Free of aches

Good pain management starts with knowing the kind of pain you are suffering from

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Pain is the most common reason for individuals to seek consultation. Pain itself is not a disease or problem. It is our body's call for attention to an injury or malfunction. However, not all pain is same; the kind of pain you feel depends on various factors.

The long and short of it

Acute pain

When pain lasts for a short duration it is called acute pain. Usually, it is associated with tissue damage, infection and/or inflammation. Acute pain is protective in nature. It may be mild and last just a moment, or severe and last for weeks or months. In most cases, acute pain does not last longer than six months and it disappears when the underlying cause has been treated.

Chronic pain

When pain persists beyond weeks, months, or years—beyond the time required for the body to heal—it becomes chronic. Such pain may have initially begun as a result of some injury, infection or some unresolved, ongoing problem in the body. Sometimes, it even exists without any proper cause.

Having endured for long, it no longer remains protective and is beyond getting curing by the help of simple measures. Such pain leads to limited mobility, changes in appetite, depression, anger, anxiety and low energy levels and hampers a person's daily life.

What's behind it?

Most pains people suffer from are of the musculoskeletal system that comprises the muscles, joints, tendons, ligaments and nerves. Hips, wrist, knees, back and other joints are most commonly affected. Let's understand the common conditions associated with pain:

Traumatic pain

Pain that is a result of any kind of injury—from accidental falls and sports mishaps, to sprains, strains and assault—is termed as traumatic pain. Such pain is an instant reaction of our body to an injury to urge us to dissociate from the source of pain.

Following an injury, the body goes into a defensive mode and depending on its severity, shows certain typical reactions like swelling due to collection of blood, or grating, crackling or popping sounds and sensations that indicate fracture of underlying bone.

The immediate recourse during such times is PRICE—Prevention of further trauma by separating and supporting the injured part; Rest; Immobilisation by external support, Cold fomentation, which helps soothe the pain and limit swelling; and Elevation above heart level to avoid collection of serious fluids.

Pain because of sedentary work

Another growing cause of pain is sedentary professional work. Usually, those in such jobs suffer from back pain, neck pain, wrist and shoulder pain.

Back pain: The causes of back pain can be complex—from prolonged abnormal sitting posture to muscle strains and stiffness. When the pain is due to prolapsed intervertebral disc or a slipped disc, lower back pain and pain radiating down the leg are common symptoms.

Knee and joint pain: Sedentary habits, obesity, growing life expectancy, ageing, injury and diseases of the joint like arthritis are some of the common causes of joint pain. Such pain can seriously limit mobility and may sometimes call for surgery and replacement of the affected joint.

Neck and shoulder pain: From exertion, pinched nerves, bad posture to joint and muscle—causes of neck and shoulder pain can be varied.

Wrist and elbow pain: Pain in these regions can result from any number of reasons including injury or sprains. But the commonest cause of pain in these parts of the body are compression of the nerve [carpel tunnel syndrome] and tendon [De Quervein disease] both of these, caused due to prolonged work involving the wrist.

Other pains

Conditions like frozen shoulder, problems of the tendon, and nerves also cause pain. Neurogenic pain originates in the nerves or nervous tissue. It is often a result of compression or irritation of the nerve. Sciatic pain is another type of pain, which is experienced in the leg and thigh and occurs due to compression of the sciatic nerve. It worsens when stretching, walking or bending forward.

When pain is associated with fever, swelling, local redness, nausea, vomiting, sudden worsening of the chronic pain, appearance of new symptoms, weakness in any body part it is serious; seek immediate medical attention.

There is also an emotional aspect to physical pain—depression, anxiety, and other emotional problems can instigate pain or make existing pain worse.

Managing the agony

Most of the pain related to work is benign and requires lifestyle changes, physical therapy, posture correction, counselling, stress relief and short-term drug treatment to treat. Other pain relief measures involve:

  • Physiotherapy: It employs methods [massage, exercises and assistive devices] to stretch and strengthen muscles and improve mobility.
  • Cold/warm fomentation: This involves applying cold and/or hot compresses to increase circulation, decrease swelling and ease pain. It is usually used in fresh injuries.
  • Electrical stimulation: Transcutaneus electrical nerve stimulation [TENS] involves sending a low-voltage electrical current through the skin via electrodes placed near the injured tissue. This stimulates the nerves and interferes with the brains normal pain perception.
  • Ultrasound therapy: Ultrasound deep heating treatment is used to heal aches in the deep joint tissues.
  • Massage therapy: Therapeutic massage relieves pain in the soft tissues. It is particularly beneficial for pain associated with diabetes, chronic pain syndrome, depression and fibromyalgia.
  • Sexual intimacy: The soothing sensation of skin-to-skin contact over and above intercourse relaxes the mind and reduces perception of pain.
  • Immobilisation: Using devices that restrict mobility such as braces or splints eases pain in specific conditions.
  • Cognitive-Behavioral Therapy [CBT]: It is used to help deal with the emotional component of pain. The therapy uses relaxation and stress management techniques like meditation and music.
  • Drug treatment: This involves prescribing non-steroidal anti-inflammatory drugs; opiods; adjuvant analgesics; local anaesthetics, steroids, muscle relaxants, topical counter irritant creams; and biophosphonates and calcitonin drugs. Nerve block, trigger point injection, patient control analgesia are newer techniques for stubborn pain.

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Rajeev Sharma
Rajeev K Sharma is senior consultant orthopaedics & joint replacement surgeon at the Indraprastha Apollo Hospital, New Delhi. Has was associated with All India Institute of Medical Sciences, New Delhi, as senior faculty from 1992-1998. He has to his credit over 2000 total joint replacement surgeries.

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