, pain management differs for every different body part and disease. While many ways have been devised to reduce pain, the three top strategies to reduce or demolish pain are to treat the source of pain by medications, injections, therapies or surgeries. Changing the perception of the pain an individual is experiencing which is mainly by psychological treatments, working with the signals which are being sent to the brain, and activations of pain being in the brain parts.

MEDICATION

The first step to any pain relief session is to provide medications. These medications are given to the patients on regular intervals in the beginning and periodic intervals when need be. We have many different pain-relief medications available, which are called analgesics.

Over-The-Counter Medication

Over-the-counter medicines are available to everyone who is suffering from pain without the doctor’s prescription. The two types of over-the-counter medications are:

• Acetaminophen (Tylenol)
• Nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen (Motrin, Advil) or naproxen (Aleve, Naprosyn)

We get these medications anywhere and everywhere as they are most easily available and can be consumed whenever there is a sensation of pain. Both these medications help treat the mild to moderate pain in your body and can be taken while in fever or suffering. These medications are also given along with other pain relievers. They reduce muscle ache and stiffness in your body. NSAIDs are also used to lessen the inflammation on your body parts which can cause pain, but they cannot be given in excess quantity as they can be bad for the heart and stomach.

Corticosteroids

These are medicines given on prescription-only. These medications provide relief to inflammation which is caused by itching, allergy, redness or easy swelling. This anti-inflammatory medicine is best for inflamed areas which cause pain to the body parts. Also, they can treat asthma, hay fever, lupus, polymyalgia rheumatic, chronic obstructive pulmonary disease (COPD), atopic eczema, urticaria (hives) and multiple sclerosis (MS). These medicines can also be used to replace certain hormones not produced by the body such as in Addison’s disease.

These medications can be found in the form of tablets (oral steroids), inhalers used as the mouth or nasal sprays, injections (in muscles) and lotions, gels or creams for inflammation. Side effects for Corticosteroids are increased hunger and weight gain, acne on skin, diabetes, mood swings, depression, high blood pressure and risk of infections. ^[10]

Opioids

Opioids are medications given for short term pain recovery such as after surgery. These medications contain natural, synthetic or semi-synthetic opiates. Medications that fall within this class include hydrocodone (e.g., Vicodin) which are given in painful conditions as dental surgery or injury pain, oxycodone (e.g., OxyContin, Percocet), morphine (e.g., Kadian, Avinza), which is used before and after a surgery would help you fight the drastic surgical pain, codeine, and related drugs.

Opioids are useful for severe pain and would not cause any stomach bleeding as the other pain relievers might. As these drugs are given to help the patient overcome pain for a short period of time, they never get addicted to these medications, but if taken in more quantity or long term, these can get patients addicted to it and therefore, doctors need to control the intake of these medicines.

Side effects of these medications include being drowsy, especially with morphine when you generally sleep after the surgery for long hours, nausea, itching, constipation and breathing problems. Long-term use can have adverse side effects as you become addicted to these drugs and get physically dependent on them. ^[11]

Anti-Depressants

Anti-depressants are the medicines which help patient to focus emotionally on the pain and work on lowering it down. These medications work on neurotransmitters (natural chemicals) in the brain. These medications make the parts of the brain available to respond to pain in a different manner and enhance the relaxation in the brain which further relaxes the pain in the body. These medications are used on the patients who have chronic pain and don’t respond to any other ways for pain-relief.

Some anti-depressants which can help patients are serotonin reuptake inhibitors (SSRIs), Tricyclic antidepressants and Serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications are given for longer time periods and will show their result in the long term as well. Anti-depressants, unlike other medicines, work on the emotional side, not the physical body parts and pain and therefore will show the effect with time.

Moreover, if taken in excess these medicines also demonstrate their side effects in the long term as well. SSRI and SNRI have fewer side effects than tricyclic antidepressants and therefore, doctors should prefer giving SSRI or SNRI first. The side effects of the medications are one’s vision getting lost, constipation issues, nausea and dry mouth. ^[12]

Anticonvulsants

Anticonvulsants are typically used to treat epileptic seizures, but some medications have also shown results in the treatment of pain. Medical researchers are still researching on how these medicines can help in pain relief though some say that due to their effect on nervous system. Some medication used in the treatment of pain is carbamazepine (Tegretol), gabapentin (Neurontin), and pregabalin (Lyrica). The adverse effects of these medicines are drowsiness, dizziness, fatigue and nausea among patients. ^[13]

Other medications

In some conditions, doctors also prescribe patients with the patches as well called Lidocaine patch. These patches are especially given by pain management specialists. They also can use TENS, which is a procedure which will use the patch placed on the skin of the body part to stop signals of the pain to reach the brain.

