Most of us may not know how to define pain, but we definitely know when we're in pain!

The English word 'pain' comes from Old French (peine), Latin (poena - meaning punishment pain), or Ancient Greek (poine - a word more related to penalty), or a combination of all three.

In medicine, pain relates to a sensation that hurts. If you feel pain it hurts, you feel discomfort, distress and perhaps agony, depending on the severity of it. Pain can be steady and constant, in which case it may be an ache. It might be a throbbing pain - a pulsating pain. The pain could have a pinching sensation, or a stabbing one.

Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting alcohol on a cut, and bumping the "funny bone." The International Association for the Study of Pain has a definition that is widely used: "Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage".

Pain motivates the individual to withdraw from damaging situations, to protect a damaged body part while it heals, and to avoid similar experiences in the future. Most pain resolves promptly once the painful stimulus is removed and the body has healed, but sometimes pain persists despite removal of the stimulus and apparent healing of the body; and sometimes pain arises in the absence of any detectable stimulus, damage or disease.

Pain is the most common reason for physician consultation in the United States. It is a major symptom in many medical conditions, and can significantly interfere with a person's quality of life and general functioning. Psychological factors such as social support, hypnotic suggestion, excitement, or distraction can significantly modulate pain's intensity or unpleasantness.

Only the person who is experiencing the pain can describe it properly. Pain is a very individual experience.

Types of Pain

Acute pain - this can be intense and short-lived, in which case we call it acute pain. Acute pain may be an indication of an injury. When the injury heals the pain usually goes away.

Chronic pain - this sensation lasts much longer than acute pain. Chronic pain can be mild or intense (severe).

How do we classify pain?

Pain can be nociceptive, non-nociveptive, somatic, visceral, neuropathic, or sympathetic.

Pain
Nociceptive		Non-Nociceptive
Somatic	Visceral	Neuropathic	Sympathetic

Nociceptive Pain - specific pain receptors are stimulated. These receptors sense temperature (hot/cold), vibration, stretch, and chemicals released from damaged cells.

Somatic Pain - a type of nociceptive pain. Pain felt on the skin, muscle, joints, bones and ligaments is called somatic pain. The term musculo-skeletal pain means somatic pain. The pain receptors are sensitive to temperature (hot/cold), vibration, and stretch (in the muscles). They are also sensitive to inflammation, as would happen if you cut yourself, sprain something that causes tissue damage. Pain as a result of lack of oxygen, as in ischemic muscle cramps, are a type of nociceptive pain. Somatic pain is generally sharp and well localized - if you touch it or move the affected area the pain will worsen.

Visceral Pain - a type of nociceptive pain. It is felt in the internal organs and main body cavities. The cavities are divided into the thorax (lungs and heart), abdomen (bowels, spleen, liver and kidneys), and the pelvis (ovaries, bladder, and the womb). The pain receptors - nociceptors - sense inflammation, stretch and ischemia (oxygen starvation).

Visceral pain is more difficult to localize than somatic pain. The sensation is more likely to be a vague deep ache. Colicky and cramping sensations are generally types of visceral pain. Visceral pain commonly refers to some type of back pain - pelvic pain generally refers to the lower back, abdominal pain to the mid-back, and thoracic pain to the upper back.
Nerve Pain or Neuropathic Pain - Nerve pain is also known as neuropathic pain. It is a type of non-nociceptive pain. It comes from within the nervous system itself. People often refer to it as pinched nerve, or trapped nerve. The pain can originate from the nerves between the tissues and the spinal cord (peripheral nervous system) and the nerves between the spinal cord and the brain (central nervous system, or CNS).

Neuropathic pain can be caused by nerve degeneration, as might be the case in a stroke, multiple-sclerosis, or oxygen starvation. It could be due to a trapped nerve, meaning there is pressure on the nerve. A torn or slipped disc will cause nerve inflammation, which will trigger neuropathic pain. Nerve infection, such as shingles, can also cause neuropathic pain.

