There is no way to tell how much pain a person has. No test can measure the intensity of pain, no imaging device can show pain, and no instrument can locate pain precisely. Sometimes, as in the case of headaches, physicians find that the best aid to diagnosis is the patient's own description of the type, duration, and location of pain. Defining pain as sharp or dull, constant or intermittent, burning or aching may give the best clues to the cause of pain. These descriptions are part of what is called the pain history, taken by the physician during the preliminary examination of a patient with pain.
Physicians,
however, do have a number of technologies they use to find the cause of pain. Primarily these include:
- Electrodiagnostic procedures include electromyography (EMG),nerve conduction studies, and evoked potential (EP) studies. Information from EMG can help physicians tell precisely which muscles or nerves are affected by weakness or pain. Thin needles are inserted in muscles and a physician can see or listen to electrical signals displayed on an EMG machine. With nerve conduction studies the doctor uses two sets of electrodes (similar to those used during an electrocardiogram) that are placed on the skin over the muscles. The first set gives the patient a mild shock that stimulates the nerve that runs to that muscle. The second set of electrodes is used to make a recording of the nerve's electrical signals, and from this information the doctor can determine if there is nerve damage. EP tests also involve two sets of electrodes-one set for stimulating a nerve (these electrodes are attached to a limb) and another set on the scalp for recording the speed of nerve signal transmission to the brain.
- Imaging, especially magnetic resonance imaging or MRI, provides physicians with pictures of the body's structures and tissues. MRI uses magnetic fields and radio waves to differentiate between healthy and diseased tissue.
- A neurological examination in which the physician tests movement, reflexes, sensation, balance, and coordination.
- X-rays produce pictures of the body's structures, such as bones and joints.
The goal of pain management is to improve function, enabling
individuals to work, attend school, or participate in other
day-to-day activities.
Acetaminophen is the basic ingredient found in Tylenol® and its many generic equivalents. It is sold over the counter, in a prescription-strength preparation, and in combination with codeine (also by prescription).
Acupuncture
dates back 2,500 years and involves the application of needles
to precise points on the body. It is part of a general category
of healing called traditional Chinese or Oriental medicine.
Analgesic refers to the class of drugs that includes most painkillers, such as aspirin, acetaminophen, and ibuprofen. The word analgesic is derived from ancient Greek and means to reduce or stop pain.
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Antidepressants are sometimes used for the treatment of pain and, along with neuroleptics
and lithium, belong to a category of drugs called psychotropic
drugs. In addition, anti-anxiety drugs called benzodiazepines
also act as muscle relaxants and are sometimes used as pain
relievers.
Antimigraine drugs include the triptans- sumatriptan (Imitrex®), naratriptan (Amerge®), and zolmitriptan (Zomig®)-and are used specifically for migraine headaches. They can have serious side effects in some people and therefore, as with all prescription medicines, should be used only under a doctor's care.
Aspirin may be the most widely used pain-relief agent and has been sold over the counter since 1905 as a treatment for fever, headache, and muscle soreness.
Biofeedback
is used for the treatment of many common pain problems, most
notably headache and back pain. Using a special electronic
machine, the patient is trained to become aware of, to follow,
and to gain control over certain bodily functions, including
muscle tension, heart rate, and skin temperature.
Capsaicin is a chemical found in chili peppers that is also a primary ingredient in pain-relieving creams
Chemonucleolysis is a treatment in which an enzyme, chymopapain, is injected directly into a herniated lumbar disc in an effort to dissolve material around the disc, thus reducing pressure and pain. The procedure's use is extremely limited, in part because some patients may have a life-threatening allergic reaction to chymopapain.
Chiropractic
refers to hand manipulation of the spine, usually for relief of
back pain, and is a treatment option that continues to grow in
popularity among many people who simply seek relief from back
disorders.
Cognitive-behavioral therapy involves a wide variety of coping skills and relaxation methods to help prepare for and cope with pain. It is used for postoperative pain, cancer pain, and the pain of childbirth.
Counseling
can give a patient suffering from pain much needed support,
whether it is derived from family, group, or individual
counseling.
COX-2 inhibitorsmay be effective for individuals with arthritis. For many years scientists have wanted to develop a drug that works as well as morphine but without its negative side effects. Nonsteroidal anti-inflammatory drugs (NSAIDs) work by blocking two enzymes, cyclooxygenase-1 and cyclooxygenase-2, both of which promote production of hormones called prostaglandins, which in turn cause inflammation, fever, and pain.
Electrical stimulation, including transcutaneous electrical stimulation (TENS), implanted electric nerve stimulation, and deep brain or spinal cord stimulation, is the modern-day extension of age-old practices in which the nerves of muscles are subjected to a variety of stimuli, including heat or massage. Electrical stimulation, no matter what form, involves a major surgical procedure and is not for everyone, nor is it 100 percent effective. The following techniques each require specialized equipment and personnel trained in the specific procedure being used:
- TENS uses tiny electrical pulses, delivered through the skin to nerve fibers, to cause changes in muscles, such as numbness or contractions. This in turn produces temporary pain relief. There is also evidence that TENS can activate subsets of peripheral nerve fibers that can block pain transmission at the spinal cord level, in much the same way that shaking your hand can reduce pain.
- Peripheral nerve stimulation uses electrodes placed surgically on a carefully selected area of the body. The patient is then able to deliver an electrical current as needed to the affected area, using an antenna and transmitter.
Exercise has come to be a prescribed part of some doctors' treatment regimes for patients with pain. . Exercise has been proven to help many people with low back pain. It is important, however, that patients carefully follow the routine laid out by their physicians.
Hypnosis,
first approved for medical use by the American Medical
Association in 1958, continues to grow in popularity, especially
as an adjunct to pain medication. In general, hypnosis is used
to control physical function or response, that is, the amount of
pain an individual can withstand.
Low-power lasers have been used occasionally by some physical therapists as a treatment for pain, but like many other treatments, this method is not without controversy.
Magnets are increasingly popular with athletes who swear by their effectiveness for the control of sports-related pain and other painful conditions. Usually worn as a collar or wristwatch, the use of magnets as a treatment dates back to the ancient Egyptians and Greeks. While it is often dismissed as quackery and pseudoscience by skeptics, proponents offer the theory that magnets may effect changes in cells or body chemistry, thus producing pain relief.
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