Patient-controlled analgesia (PCA) is also a method used to control the pain where the patient himself monitors the dose of medicine depending on his pain and its intensity. The button links to a tube which is computerized and will provide the patient with instant pain control medicine. ^[14]

SURGERIES

Surgical procedures are only used when the medications and therapies are of no use and doctors have lost hope. If doctors consider it medically necessary, only then should one move forward with a surgical treatment as it is not the best option. After surgical treatment, the patient cannot feel light touch or temperature changes in the body.

Pain surgeries implant individual systems under the skin, which result in no pain being felt by the patient. The sensation of pain is either not sent to the brain, which results in no pain feeling to the patient or the drug for pain is directly delivered to the body part where the pain sustains. Chemical sympathectomy is also used in some cases to destroy the nerves present in the body, which transfers the pain signals.

Decompression is also a type of surgery where doctors cut the skin and move the nerves from pressing to the part, which was causing immense pain to the patient. All surgeries result in some pain which has to be controlled by further medications. The pain after surgery is an acute pain and can be controlled by medications described above or injections of the same medicines.

THERAPY

When in pain, a patient feels stressful, sad and angry as all his pain is coming out in the form of emotions. The pain and emotions related to it have an effect on your personal and professional lives as well. The theory stating that pain is not just physical damage but a combination of physical and emotional dilemma led to work on ways to decrease the pain emotionally.

Therapies are ways to reduce or eliminate the pain without the use of drugs or medications. The treatments help the patient to learn how to cope up with the pain and not let it affect your life and the situations. The treatments are related to physiology and how to condition your brain to help the patient forget about the pain. These therapies are rightly called psychological therapies and are done in the presence of psychologists and pain specialists.

Psychological treatments and therapies are the most used method after medications and are more beneficial for the patients as these do not involve the utilization of any drug, and will hence have no adverse effect on the body. The reason why medications are more favored by doctors and patients is that medications have an effect on pain quickly while psychological therapies are long term and will have an effect on pain with time. Psychological therapies are of different types, and medical researchers are working on the use of therapies for the treatment of pain, as it has no adverse effects. Some major therapies are outlined below for understanding.

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy changes the way one perceives pain. Cognitive therapies are used to modify the emotions, thoughts and behavior of a patient in pain. It also helps you to work on coping up with the body pain and will remove the feelings of anger and distress from your mind which have evolved due to excellent chronic pain conditions. When a person is in stress due to pain, this arouses norepinephrine and serotonin in the mind which results in the intensity of pain to increase. When working with cognitive behavioral therapy, the patient’s internal mechanism for pain relief strengthens which reduces the activation of pain and chemicals in the body. CBT is divided into some major therapies including talk therapy, while on the other hand also works on reducing stress, providing relaxation, and pain coping skills training to the patients.

Talk Therapy: Talk therapy is about accepting your pain and letting the pain out with words. Patients want a combination of talk therapies and physiotherapies to cope up with the pain in their bodies. It has been worked upon that the chronic pain associated with the lower back has been worked up with the talk therapy in last few years, and patients show signs of satisfaction. The researchers suggest that for chronic pain, stress is a major problem and talk therapy works to eliminate the stress in the human body. Talk therapies are conducted by physiologists who help patients talk about their stress, their pain, and their lives being affected by the pain and about coping up with the pain. It has also been discovered that patients prefer individual talk therapies rather than talk therapies in a group which are a trend these days. ^[15]

Behavioral Activation: Patients who are suffering from pain tend not to participate in games or any other activity for fear of increasing their pain or due to stress or anxiety due to chronic pain. This results in their body are getting stiff and increases the pain. Cognitive behavioral therapy works on behavioral activation where the patient is encouraged to become involved in different physical activities and be part of different situations. This method has them play sports and get involved with activities in order to encourage them to get involved in it further.

Change Thinking Processes: Patients in pain are more bound to get negative and think negative about things in their life and about their pain. This is again due to distress in life caused by the chronic pain. Cognitive therapy gets patients to involve themselves in situations which lead to positive thinking and creating optimism in the patient’s life. Once you “think” you are better, you automatically feel better. CBT works on the same platform to help patients feel in a constructive and positive way. This process also helps them to work on the relaxation techniques as well.