Pain that comes from the nervous system is called non-nociceptive because there are no specific pain receptors. Nociceptive in this text means responding to pain. When a nerve is injured it becomes unstable and its signaling system becomes muddled and haphazard. The brain interprets these abnormal signals as pain. This randomness can also cause other sensations, such as numbness, pins and needles, tingling, and hypersensitivity to temperature, vibration and touch. The pain can sometimes be unpredictable because of this.

Sympathetic Pain - The sympathetic nervous system controls our blood flow to our skin and muscles, perspiration (sweating) by the skin, and how quickly the peripheral nervous system works.

Sympathetic pain occurs generally after a fracture or a soft tissue injury of the limbs. This pain is non-nociceptive - there are no specific pain receptors. As with neuropathic pain, the nerve is injured, becomes unstable and fires off random, chaotic, abnormal signals to the brain, which interprets them as pain.

Generally with this kind of pain the skin and the area around the injury become extremely sensitive. The pain often becomes so intense that the sufferer daren't use the affected arm or leg. Lack of limb use after a time can cause other problems, such as muscle wasting, osteoporosis, and stiffness in the joints.

Pain Management

Millions of people live with chronic pain, which can affect a particular body part like the hip, back, or neck, or be experienced as general all-over body pain. But whatever part of you hurts, you just want the pain to stop.

Pain Management (also called pain medicine or algiatry) is a branch of medicine employing an interdisciplinary approach for easing the suffering and improving the quality of life of those living with pain.

The typical pain management team includes medical practitioners, clinical psychologists, physiotherapists, occupational therapists, and nurse practitioners.

Pain sometimes resolves promptly once the underlying trauma or pathology has healed, and is treated by one practitioner, with drugs such as analgesics and (occasionally) anxiolytics. Effective management of long term pain, however, frequently requires the coordinated efforts of the management team.

Medicine treats injury and pathology to support and speed healing; and treats distressing symptoms such as pain to relieve suffering during treatment and healing.

When a painful injury or pathology is resistant to treatment and persists, when pain persists after the injury or pathology has healed, and when medical science cannot identify the cause of pain, the task of medicine is to relieve suffering.

Treatment approaches to long term pain include pharmacologic measures, such as analgesics, tricyclic antidepressants and anticonvulsants, interventional procedures, physical therapy, physical exercise, application of ice and/or heat, and psychological measures, such as biofeedback and cognitive behavioral therapy.

Because pain symptoms vary from person to person, the right pain treatment must be tailored to the individual. Fortunately, there are many drug-related and non-drug-related treatment options for pain management.

Drug Treatments for Pain

An underlying disorder, if treated effectively, will also get rid of the pain, or at least reduce it. If you have an infection and take antibiotics, the antibiotics may get rid of that infection, resulting also in the elimination of pain. Even if an underlying problem can be treated, you may still need analgesics (pain relievers).

Analgesics are good at relieving nociceptive pain, but not neuropathic pain. Chronic pain - long-lasting pain - may need other non-drug treatments as well.

Warning: Long term use or even short term use of many of the following pain-related drugs may cause damage to your liver and/or kidneys, so be careful.

Opioid Analgesics

Opioid analgesics are also known as narcotics. These are the strongest painkillers and are commonly used after surgery, for cancer, broken bones, burns, and various other situations. Even though opioids are not commonly used to treat non-cancer pain, their usage for non-cancer pain is becoming more widespread and acceptable. Some patients do not respond well to opioids and should not take them.

The patient will be given opioids in gradually increasing dosages. The ideal dose is reached when the pain is relieved and the side-effects are tolerable (increase any higher and the side effects become too much for the patient). Dosages should be generally much lower for older patients and infants.

The patient is administered opioids every few hours - each dose coinciding with the moment just before the pain starts becoming severe. Some patients are given higher dosages if the pain becomes more intense, while others are given other medications alongside the opioid. Pain can become more intense if the patient needs to move about, or if a wound dressing needs to be changed.

The dosage goes down if the pain intensity drops, until if possible, the doctor switches to a non-opioid analgesic.

