There is a big difference between acute and chronic pain, and these conditions are managed differently to provide the patient with the best suited treatment plan.
Acute pain is experienced as an injury occurs, where chronic pain is an ongoing feeling of discomfort which can negatively impact on daily life activities.
What are the differences between Chronic and Acute pain?
- Acute pain – is the body’s protective mechanism which makes one aware of injury, as and when it happens.
- Chronic pain – is a persistent pain which can last a long period of time, and reduce the quality of life.
Most people with chronic pain report that they have disruptions daily in their activities, and some struggle with relationships where they are negatively impacted. Pain management of chronic pain has shown long term side effects. Over the counter medication such as ibuprofen are linked with liver and kidney damage, and even heart attacks.
How to understand pain?
- Acute pain is a predictable, short lived pain with a pattern, which is also easy to diagnose and treat.
- Pain that lasts longer than 3 months, with no sign of getting better is referred to as chronic pain. It is difficult to pin point the cause of this pain that can persist over a length of time and often various interventions are required to improve the condition.
What are the most common classifications to differentiate between pain complaints?
- Nociceptive – This guards the body against any injury, and occurs because of the reaction of the peripheral pain receptors, which are activated when injured. The stimuli is conveyed by an electrical signal along the nerve cells in the spine or brain – where it gets relayed that there is an unpleasant sensation.
- Neuropathic – This is caused by cause of injury or dysfunction in the nervous system, which has a variety of pain sensations which could be described as burning, crushing or “pins and needles”. This pain persists for prolonged periods of time, even after the trauma or dysfunction has been addressed, seen that this pain is more complex, it is more difficult to treat.
What is Nociceptive Pain and Inflammation?
- These two go hand in hand, inflammation is caused by tissue injury which has a cascade of biochemical reactions that alert the nervous system for pain sensing.
- Long term inflammation causes changes in the nervous system which can cause the sensation of pain to escalate, for example inflamed tissue like an arthritic knee, and could become more tender by touching the area.
- This pain is caused by a trigger in the nervous system and is not spontaneous, called nociceptors.
- When someone experiences injury, mediators are released at the site of injury and react to nociceptors, which then signals pain through the nervous system.
- When you have Osteoarthritis there is an increased level of mediators at the affected site, which can predispose you to increased pain sensations.
- By taking drugs to treat the pain, like ibuprofen, it can interfere with the sensation of pain, because of its anti-inflammatory nature, and lead to pain relief.
- However, even though these types of drugs can reduce pain levels, they can have side effects which compromises the long term effect when used continuously.
- By using natural compounds, which target inflammation and reduction of pain levels, they also have powerful anti-inflammatory effects without unwanted side effects.
What can be done for pain management?
- Exercise and behavioral therapy is effective in decreasing pain, and increasing the functioning of people who struggle with chronic pain.
- Non pharmacological methods to treat chronic pain like, meditation, biofeedback, acupuncture, electrical stimulation and surgery, are used when people cannot make use of medication to treat pain.
- Pharmacological therapy is a very popular way to treat chronic pain in individuals, based on diagnosis of it being nociceptive or neuropathic pain.
What are the most popular ways to treat pain pharma logical?
- Non-Opioid analgesics
- Opioids
- Antidepressants
- Anti-epileptic drugs
- Muscle relaxants
- topical analgesic agents
Why is over the counter mediation not recommended for Chronic pain sufferers?
- As these drugs do not need a prescription from a doctor, people assume that they do not need to be careful in how they use the dosage as opposed to prescription medication.
- It is important for chronic pain sufferers to be educated about the side effects of using non-prescription drugs, as long term use can cause severe side effects.
- Non-prescription medication is safe when used appropriately, however it can be very dangerous for example when there may occur unintentional overdose, and is also the leading cause of liver failure.
What are the recommendations for using non-prescription medications?
- The user should not exceed the maximum dose prescribed per day, and space the doses as instructed.
- Many prescription pain medications contain paracetamol, which should not be used without medical consent, as it increases the risk of kidney toxicity.
- Do not take medication with alcohol, as this increases the risk of liver toxicity.
- Taking these type of medications can have adverse side effects such as gastrointestinal bleeding, peptic ulcers, high blood pressure, oedema, kidney disease, and heart attack.
- Using such medications over the long term can also cause renal failure, renal necrosis and glomerular filtration.
- Aspirin is commonly used for aches and pains, which thins the blood and poses a greater risk of bleeding. This is also used for heart protection and stroke prevention in low doses. Other side effects to using aspirin are, heartburn, vomiting, nausea, stomach ache, ringing in the ears, hearing loss and rash, and also should not be used with other anticoagulant drugs and alcohol.
- Other common side effects include, constipation, excessive sleepiness, itchiness, respiratory depression.
What effects do opioids have on the dysfunction of the endocrine system?
It has been noted that using opioids for a long period decreases the function of the endocrine system, and as a result causes hormone imbalances.
The hormone imbalances start with a decrease in the hormone released in the hypothalamus, which then decreases the function of the pituitary gland.As a results it affects the functioning of the hypothalamus, the pituitary gland and the reproductive organs. It will have a result of hypogonadism (a reduction or absence of hormone secretion or other physiological activity of the gonads) if used over a long period of time.
Opioids are also known to lower testosterone levels, which are associated with increased cholesterol levels, and a decrease in insulin sensitivity, this can also be detected via hormone testing and patient history.