Change in Lifestyle:  The therapist works on your behaviors and lifestyle by improving your sleep and helping you relax. The techniques used by the therapist helps the patient to increase their sleep and change their sleeping patterns along with providing them with relaxation techniques. The techniques include deep breathing, meditation, and biofeedback.

To get the best results out of the CBT, the therapist should explain to the patient to believe in the therapy that it will work the best for you. If you believe it, the effects of the therapy will increase. The patient should participate in the therapy with an open heart and try learning more and more skills. The therapy is a long due process and doesn’t show results in a week like other medications does and therefore, the patient should stay positive and keep working with the therapist on his pain problems. It is necessary that the patient completes the program with an open mind and finishes his homework.

Music Therapy

Music therapy is a renowned method of working on different mind problems including relationships, depression, and pain. Music is used to block the sensation of pain from the human body and has been quite effective in the case of chronic pain. When on music therapy, patients are observed to complain less about the pain and rely less on medications. It is also being researched that when music is being played during psychological therapy, the effect of treatment increases. Moreover, during the surgery, if the music is played, the patient is less thought of having pain during and after the surgery, and thus, less intake of morphine is needed by the patient. This is due to the qualities music has as it changes the mood in seconds and can soothe or uplift your mind. Music acts as hypnosis in some cases as well. ^[16]

OTHER TREATMENTS

There are many other methods to treat pain, which is found to be useful for different individuals depending on the pain types and body part. Some of the options are:

Acupuncture

Acupuncture is the method used by Sixteenth Century Chinese doctors which involve the use of stainless steel needles which are placed on 14 meridians in the body and are used to perfect the imbalance in the body due to which illness or pain has been caused. The World Health Organization has authenticated this method and said that this approach can treat 30 different illnesses and suffering is one of them.

Acupuncture is also said to decrease the pain by increasing the release of endorphins, which are chemicals that control pain. The acupoints are situated near the nerves and when given stimulation, these nerves, in turn, will fill the feeling on dullness in nerves. The muscles send the message to the brain, which secretes endorphins. Morphine is also used to produce these chemicals, which are being produced in acupuncture without any medication. Acupuncture is now used to treat many different acute pains including a headache, low back pain, menstrual cramps and many more diseases. Acupuncture is a part of many pain management programs as well.

Therapeutic Touch and Reiki Healing

Therapeutic Touch is a pain treatment method when the therapist puts the hand on the patient’s body with pain thinking to heal the pain. It is being thought that the human body is an open source of energy and by putting the hand on the human body, the therapist is consciously directing energy from an individual’s body by being in contact with the energy fields. This process helps to balance the energies in the human body, which can be a reason to pain.

Reiki Healing, on the other hand, works to decrease pain by spiritual, vibration healing to balance the human body energies. There is no injection of any substance in the human body, but it is thought to work on the surrounding of the human body which has a subtle vibrational field.

Massage Therapy

Massage therapy is said to be the most effective amongst the treatments of pain. The therapy works by giving pressure to some important pressure points of the body which have nerves surrounded by them and can be effective while in pain. The pressure points are soft body tissues to enhance the health of the patient. This therapy results in being a peaceful way of healing pain and is very effective among patients. Massage is used to help patients get out of stress and feel relaxed other than just being tied with physical pressure points where the pain is situated. There are special relaxation styles, which differ according to the pain and the pressure on your mind. These methods improve the patients’ sleep, help them get rid of stress, open their energy systems, enhance their sense of well-being and take them to a trip to a peaceful world.

SPINAL CORD STIMULATION AND PAIN MANAGEMENT

Spinal cord stimulation is a major source of pain reduction for many patients suffering from chronic pain. Not many patients qualify to go through spinal cord stimulation as the treatment is not feasible for everybody, but those who did qualify recorded that 60 to 80% of the pain was demolished after the spinal cord stimulation procedure. Many others said that their medicine intake for pain has decreased to a significant amount after going through the procedure. Due to these many benefits, spinal cord stimulation has been given much consideration by researchers and specialists.

Spinal cord stimulation is known to provide an electric current to the body part where the patient experiences chronic pain. The electric current stops and blocks the signals which were being transferred to the brain previously and thus, the brain does not send back the messages of pain.