People with kidney failure, liver problems, COPD (chronic obstructive pulmonary disease, dementia, tend to have more side effects when given opioids. The most common opioid side effects are drowsiness, constipation, nausea, vomiting, and itching. Generally, the side effects lessen as after time. Taking too much opioid can be dangerous. Patients who take opioids for long period become physically dependent and will have withdrawal symptoms when treatment is stopped - it is important that their dosage is tapered off gradually.

Nonopioid Analgesics

Nonopioid analgesics are used generally for mild to moderate pain. They are not addictive and their pain-relieving effects do not dwindle over time.

NSAIDs (nonsteroidal anti-inflammatory drugs)

These may be obtained either OTC (over-the-counter) or as a prescription medication, it depends on the dosage. Low dosage NSAIDs are effective for headaches, muscle aches, fever,  and minor pains. At a higher dose they help reduce joint inflammation. There are three main types of NSAIDs, and they all block prostaglandins - hormone-like substances that cause pain, inflammation, muscle cramps, and fever.

• Traditional NSAIDs - the largest subset of NSAIDs. As is the case with most drugs, they do carry a risk of side-effects, such as stomach upset and gastrointestinal bleeding. The risk of side effects is significantly higher if the patient is over 60. At higher doses, they should only be taken when monitored by a doctor.
• COX-2 inhibitors - these also reduce pain and inflammation. However, they are designed to have fewer stomach and gastrointestinal side-effects. In 2004/2005 Vioxx and Bextra were withdrawn from the market after major studies showed Vioxx carried increased cardiovascular risks, while Bextra triggered serious skin reactions. Some other COX-2 inhibitors are also being investigated for side-effects. The FDA told makers of NSAIDs to highlight warnings on their labels in a black box.
• Salicylates - these include aspirin which continues to be a popular medication for many doctors and patients. If your plan to take aspirin more than just occasionally you should consult your doctor. Long term high dosage usage of aspirin carries with it a significant risk of serious undesirable side effects, such as kidney problems and gastrointestinal bleeding. For effective control of arthritis  pain and inflammation frequent large doses are needed. Nonacetylated salicylate is designed to have fewer side effects than aspirin. Some doctors may prescribe nonacetylated salicylate if they feel aspirin is too risky for their patient. Nonacetylated salicylate does not have the chemical aspirin has which protects against cardiovascular disease. Some doctors prescribe low dose aspirin along with nonacetylated salicylate for patients who they feel need cardiovascular protection.

Non-Drug Treatments for Pain

There are many effective non-drug, natural ways to manage and reduce pain, i.e. herbs, detox, healing foods, physical therapy, chiropractic therapy, etc. But, these natural methods tend to take longer than conventional drug treatment to reduce and eliminate the pain.

When chronic pain sets in, most people immediately look in their medicine cabinet or rush to the drugstore. But medication  usually offers only temporary pain management relief — it's not going to stop the pain or cure what's causing it. Fortunately, there are many approaches available through pain management specialists who can provide you with better pain management strategies.

Pain Management Without Drugs

Acupuncture

One of the oldest pain management techniques is the Chinese practice of acupuncture. Acupuncture uses tiny needles, placed in specific points along the body, to help alleviate chronic pain. One large study of people with knee osteoarthritis found that acupuncture provided significant pain relief when medications couldn't. But the study did find that acupuncture must be used long-term for the maximum effect; most of the time, it took at least 14 weeks to appreciate the results.

Massage

When doesn't a massage feel good? Massage also offers therapeutic benefits for chronic pain management: From deep tissue massage to more gentle techniques, massage can help relax muscles and sore tissues and ease chronic pain. One recent study in the Annals of Internal Medicine found that the benefits of massage in easing lower back pain may last for six months or longer.

Physical Therapy

Physical therapy teaches you how to gently move and stretch your muscles and work your joints to strengthen them, which will help alleviate pain. Unlike medication, physical therapy can actually help treat the underlying source of your pain, whether it's arthritis or another condition, and will help chronic pain improve over time. Physical therapy may include water therapy, such as working muscles in a pool or whirlpool. Physical therapy also includes regular exercise, and working with pain specialists trained in physical therapy can teach you the right way to exercise to alleviate pain, not increase it. A January 2012 article in Annals of Internal Medicine found that doing home exercises taught by physical therapists was more helpful for neck pain than drugs.

