I have been practicing medicine for a lot of years. Lately, I see a lot of patients whose major symptom is “pain”. It seems that the answer to this, in our society today, is some type of “Narcotic” medication. It really doesn’t seem to matter what kind of pain it is, my patients want their “pain pills”. I would like to address the difference between acute pain and chronic pain. I would also like to address some treatments you can expect, at home and from your doctor, urgent care or emergency room.
First, I think we should define acute pain. Acute pain is pain that has happened recently, from an illness or a trauma. Trauma can and does include a surgical procedure. Examples of acute pain include pain from a broken leg, a heart attack, a car accident or appendicitis. This pain comes on relatively suddenly and is limited in the amount of time it will continue to bother you. Acute pain is usually treated with opioids and other measures. “Opioid” is doctor talk for what patients call narcotics.
Doctors may treat you with surgery. You may need your appendix removed or your bowel resected. You may need your leg or arm set or pinned and then casted. You will get multiple types of medications for heart attacks or other painful medical conditions like infections. Once the pain is better, the need for medication is less. Your opioids will be stopped. Your minimal pain that is left can be managed with acetaminophen or aspirin.
Chronic pain is pain from arthritis, endometriosis, cancer or some other chronic process. This usually comes on slowly. It gets worse over months or years. It may also have started as acute pain, but then have continued to hurt for a prolonged period of time. This pain should be treated by several different methods. If you have chronic pain, you may need to see several different doctors, have lots of testing, and possibly need surgery or injections.
Some of the treatment methods for chronic pain include, but are not limited to:
• Heat – some people find this helpful, especially to relax muscles that are spastic
• Ice – this is helpful for chronically inflamed muscles
• Physical therapy – therapists have a variety of treatments, from ultrasound to exercises to help with chronic musculoskeletal problems
• Acetaminophen – daily, and in combination with other medications. There is a limit above which liver damage may occur.
• Anti-inflammatory medications – these work in several different ways. May be used in combination with other medications. Upper limits, above which kidney damage may occur.
• Seizure Medications – work in the central nervous system to help with chronic pain. Some of these medications include Topamax (topiramate) and Neurontin (gabapentin)
• Local injections of steroids or numbing medications – especially good in certain joints and if there are specific nerve entrapments.
• Topical medications – There are topical numbing medications, topical anti-inflammatory creams and patches, over the counter and prescription menthol creams, capsaicin, and the list goes on. Whatever helps your pain get better for a while is something you can use.
• Compression garments – Some people by over the counter garments and some people have custom garments made.
• TENS units – This is a nerve stimulator that can be placed across the area for a given period of time during the day. It feels like the area has had a very deep massage.
• Exercise – there are many exercises that can strengthen specific muscles or help stretch or relax other muscles. I often recommend Yoga or Pilates to my patients to help with stress or tight muscles. It’s cheap and easy to do. Some of the stretches can even be done at your desk or computer to release that shoulder tension you have right now.
So, if your doctor recommends therapies other than “narcotics”, listen carefully. Many of these are much better for you and will help you control your pain. Besides, they are much less addictive. This is according to the government. Personally, I could get addicted to massage any time someone wants to do an experimental trial.