In spinal cord stimulation, wires are placed electrically through a needle on the back of the spinal cord. A small generator is then placed above the wires which pass an electrical current through the wires to the spinal cord. The generator can be controlled entirely by anyone, can be turned on or off and can be changed to whatever intensity selected by the specialists. After programming, even patients can control the amount of current they receive or wish to receive.  The treatment of pain varies from person to person after the procedure and therefore, the generator has to be controlled according to the need and pain intensity of the patient.

This is to be noted that the pain is not permanently removed from the body, but the signals are stopped from being sent to the brain. Therefore, the usage of this procedure limits to only those conditions where the surgeries and medicines have failed and the patient is in extreme pain due to the failures. Some other situations where there is a burning pain caused by the body or nerves, specialists can allow having spinal cord stimulation. Due to complexity, not everyone is allowed to go through the procedure.

DOES PHARMACOGENETIC TESTING IMPROVE THE TREATMENT OF PAIN?

Pharmacogenetic treatment is a new method of treating diseases by providing personalized medications to the patient. This new approach has taken a buzz in the medical industry with many medical researchers working on this testing method. Pharmacogenetics is the study of inheriting genetic differences from the patient to the drug utilization. Pharmacogenetics testing is the method of screening genes and their drug predictability to enhance the patient’s experience further. The testing leads to a more personalized experience being provided to the patients as the medication and treatment have been done while taking care of your genetics. This also means that the adverse effects of medicine on your body can be known prior and thus can be stopped. Doctors only provide the medication, which is in contrast with your gene and the variant.

Pharmacogenetic testing has recently been introduced to the world of pain management and has shown some good results regarding pain treatment and management of emotional content in patients with chronic pain. The concept is to provide the right medicine to the right patient by knowing their characteristics of body and genes. Pharmacogenetic testing has shown wonders in oncology, cardiology, and psychiatry. The success of these trials in the above fields led pain specialists to try their luck on pharmacogenetic testing as well. Being in the initial phase of research, the guidelines are quite small, but the testing has still led a way forward for patients and pain management specialists.

Pain management is complex, as chronic pain stays with the individual for long and has an effect on their state of mind as well. Using pharmacogenetic testing to pain management gives the specialist an edge to reduce the trial and error phase. The testing helps us to know whether the genes of the particular body will react to a particular human body or not. This also improves the utility and efficacy of both current and future pain.

This method of providing personalized medication to each individual can increase the likelihood of getting rid of pain quickly, as there is no time wasted in a trial and error phase. The probability of adverse effects of a drug on the human body is demolished, and the clinical procedure is improved, and decision making is made easier for doctors and less timely for the patients.

Discussing the advantages of pharmacogenetic testing and treatment, the future of pain management seems to get simpler and efficient for specialists and the patients though only time can tell whether better treatment will be achieved by pharmacogenetic treatment or will it be a failure in the field of pain management.

HORMONES AND PAINCARE

We discussed how hormone testing could improve the efficiency of pain treatment and can be worth the research. Hormones are related to pain other than just by pharmacogenetic testing. Hormones can result in a disease in the human body, which is causing pain, hormones can because of pain by the abnormalities. Hormones are also related to pain by the intensity of pain in different people, their gender, and genes.

Hormonal imbalance can cause pain in the human body, but mostly doctors miss out the real cause of pain being the hormonal imbalance and don’t treat it in a particular way. This leads to long-term pain and no treatment working on the pain. Starting from the first hormone, which causes feelings of pain, is thyroid. This is a hormone produced by the thyroid gland near the throat. This gland has functions to control heart, lungs, muscle and nerves. The imbalance in this gland can be a cause of pain being posed in the human body.

Next, testosterone is a hormone which is produced in both men and women, and in many different areas of the body. The increasing use of opioids by pain patients as medicines does see much imbalance in testosterone hormone.

Estrogen is a hormone which is used while reproducing. Though everyone knows this fact, not many know that estrogen also has an effect on cancer, strokes, and pain. When estrogen levels fall, they make progesterone and testosterone fall with them. When estrogen is increased artificially by giving a dose, the patient experiences spinal pain in the body. Hormone changes with estrogen also lead to sleep deprivation and further to pain in different parts of the body.

Serum levels of pituitary, adrenal, and gonadal hormones are considered to be the producers of pain in the body. It is essential that specialists determine the imbalance in serum hormone levels as it can be a reason for the presence of pain, can help in further treatment, and identify which hormone is the cause of the issue and how it should be handled.

Other hormonal imbalances include that of Vitamin D, which causes inflammation and pain; the Cortisol level gets low when being in contact with the pain.