What are the common endocrine problems associated with long-term use of opioids?
- Decreased Body Hair
- Adrenal dysfunction
- Decreased growth hormone
- Miscellaneous hormonal abnormalities
- Erectile dysfunction
- Infertility
- Decreased libido
- Osteoporosis
- Depression
- Missed Menstruation
What three therapeutic options are there for these side effects?
- Try a different opioid
- Use a non-opioid analgesic
- Hormone replacement therapy
What is the effect of using centrally-acting drugs for pain relief?
- The chronic activation of pain sensors for example osteoarthritis, may alter the central pain processing overtime.
- Chronic pain that is ongoing, can have an adaptive nature on the nervous system and contribute to altering the pain sensitivity and cause the brain to become used to the pain it processes. This is called Central Sensitization.
- When the nervous system becomes used to the pain, these sensations can be augmented as they are no longer being reinforced by the mechanisms in the brain and spinal cord.
- Thus causing the chronic pain to be peripheral and a central element.
- The brain functioning of people who have chronic pain have adapted to processing the pain and have become hyper-sensitive to the pain stimuli.
- Traditional therapies like anti-inflammatory drugs do not work as well anymore, as it cannot identify where the pain is located anymore due to the sensitized nervous system.
- Antidepressants and antiepileptic complement these drugs by changing the biochemistry
- This is also due to their mood altering affects, and the antiepileptic medication, change the calcium signals to the brain which control seizures.
- Centrally acting drugs are critical to neuropathic pain, in chronic patients.
Nutrition and Pain Management
Pain can be managed by making small dietary changes, as outlined in the below section.
How does your diet influence pain management?
Chronic pain can result in a decreased protein intake and increase in sugar and starch intake. There is a strong link between food and pain:
- Periods of fasting have been related to pain relief in many patients.
- For long term pain relief, a high protein low carbohydrate diet is recommended, which results in decreased pain sensitivity and inflammation.
- Vegan/Vegetarian diet is also beneficial to chronic pain conditions.
- A diet rich in antioxidants neutralize free radicals and oxidative stress, play a role in which has an increase in pain sensitivity.
- Studies have shown that a diet with a high protein intake may help chronic pain patients avoid muscle loss and weakness.
How can targeted nutritional interventions of Omega supplement assist in pain management?
Omega-3 Fatty Acids – Are a vitally important source of energy for the body and also have other biological functions:
- By taking Omegas it helps to reduce both inflammatory and neuropathic pain, especially reducing the pain in patients with osteoarthritis, pain during menstruation, inflammatory bowel disease and neuropathy.
- Positive effect of Omega-3 on neuropathic pain is by their ability to block sodium channels that interfere with pain signalling.
- Omega–3 has a positive change on cognition, mood and behaviour, and is also beneficial to central pain processing.
- Supplementation can reduce anti-inflammatory analgesic consumption, and thus reduce gastrointestinal side effects from developing.
Gamma Linolenic Acid
- Omega-6 fatty acid – Plant derived omega 6, and is found in seeds of an Eastern flower – borage.
- Plays an important role in modulating inflammation in the body, when it’s incorporated in the membranes of the immune system cells.
- It has been noted that it relieves pain from a variety of conditions such as neuropathy, breast pain and rheumatoid arthritis.
- Caution: High levels of Omega 6 are associated with inflammatory activities, this can lead up to tissue destruction, chronic inflammation, and increase resistance of tumour cells. It can also promote abnormal arterial blood clotting, causing heart attacks and strokes.
Which Vitamins can assist in effective pain relief?
B Vitamins – Vitamins B1, B6, and B12 are not only beneficial for managing pain as a result from Vitamin B deficiency, but is also effective when combined with medication for some painful diseases like degenerative spine disease, rheumatic diseases, lower back pain, and tonsillectomy pain.
- Vitamin B1, 6 and 12 – have been shown to reduce neuropathic pain in both humans and animals, and can help to treat peripheral neuropathies.
- Benfotiamine - suggested for reducing inflammatory and neuropathic pain in humans.
- Neuropathic pain plays a considerable role in people with chronic pain, and B-vitamins provide relief by targeting pathways associated with central neural pain processing.
- Vitamin C – (ascorbic acid) is an antioxidant, which may act as another natural shield against pain.
- Free radicals play a role in increasing pain hypersensitivity.
- Vitamin C and E has a rapid pain relieving effect in animal studies, with peripheral injuries.
- Vitamin C reduces spontaneous pain associated with post peripheral neuropathic pain.
- Vitamin D – Inhibits inflammation by regulating some genes responsible for producing pro-inflammatory mediators
- Vitamin D deficiency is linked to fibromyalgia, chronic widespread pain, and bone pain.
- Reduces pain in woman with chronically painful periods
- If Vitamin D levels are low, Vitamin D supplementation Can improve pain levels
- Blood levels of 25-hydroxyvitamin D should be between 50/80ng/ml for optimal health.
- Vitamin E– Is associated with a reduction in the severity of cyclic breast pain, as well as being effective in relieving menstrual cramps
- Vitamin E has been proven to improve neuropathic pain levels associated with diabetic and alcoholic neuropathy in animals
- Vitamin E has an analgesic effect, through its antioxidant properties, by blocking the production of reactive oxygen species, involved in neuropathic pain.
- Its analgesic effect has the ability to make the brain less sensitive to pain.