Hot and Cold Therapy

Heat therapy boosts blood flow to areas of the body in pain due to inflammation, and allows muscles to relax. You can apply a heating pad or a heat wrap, or relax in a hot bath for pain management, which can soothe body and soul.

Cold therapy can also be useful in pain management. By slowing blood flow to a painful joint, swelling is reduced and nerves aren't able to quickly send messages of pain. Applying ice, a cold wrap, or a cold pack can ease a flaring, painful joint.

Exercise

Movement, whether it's walking or pool therapy, is key to pain relief. "Exercise is at the top of my list of non-medication solutions for pain," says Jennifer Schneider, MD, PhD, a chronic pain specialist and author of the book Living With Chronic Pain. Dr. Schneider says, "The less you do, the less you use your muscles, the more it hurts when you finally use your muscles." Increase your movements gradually, though, and consult a doctor if you're concerned about how exercise may initially affect your pain.

Yoga

Another type of movement that may be beneficial for pain relief is yoga. Though more research is needed, one small study found that yoga was more effective for managing chronic lower back pain than following the advice in a self-care book.

Be cautious when doing yoga, though, and start with simple, gentle poses. Some stretches or postures have the potential to aggravate pain conditions or bring up new pain problems.

Therapy for the Mind

Anxiety, stress, and depression can aggravate chronic pain, so it's important not to ignore the emotional side of your pain. Cognitive-behavioral therapy, which can teach you how to manage thoughts and feelings and your body's physical response, can effectively manage chronic pain. Biofeedback is another method that teaches you how to control your body's reactions to pain, while hypnosis allows deep relaxation to help with pain management.

TENS Treatment

By electrically stimulating the area where the pain is localized, you can actually help alleviate it. Transcutaneous electrical nerve stimulation, or TENS, is the electrical stimulation technique most often used in pain management. A small device attached to the skin sends electrical impulses to the painful area, stimulates the nerves, and as a result, reduces pain.

Herbs

There are various herbs such as capsaicin, feverfew, and St. John's Wort that help to manage and reduce pain, but they take longer than the conventional drugs to reduce the pain.

Herbal Treatment for Pain

Pharmaceutical drugs may not be your only path to pain relief. Natural pain treatments — like herbal medicine, in which parts of a plant are used medicinally to treat health problems — is an increasingly popular way to manage pain as well.

Though research on herbal remedies is still in its early phases, many herbs are thought to provide pain management and decrease inflammation. However, it’s important to exercise caution.

"Herbals or other nutraceuticals that may help in some way — as well as those which may not actually help — do almost universally have the potential to harm through unwanted side effects, allergic reactions, and undesirable interactions with other substances and medicines," says Sam Moon, MD, MPH, associate director of education at Duke Integrative Medicine, a division of Duke University Medical Center in Durham, N.C. "Relative safety must be very carefully balanced against likely effectiveness."

Natural Pain Relief: Popular Herbal Options

Here are some common herbal remedies used for natural pain relief:

• Capsaicin. Derived from hot chile peppers, topical capsaicin may be useful for some people in relieving pain. "Capsaicin works by depleting substance P, a compound that conveys the pain sensation from the peripheral to the central nervous system. It takes a couple of days for this to occur," says David Kiefer, MD, assistant clinical professor of medicine at the Arizona Center for Integrative Medicine.

• Ginger. Though more studies are needed, says Dr. Kiefer, ginger extract may help with joint and muscle pain because it contains phytochemicals, which help stop inflammation. Few side effects have been linked to ginger when taken in small doses.

• Feverfew. Feverfew has been used for centuries to treat headaches, stomachaches, and toothaches. Nowadays it's also used for migraines and rheumatoid arthritis More studies are required to confirm whether feverfew is actually effective, but the herb may be worth trying since it hasn't been associated with serious side effects. Mild side effects include canker sores and irritation of the tongue and lips. Pregnant women should avoid this remedy.

