Pain

Pain is a broad symptom that can manifest differently in every person. It can be isolated in a single area or spread throughout the whole body, and it is often categorized as either acute or chronic. Acute pain typically refers to a mild to sharp pain that can last from a few seconds up to a few months. Chronic pain typically refers to persistent pain that lasts from a few weeks to years.

There are four widely accepted types of pain: 

  1. Functional Pain: Pain that doesn’t come from an obvious origin such as IBS (irritable bowel syndrome) or fibromyalgia. 

  2. Neuropathic Pain: Pain that comes from nerve damage or irritation such as neuralgia or neuropathy. This pain can also come from damage to or dysfunction of the brain or spinal cord or other nerves. 

    1. Pressure on a nerve: This can come from a ruptured or bulging disk in the spine that subsequently causes back pain that then radiates to the leg. 

    2. Nerve damage: This occurs often in people who have type 2 diabetes or the pain one experiences after shingles.

  3. Nociceptive Pain: Pain that comes from tissue damage or injury such as back pain, pain following a surgical procedure, or arthritis. This is also called acute pain.

  4. Inflammatory Pain: Pain caused by inflammation such as rheumatoid arthritis or gout. This pain is often a response from your body’s immune system.

People Affected

Pain is one of the most common reasons that people go to the doctor. Generally speaking, pain symptoms are more common as the human body ages. 

Chronic pain is the most common cause of long-term disability in the United States. It can affect almost anyone but occurs more in females and those who are injured, have a chronic condition, or are obese. Chronic pain usually lasts longer than 12 weeks.

Risk Factors

Pain can affect a wide range of ages and people but is more common as we get older. Three major categories of risk factors have been identified for chronic pain: 

  • Lifestyle risk factors: For example, people who do heavy lifting as part of their job or an athlete who experiences strenuous physical activity. 

  • Biological risk factors: These may be related to your medical history or conditions and also your physical characteristics.

  • Psychological risk factors: This is your risk for chronic pain depending on your mood or personality. 

To break it down even further, there are several other risk factors besides age that can put you at risk for chronic pain including: 

  • Being overweight or obese

  • Having a surgical procedure

  • Having an injury

  • Being female 

  • Being a smoker

  • People with chronic stress or PTSD (post-traumatic stress disorder)

Signs & Symptoms

As mentioned above, symptoms and intensity of pain can vary from person to person. Common symptoms of chronic pain include fatigue, insomnia, anxiety, pain that is persistent, and pain that presents in the back and joints.

Pharmacist Tip

Start with the lowest effective dose of pain treatment and then only increase as needed. For example, if the directions say, “Take 1 to 2 tablets by mouth every 6 hours,” then start with just one tablet. This way, you will get adequate pain relief with the least amount of adverse effects.

Anti-inflammatory pain medications such as NSAIDs are not addictive. That being said, they can increase your risk of stroke and heart attack or lead to heart failure, and they can cause complications if you have heart, blood pressure, kidney conditions, or certain stomach conditions. Make sure to check with your doctor before taking them, even if they are over-the-counter. NSAIDs should be taken with food to help protect your stomach from the long-term use risk of nausea, stomach bleeding, and ulcers. For patients with significant stomach issues, there is also a topical anti-inflammatory gel option (such as Voltaren 1% topical gel) that is available both as prescription and over-the-counter. 

For prescription ibuprofen, the max amount you should take per day is 3200mg (1200mg if it’s over-the-counter). For prescription Naproxen Base, the max amount you can take is 1250mg per day (660mg per day if it’s over-the-counter). For acetaminophen, the max amount you can take per day is 3000mg. 

Lastly, nerve pain medications can cause drowsiness. Try your first dose in the evening to see if this is bothersome before taking it in the day time or while at work. Be careful when operating heavy machinery and driving. 

Medical Experts

Because pain is such a wide category with different presentations, causes, and symptoms, there are many specialists who can treat pain: 

  • Primary Care Physician: Your general doctor can diagnose and treat your pain. 

  • Pain Medicine Specialists: These doctors specialize in pain caused by surgery, injury, conditions like diabetes, or most commonly, nerve damage. Pain specialists also see patients who have pain that doesn’t have a clear cause. 

  • Osteopathic Doctors (DOs): Similar to MDs (medical doctors), DOs have extra training and education in the musculoskeletal system, which includes the bones, muscles, and nerves. 

  • Orthopedic Surgeons and Specialists: These doctors specialize in pain from your bones, joints, ligaments, tendons, and muscles. Some specialize in different areas of the body such as knees, hips, shoulders, etc. 

  • Rheumatologists: These docs treat rheumatic diseases. Rheumatic diseases include arthritis, osteoarthritis, tendinitis, gout, and rheumatoid arthritis. These usually cause swelling, pain, and stiffness of the bones, joints, and muscles. 

  • Acupuncturists and Chiropractors: Acupuncturists insert very small, thin needles into specific points of your body to heal knee pain, low back pain, neck pain, sciatica, sprains, osteoarthritis, and headaches. Chiropractors use manual adjustment techniques to adjust your spine and treat and diagnose neuromuscular problems. 

  • Physiatrists, Physical Therapists, and Occupational Therapists: Physiatrists diagnose and treat pain related to your bones, muscles, and nerves and often treat post-surgery pain. Carpal tunnel, sports and work injuries, herniated discs, arthritis, concussions, and pinched nerves are treated by Physiatrists and Rehabilitation Physicians. Heat, ice, exercise, stretching, and massage are often used to help ease pain and increase mobility by physical and occupational therapists. They usually work with people who need to recover from surgery or an injury.

Diagnosis

Depending on the location and type of pain you’re experiencing, your doctor may perform a number of different tests, including possible nerve testing imaging or blood work.

Common tests performed are: 

  • X-rays

  • MRIs

  • CT scans

  • Optometrist consult (usually for patients with chronic headache pain)

  • Blood work (to rule out rheumatic diseases such as lupus)

  • Neurological testing (to rule out multiple sclerosis)

Prescription Treatment

Prescription treatment can vary widely depending on diagnosis and condition. As pharmacists, we recommend making sure that when describing pain to your doctor you use the following categories: 

  • Severity Scale: How bad is it or how bad does it hurt from a scale from 1-10?

  • Provocation and Palliation: What makes your pain worse? What makes it better? And what are you doing when you feel the pain?

  • Timing: Does your pain change based on your position, the time of day, the weather, or activity?

  • Quantity/Quality: How often do you feel the pain? How does it feel—is it throbbing, nauseating, dull, sharp, etc? 

  • Location: If you can point it out, where is your pain exactly located? Is it pain that radiates or does it stay in one place? Does it always happen in the same place?

Based on your answers, your doctor can recommend the best over-the-counter, lifestyle, or prescription changes. 

Not all generics are the same. Different people respond better to different versions of the same drug, depending on the manufacturer. You can search our website to find the best fit for you.

Lifestyle Remedies

Pain can be addressed in a variety of ways that don’t require prescription treatment. Exercise, yoga, meditation, physical therapy, massage, and acupuncture can all potentially work as pain relievers. Spinal traction, a form of decompression therapy that relieves pressure on the spine, can be especially effective for neck and back pain. Transcutaneous electrical nerve stimulation (TENS) can also help with that type of pain. Small adhesive pads are attached to the skin, and electrodes pass on electrical signals that reduce the transmission of pain signals to the brain and spinal cord.

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