Pain: What it is, Diagnosis and treatment
Pain is the most common symptom of disease. It is an unpleasant sensation localized to a part of the body. It is often described in terms of a penetrating or tissue-destructive process (e.g., stabbing, burning, twisting, tearing, squeezing) and/or of a bodily or emotional reaction (e.g., terrifying, nauseating, sickening). Any pain of moderate or higher intensity is accompanied by anxiety and the urge to escape or terminate the feeling.
Self-report is the key to pain assessment. In non- or pre verbal children, facial expression is the most valid indicator of pain; therefore use faces pain scale to assess severity. Pain should be assessed by:
- Severity, e.g. does the patient wake up because of the pain site
- Character, e.g. stabbing, throbbing, crushing, cramp like
- Persistent or intermittent
- Relieving or aggravating factors
- Accompanying symptoms
- Distribution of pain
- In children pain can be assessed by child’s crying voice, posture, movement and color.
Treatment for Acute and Mild pain
Treatment for Severe Pain
Opioids are the most potent pain-relieving drugs currently available. They have the broadest range of efficacy, providing the most reliable and effective method for rapid pain relief.
Treatment for Chronic Non Cancer Pain
Chronic pain is a pain that persist for more than 4 weeks chronic pain can arise from:
- Tissue damage (nociceptive pain), e.g. arthritis, fibromyalgia’s, lower back pain, pleurisy, cancer pain etc
- Injury to nerves (neuropathic pain) e.g. post herpetic neuralgia (pain following shingles), trigeminal neuralgia, diabetic neuropathy, HIV related peripheral neuropathy, drug induced peripheral neuropathy or phantom limb
- Abnormal nerve activity following disease
Psychological evaluation and behaviorally based treatment paradigms are frequently helpful, particularly in the setting of a multidisciplinary pain-management center.
Chronic Cancer Pain
The long-term use of opioids is accepted for patients with pain due to malignant disease. Some degree of tolerance and physical dependence are likely with long-term use. Therefore, before embarking on opioid therapy, other options should be explored, and the limitations and risks of opioids should be explained to the patient