Pain Causes and Treatments

Pain Causes and Treatments

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Pain is an emotionally discomforting sensation described as aching, soreness, tenderness, and stabbing, boring, constricting, burning and agonizing pain. This is one of the most common symptoms a patient complains of. Two out of three patients seek relief from pain.

Pain is a peculiar phenomenon in the sense that the degree of pain may have no relation to the underlying disease condition if any. It is a subjective feeling by a patient.

The causes of pain are many. The complexity of pain is manifested as a function of the higher centres in the brain.

Is a result of injury to tissue, and causes a stimulation of nerve endings carrying the pain sensation. These may be localized in the skin or in internal organs. The pain felt from a skin stimulus is called somatic pain and is generally localized to that specific area.

Is called visceral pain and may be felt in a skin area away from the site of pain i.e. radiating or referred pain.

Pain is not an event in any part of the body that is hurt nor in the nerves that conduct impulses from that part, but in an area of the brain where the impulse is translated into conscious feeling. The use of pain is in the nature of a warning. It can prevent further injury by discouraging the activity that has aroused it. Not all tissue injury gives rise to pain. Pain arises from pressure, painful stimuli, and loss of blood supply to a part. The skin and lining of organs are sensitive to pain, but bones, solid organs like liver, spleen and brain have no sensation of pain. So the degree of pain gives no indication of the extent of injury.

Whatever is the cause of pain a person seeks relief from it and this relief maybe temporary or permanent. Analgesics and pain relieving drugs will give immediate temporary relief by blocking the pain pathways to the brain, but permanent relief will only occur when the underlying cause has been removed.

- Burns, cuts, hot and cold temperature, skin lesions like dermatitis, hoils etc.

- Headache in sinusitis, meningitis, fevers, cerebrovascular accidents, hypertension,toothache, cerebral oedema, head injury etc.- Lymph, nodes enlarged on the side of the neck, tonsillitis, laryngitis, cervical spondylitis.

- Angina, heart attack or myocardial infarction, heart and lung conditions, pleurisy, pericarditis, chest wall conditions, cervical spondylosis.

- Inflammation of the gall bladder, kidney, ureter, bladder, spine, diarrhoea, dysentery, appendicitis, dysmenorrhoea.

-Malignancies i.e. cancer, chronic debilitating conditions.

Pain relievers and antipyretics or fever lowering agents:

• Aspirin is the most commonly used drug for relief of pain. Originally aspirin was used to lower fevers. It is chemically a salicylate. It has a bitter glycoside called salicin which was first discovered for its fever lowering properties by Leroux in 1827. Six years later salicin was discovered in oil of wintergreen. It was manufactured synthetically from phenol by Kolbe and Lautemann in 1860. As aspirin—acetyl salycylic acid—it only came into being in 1899 when Dresser introduced it and it completely replaced salicin available from natural sources.

Aspirin alleviates certain types of pain. It also has an anti inflammatory action. So most pain due to infections and inflammation, e.g. post injury, will be relieved by it. It will relieve a headache due to cold or sinusitis but may not relieve a headache due to hypertension. It has been valuable for its non-specific relief in headache, arthritis, dysmenorrhoea, neuralgia, malaria and other such conditions. It is commonly used for relief of colds and other minor respiratory infections. But though it makes the patient more comfortable by relieving the fever and pain, it does nothing to change the course of disease.

At times the patient becoming ambulatory i.e. able to move without discomfort, may actually do more harm than good. The use of aspirin in gargles has no value.

The pain of gout gets relief with aspirin as it helps in uric acid excretion from the kidneys—thus acting on the cause of the condition. However newer and better drugs have now come into use—especially for chronic cases.

Rheumatic fever and joint pains have been treated for decades with salicylates or aspirin. Within 24-48 hours after adequate dosage, the swelling, pain and immobility, local heat and redness disappears. Because of its fever lowering action the fever also comes down. So aspirin suppresses the acute inflammatory process of the disease but does not affect the progression of the disease or the later phases of inflammation and scar formation. Hence improvement must not be mistaken for control of disease.

Indiscriminate and prolonged use of aspirin can give rise to toxic reactions like:

2. Certain factors in the clotting mechanism of the blood can be adversely affected, causing bleeding disorders.

3. Gastric acidity—bleeding from gastric mucosa because of exfoliation of mucosal cells. Sometimes the bleeding cannot be seen e.g. occult bleeding in stools.

Investigations done by doctors have shown that 3 gms of aspirin per day, for three to six days results in an average faecal blood loss of 5ml per day. In those cases where patients chronically take aspirin seventy per cent will show occult blood loss.

4. The central nervous system gets affected when toxic amounts are taken. Confusion, dizziness, vomiting, high tone deafness, delirium, psychosis, stupor and coma may occur.

NOTE: Children with fever and dehydration are particularly prone to intoxication with aspirin, hence children should not be given aspirin except under medical supervision, if at all. Children between the ages of five and eighteen years may get an acute metabolic encephalopathy associated with a lowering of blood sugar, and liver cell damage when given aspirin in certain viral fevers/infection. Since one does not know the cause of fever without investigating it, it is safer not to give aspirin to children.

First used in medicine by Von Mering in 1893.

The effects and uses of paracetamol are similar to aspirin but with fewer side effects. Its primary effect is to lower fever and next, to relieve pain of moderate intensity, such as that associated with conditions like headache, dysmenorrhoea, muscle, joint and peripheral nerve affections. Intense pain or that arising from hollow organs is not relieved.

1. Toxic ingestion can cause methaemoglobinemia i.e. a condition affecting the haemoglobin in the blood. The substance which carries oxygen can form another compound with paracetamol and not combine with oxygen. So there is less oxygen going to your tissues and a state of oxygen starvation occurs, metabolites accumulate and cyanosis occurs. Because of this effect subsequent damage to other tissues and organs occurs, which maybe the heart, liver or kidneys.

NOTE: Most off-the-counter drugs available have a combination prescription of two or more drugs and since the side effects are similar a double dosage is taken. Sometimes the combinations are mismatched. So do not take these drugs indiscriminately. Take one or two doses of a single drug preparation and if your pain or fever does not improve, see your doctor.

These drugs or drug combinations are available in a greasy base which is applied locally over the painful, unabraided area to cause a local reaction which stimulates the nerve endings to produce a counter irritant effect to the original cause of pain.

There is localized increase in blood supply to the area, which gives a feeling of warmth and comfort. This is called rubefacient action.

When the pain arises from an internal organ, sensory pain impulses simultaneously coming from the skin as a result of the action of the irritant, either alter the original pain sensation from the internal organ, or occupy the same pathway and block those impulses totally. Commonly available off the counter drugs in this group are balms and oitments.

The most commonly used rubefacient for pain is heat. Heat is often applied by means of a hot water bottle or heating pad, moist hot pack, or heat lamp.

Shortwave diathermy is the most effective way of giving this heat. The latest techniques in use are:

• TENS (Trans Electronic Neural Stimulation.) This is not done at home.

• Sprays—locally acting drugs in sprays which relieve pain.

• Acupuncture—done by a trained acupuncturist.

Tags: Analgesics, Internal Pain, Paracetamol-Acetaminophen, Paracetamol-Acetaminophen Side Effects, Physical Pain, Side Effects of Aspirin

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