Pain and how to manage it
Pain management, pain medicine, pain control or algiatry, is a branch of
medicine employing an interdisciplinary approach for easing the suffering and
improving the quality of life of those living with chronic pain. The typical
pain management team includes medical practitioners, pharmacists, clinical
psychologists, physiotherapists, occupational therapists, physician assistants,
nurse practitioners, and clinical nurse specialists. The team may also include
other mental health specialists and massage therapists. Pain sometimes resolves
promptly once the underlying trauma or pathology has healed, and is treated by
one practitioner, with drugs such as analgesics and (occasionally) anxiolytics.
Effective management of chronic (long-term) pain, however, frequently requires
the coordinated efforts of the management team.
Medicine treats injury and pathology to support and speed healing; and
treats distressing symptoms such as pain to relieve suffering during treatment
and healing. When a painful injury or pathology is resistant to treatment and
persists, when pain persists after the injury or pathology has healed, and when
medical science cannot identify the cause of pain, the task of medicine is to
relieve suffering. Treatment approaches to chronic pain include pharmacological
measures, such as analgesics, antidepressants and anticonvulsants,
interventional procedures, physical therapy, physical exercise, application of
ice and/or heat, and psychological measures, such as biofeedback and cognitive
behavioral therapy.
According to the National Institutes of Health, studies have shown that
properly managed medical use of opioid analgesic compounds (taken exactly as
prescribed) is safe, can manage pain effectively, and rarely causes addiction.
Opioid medications can provide short, intermediate or long acting
analgesia depending upon the specific properties of the medication and whether
it is formulated as an extended release drug. Opioid medications may be
administered orally, by injection, via nasal mucosa or oral mucosa, rectally,
transdermally, intravenously, epidurally and intrathecally. In chronic pain
conditions that are opioid responsive a combination of a long-acting
(OxyContin, MS Contin, Opana ER, Exalgo and Methadone) or extended release
medication is often prescribed in conjunction with a shorter-acting medication
(oxycodone, morphine or hydromorphone) for breakthrough pain, or exacerbations.
Most opioid treatment used by patients outside of healthcare settings is
oral (tablet, capsule or liquid), but suppositories and skin patches can be
prescribed. An opioid injection is rarely needed for patients with chronic
pain.
Although opioids are strong analgesics, they do not provide complete
analgesia regardless of whether the pain is acute or chronic in origin. Opioids
are efficacious analgesics in chronic malignant pain and modestly effective in
nonmalignant pain management. However, there are associated adverse effects,
especially during the commencement or change in dose. When opioids are used for
prolonged periods drug tolerance, chemical dependency, diversion and addiction
may occur. Hence clinical guidelines for prescribing opioids for chronic pain
have been issued by the Medical authorities.
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