If a patient is undergoing medication and therapy treatments for chronic pain since long and has not seen any results whatsoever, checking the hormones and getting a test done for an imbalance will be a great option to open more gates for treatment.

There is a vice versa relation between hormone and pain. Some hormones are the reason for pain while some pain relief medications can be a source of low hormones being secreted.

Hormones also have an effect on how you consider pain and the level of tolerance you have for pain. Women can experience and handle more pain due to the hormone estrogen in them. They can get out of the pain sensation quickly and won’t let pain control their lives. Hormones in animals are more tolerated to pain while that in the human body.

PAIN MANAGEMENT IN LABOR

Labor pain is considered to be the most extreme pain among all other pain types. Active labor ranges from about two to eight hours and contractions can be longer, stronger and closer when the cervix dilates to 7 centimeters. This is the most a woman can experience, and the pain is given pain relievers and medications to control the pain. It is said that labor pain is the most painful condition which anyone ever has to experience, and yet we do not see much medications or treatments being provided before the labor. Depending on different labor situations, different treatments are available to the mother. During the whole pregnancy, the progress is being noticed, and this is decided on which medication and treatment would women need during active labor pain.

There are a wide variety of methods to minimize the pain during labor which is being used by nurses on the patients. Nurses try to minimize the use of medications as it can hurt the baby as it enters the bloodstream of the baby as well. The other method to reduce the intensity of pain among mothers is famous and can be useful to a certain amount. The most used method for pain management during labor pain is to provide relaxation. One simply needs to lessen up the fear caused by the thought of labor pain and baby’s condition which will in adverse increase the sensation of a pain than it normally is. Talk to the mom about her plans for the baby and how everything will be okay if she relaxes. Breathing is the next best thing to being advised to the mom when in labor pain. Deep inhale and exhale can minimize the sensation of pain and contractions. Move her around the room and provide her with warm water to further decrease the pain sensations.

The three top medications to avoid the labor pain and treat them are giving local anesthesia, general anesthesia or regional anesthesia. Local anesthesia is given to numb the area during delivery. Regional anesthesia, known as epidural or spinal anesthesia, is provided by anesthesiologist which reduces the pain during labor. This sort of anesthesia will block the back parts, so the parts go numb but the patients stay up to experience the moment of birth of her baby. General anesthesia is like the standard anesthesia given during any other surgery which makes you sleep. This anesthesia is not given in normal conditions as this does not allow the mother to see the baby right after the birth and no one would want to leave that moment. Anesthesia will start its effect in 10 to 20 minutes and will have no adverse effect on the patient or the baby. When giving a regional anesthesia, the mother will ask you a bunch of questions as she is worried about the baby and her most beautiful moment and thus you should be ready with all your answers. The standard anesthesia lasts around 2.5 hours, but if the labor is getting long, the medications can provide alongside which will maximize the effect of anesthesia as much as it can. In some women, the epidural and spinal anesthesia will slow the process of labor and will increase the time as well.

Other pains relieving medications are also given to the labor pain which is injected into a vein or muscle. This allows the pain to lessen while no medication can get rid of the pain. Women who cannot or do not want to have regional anesthesia can be provided with opioids as Demerol and Stadol delivered via IV. These opioids are the not the best option as they will make the patient drowsy and will enter the blood stream of the baby.

RELATION OF PAIN AND DEPRESSION

Chronic pain lasts for as long as a year to forever and this results in an adverse effect on the life of the patient. The relation between pain and depression is interchangeable. Pain can cause depression and depression in turn can cause more pain to the human body. Being interchangeable, both will create a cycle where pain will create depression while further the same depression will increase the sensation and feelings of pain even more.

According to the American Pain Foundation, around 32 million people in the US report that they had pain which lasted longer than a year and had caused them feelings of distress while affecting their lives. Moreover, 65% of people who were in depression said they experience pain in different parts of the body.

Long due pain gets the patient to get rude about his condition, will feel sad, angry and in stress. All these feelings combined will have him depressed about his situation and condition. Many patients have to stop their activities due to some pain they experience. Their whole life changes due to some pain related problems. If a footballer gets into an accident or injury due to which he has back pain, he cannot play anymore. This will come as a disaster to his life. Similarly, if a teacher gets into chronic throat pain, she cannot teach anymore and has to find a different way of living other than her passion. These situations led them to think adverse of their circumstances and enter into a state of depression. The lack of activities in their lives and bad situations of their career will have them think of pain as the end of life. Pain also affects the sleep patterns and lifestyle and decreases the number of activities in individual’s life and lack of energy. All this again gets the patient into the depressing state.