• Turmeric. This spice has been used to relieve arthritis pain and heartburn, and to reduce inflammation. It's unclear how turmeric works against pain or inflammation, but its activity may be due to a chemical called curcumin, which has anti-inflammatory properties. Turmeric is usually safe to use, but high doses or long-term use may cause indigestion. Also, people with gallbladder disease should avoid using turmeric.

• Devil's Claw. There is some scientific evidence that this South African herb may be effective in managing arthritis and lower back pain, but more research is needed. Side effects are very rare if taken at a therapeutic dose for the short term, but it’s not advised for pregnant women and those with gallstones or stomach or intestinal ulcers.

Natural Pain Relief: Proceed With Caution

There are many other herbal remedies for natural pain relief, such as boswellia and willow bark. The American Pain Foundation also lists these herbs for pain management:

• Ginseng for fibromyalgia
• Kava Kava for tension headaches and neuropathic pain
• St. John’s Wort for sciatica, arthritis, and neuropathic pain
• Valerian root for spasms and muscle cramps

Since herbal therapies for pain management have yet to be thoroughly studied, be careful when embarking on this treatment path. Regardless of the herb you try, remember that they're not benign. Research into their safety and efficacy is still limited, and the government doesn't regulate herbal products for quality. The best course is to talk to a health-care professional before testing out a herbal remedy.

Homeopathic Treatment for Pain

Pain is one of the most common reasons why people seek out alternative therapies. And when you’re looking for pain relief, you may want to research all of your options, including homeopathic pain remedies.

“Homeopathy is a separate system of medicine that is really not in the same framework as what we consider conventional medicine,” says homeopath Brad Lichtenstein, ND, assistant professor at Bastyr University in Seattle, Wash. “Most commonly people define it by talking about the principle of ‘like cures like.’”

The system of homeopathy was developed by German physician Samuel Christian Hahnemann over 200 years ago. Hahnemann observed that, in some cases, people could be cured of their health conditions if they were given a small amount of a substance that would, in a healthy individual and in stronger doses, cause the same symptoms.

However, there is more to treating a condition than simply asking about a symptom and seeking a homeopathic pain treatment. There are thousands of treatments available in the homeopathic system. A practitioner will select the appropriate one based not only on a person’s symptoms, but also on the overall impact of the ailment on that individual.

Homeopathy looks at the whole person as much as possible instead of just treating a symptom. A homeopath needs to know more about the symptoms than most conventional or even naturopathic care does. If you break a bone you could use herbal medicine, but with homeopathy you need to know about the quality of the pain and what else happens for the person. For example, a practitioner might ask the patient to describe the pain and how it affects him, such as whether it makes him feel irritable or sluggish.

However, extensive research has not been done on homeopathic pain treatments. Some research suggests that natural pain relief may be effective. For instance, extracts of the herb calendula helped lab rats with skin burns heal faster. But in another study, a homeopathic remedy was no more effective than a placebo in reducing the need for morphine after knee surgery.

Homeopathic Pain Treatment

Here are a few of the most commonly used homeopathic pain remedies:

• Arnica. This is an herbal remedy used since the 1500s to soothe aching muscles and heal wounds. Lichtenstein says that it is good for sprains and bruises.
• Bryonia alba is for pain that feels like a sticking, cutting, or tearing sensation when you’re in motion, especially in joints or muscles.
• Guaiacum is for achy, swollen, stiff joints that feel worse with pressure, often for pain in the head, face, or neck.
• Hypericum, also known as St. John’s wort, may be recommended for “shooting” pain, such as for injuries that involve nerve damage.
• Ledum may be taken for conditions that affect the joints, such as swollen or cold joints, or pain that gets worse when the body is in motion.
• Rhus toxicodenrun is made from poison ivy. This remedy is recommended for back pain, arthritis, and any pain that is worse in the morning and gets better with heat and motion.

The pros of homeopathic pain treatment include:

• Treatments are personalized.
• Remedies may be less expensive than pharmaceuticals. 
• Combination remedies often include at least one ingredient that may help you.