HOW TO HANDLE DEPRESSION AND THE PAIN CYCLE?

Depression and suffering combined will have a severe impact on a patient’s life if not treated properly. Because there is a connection between depression and suffering, the treatment for both of them intersects. The medications used for pain can get the pain to reduce, which will again help you get out of the depression.

Therapies are the most used way to handle pain when an individual is in pain and depression. All the treatments we discussed above used to use psychology and psychotherapy to enhance the condition of the patient and help the patient agree with him the situation of pain. The therapies involve the same cognitive behavior therapy, which will help patient talk out the problems, gives anti-depressants and work on the neurotransmitters in the body.

Many people avoid exercising during chronic pain and not exercising will get you out of shape and will worsen the pain situation. Plus, the depression can be best fought by engaging in activities which secrete positive hormones in the body. It is important that people with chronic pain take control of their situations as this is the only way they can be confident about their treatment and the treatment will work. If they will stay in a state of denial and not accept their situation as in the case of depression and do not believe in the therapy they are going through; there is no way that the depression will go, and the chronic pain will be able to be treated by any medication, doctor or specialist.

For proper treatment of chronic pain, depression has to leave and therefore, studying depression and helping the patient get out of it is as important as learning about other pain management solutions or treatments.

ANALYZING PAIN MANAGEMENT TECHNIQUES

Pain management is a large study in itself as all the diseases, or health related problems are somehow connected with the sensation of pain. More and more researchers and medical specialists are working to bring out effective methods to pain management. With a variety of diseases, body parts, types and intensity there are a variety of methods for pain management, which are being researched, tested and used.

The effectiveness of different pain management techniques is dependent upon the hormones or genes of different people. Each patient you work with has a unique genetic code, a single body, and unique brain. As the pain is associated with all three states being genes, physical body, and mind, therefore the effectiveness of one drug, therapy method or other techniques cannot be similar.

Various ways we discussed above were all pain-relieving methods, which have been effective in some individuals while not in another person. This is mainly due to the differences in patients’ intensity of pain; the situation the person is in when he experiences the pain and his mental condition. Though medications depend on the genes of the patient, the analysis of therapies depends on the situations and emotional content of the patient.

Many studies have tried to collect information on which psychological treatment is best for which situation, type of disease or injury. Though the probabilities are high, no one can make a perfect set of pain management techniques being in line with complete chronic pain and trial and error is always the only option. Pharmacogenetic testing is one step forward to get rid of the trial and error and make personalized medicine, though the study is its early phases and is expensive for masses. It is to see whether can researchers and medical examiners can work on some methods and techniques to present a personalized therapy option to patients which can be fast, efficient and doesn’t require trial and error approach.

PAIN MANAGEMENT CENTER AND PAIN MANAGEMENT SPECIALISTS

Recent developments in the concept of pain and pain management have led to the development of pain management centers in many localities and are mostly part of hospitals. Pain management centers are the hub of all the pain related activities, and they fulfill two major aspects. Firstly, pain management centers combine all the patients together and work on their well-being in one environment so they can learn and interact with people around them suffering from different types of pain and stay under the supervision of their doctors and nurses. As mentioned above, pain management does not always include providing medication or injection which will banish the pain in an hour or so. Pain management centers have all the therapies under one roof for everyone fighting from one type of pain or other. These centers also have massage parlors which are trained in working on pain management, and other techniques used for managing the pain of an individual. These centers work on the patients with issues of long-standing pain. Secondly, pain management centers work on the researchers and patients more to bring new medications, new therapies and other techniques for the recovery of pain in patients. The centers have research projects and clinical going on which are focused on all the patients they have in the center and using them to create more valuable and easy ways of pain management learning from different types of pain. The primary reason for the development of these centers is to help the patients get rid of their pain and improve the quality of life of patients.

Normally, pain management centers have pain management specialists including doctors, nurses, psychologists and psychotherapists working on and with their patients to improve the condition of the individual. There are specialized training for being a pain specialist. Pain specialists decide on what’s the core cause of the pain is and what should be the treatment for the pain. The treatment can range from short-term medications to long-term therapies or psychological therapies. Specialists in psychology, psychotherapy, and behavioral science can also be part of the pain management process as forwarded by the pain management specialist.

The trend for pain management centers is increasing and so is the degree of pain management specialists. Many pain management centers focus on a particular part of the body while others concentrate on all types of pain.

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