The cons of homeopathic pain treatment include:

• Health insurance likely won’t pay for these treatments.
• There are side effects, as with all remedies.
• Research into the use of homeopathic remedies for pain is not conclusive.

How to Find a Practitioner

There are no national certification programs for homeopaths. When you are trying to find a qualified homeopath, make sure that you ask how long he has been practicing and where he studied or trained in homeopathy. The question-and-answer process may also help you determine whether you could work with him over a long period of time.

Many homeopathic practitioners sell the remedies they recommend at their office. You should be able to buy homeopathic pain remedies at an organic food store. If you live in an area where there are no homeopathic practitioners or stores that sell homeopathic remedies, it is usually safe to order combination remedies online from reputable sellers.

Physical Therapy for Pain Management
Chronic pain may leave you wanting to curl up in bed with a heating pad and a bottle of medication to help ease your aches. Although doing exercise may sound like sheer torture, it may actually be one of the best pain management options for your chronic pain.

Physical therapy is used to alleviate sources of chronic pain, including:

• Osteoarthritis
• Fibromyalgia
• Chronic headaches
• Rheumatoid arthritis
• Neuropathic pain (pain caused by injury to tissues or nerves)

One of the goals of physical therapy to help chronic pain patients become stronger, because they're usually weak from not moving.

As a chronic pain treatment, physical therapy can teach people how to move safely and functionally in ways that they haven't been able to for quite a while, Watson adds.

Physical Therapy: Chronic Pain Treatment Options

Physical therapy involves a number of different types of pain management methods, says Watson, including:

• Massage
• Manipulation of joints and bones
• Manual therapy using hands or tools on soft tissue
• Cold laser therapy to alleviate inflammation and pain and release endorphins
• Microcurrent stimulation, which emits alpha waves into the brain and increases serotonin and dopamine to alleviate pain naturally
• Movement therapy and exercise

Within each of these categories, there's much that a physical therapist has to offer as far as variety of treatments. Exercise may involve walking on a treadmill or swimming in a pool, depending on the person's pain and physical abilities.

A physical therapist works with each patient to understand his or her particular pain — what causes it and what can be done to manage it. This is the kind of attention that a regular doctor doesn't often have the time to give, but a physical therapist can ask questions and talk about pain issues as you are going through your exercise routine.

How Physical Therapy Helps Chronic Pain

Exercising for just 30 minutes a day on at least three or four days a week will help you with chronic pain management by increasing:

• Strength in the muscles
• Endurance
• Stability in the joints
• Flexibility in the muscles and joints

Keeping a consistent exercise routine will also help control chronic pain. Regular therapeutic exercise will help you maintain the ability to move and function physically, rather than becoming disabled by your chronic pain.

Physical therapy tackles the physical side of the inflammation, stiffness, and soreness with exercise, manipulation, and massage, but it also works to help the body heal itself by encouraging the production of the body's natural pain-relieving chemicals. This two-pronged approach is what helps make physical therapy so effective as a chronic pain treatment. 

Pain Management: Finding the Right Combination

The less you move, the more pain you'll experience. Conversely, the more safe, therapeutic activity and exercise you get — and the more you learn how to exercise to accommodate your pain, the less pain you'll feel and the more you'll be able to function on a daily basis.

While physical therapy can be extremely effective against chronic pain, says Watson, it's important to understand that physical therapy is part of a combination approach to resolving chronic pain.

Some therapists recommend nutritional supplements, heat and cold therapy, and even transcutaneous electrical nerve stimulation (TENS) therapy as good additional pain management options along with physical therapy. It is important to work not just with a physical therapist, but also with a medical doctor who can prescribe any necessary medications. A clinical psychologist and a pharmacist are also important members of a pain management team. Put all these components together to find the most effective chronic pain treatment for you.

The Right Solution for You

You don't have to live with chronic pain or rely on a bottle of pills for the rest of your life. There are so many pain management options to choose from that by consulting with your doctor, naturopathic doctor and/or pain management team, you're sure to find a method that works to control your pain.


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