Treatment of pain

What is pain treatment?

Good pain treatment should be simple. It should be provided by our practitioner who should listen to us carefully and then select a suitable medicine. More difficult cases are transferred to a specialist in a pain treatment outpatient clinic. Before our visit to a specialist we should analyze our pain so that we can help in its treatment. Our cooperation in the treatment of our pain is very important for our doctor.

How to understand our pain

Everybody perceives and tolerates pain differently and so it is necessary to understand our pain. Often it is necessary for our doctor to know something that to us seems unimportant. We must describe where the pain begins, how and where it spreads, how and how much it hurts, what triggers it, what relieves it, if it wakes us up at night, what the reaction is to medicine. It is important not to underestimate pain at its outset and to help to end it before it develops.

Ways of treating pain

The most common ways of treating pain are:

• Medicine
• Special technologies which often require minor or major surgery
• Complementary treatment such as rehabilitation, relaxation techniques etc.

Further in the text we will refer to pain treatment as “medicine”.

The most common pain treatment medicine

When we have a headache and take an Aspirin, we have used a simple and efficient pain treatment. Aspirin and similar medicines (Paralen, Acylpyirin, Ibuprofen etc.) called anti-inflammatory medicine are the primary treatments for the most common types of pain. They begin working within half an hour and last from four to twelve hours.

For treatment of moderate to severe pain, stronger medicines called opioid analgetics (opioids) are used. There are many preparations ranging from weak ones like Tramal and Dolsin to stronger ones such as MST, Vendal (containing morphine) or durogesic, Transtec (containing fentanyl). Opioid analgetics can be prescribed by any doctor.

For pain treatment, other groups of medicine are also used which are primarily used in other areas of medicine. These are called auxiliary remedies (such as corticoids, antidepressants, antiepileptics, etc.) and can make the treatment more efficient overall.

Basic rules for medicine use and dosage

When using any medicine in combination with other medicines it is necessary to observe very strict rules and to do it under a doctor’s supervision. Pain medicine is prescribed according to the intensity of pain and degree of efficiency, i.e. from weakest to strongest. When pain treatment is long-term, medicine must be administered regularly at fixed time intervals to prevent the reappearance of pain. If the pain occurs between these intervals, it is necessary to increase the basic dosage or add supplementary medicine from other medicine groups.

Tablets must not be cut into smaller pieces, crushed or dissolved if not explicitly mentioned in the enclosed instructions. Some medicine is produced in a dissolvable form that allows the medicine to dissolve as late as in the intestine. This ensures the correct effect of the medicine. If the tablet is cut in half or crushed, the active treatment ingredient could be corrupted.

We must never combine various types of medicine without consulting the doctor first. Certain types of medicine may have different names while containing the same active ingredient. Combining them thus does not increase pain relief and only increases the risk of side effects. Even “mere” vitamins or food supplements can change the efficiency of the medicine.

It is not good to use higher daily doses than recommended. We will not reduce our pain but the side effects will be stronger. We should always consult the doctor about every dosage increase or addition of another medicine.

Methods of medicine administration

Most medicine is administered in the form of tablets or oral drops. Suppositories are administered rectally as well as some tablets. If it is necessary to take the medicine long-term, it is desirable to administer the pain medicine trans-dermally using a bandage. Active ingredients are released from them to the body gradually, usually over several days. Pain medicine is also administered by injection (under the skin, into a muscle, intravenously).

The most common side effects of medicine

As as with all medicine, pain medicine has unpleasant side effects. These can be prevented by proper dosage and sometimes by administering other medicines that suppress the side effects.

• Stomach pain and ulcer disease: this is caused principally by anti-inflammatory medicine and corticoid types of medicine when taken long-term. We should never exceed the maximum daily dosage. The doctor will decide whether it is necessary or useful to administer medicine to protect the stomach lining.
• Nausea and vomiting: these can be caused by medicines from the opioid group, mainly at the beginning of treatment (in the first week). Nausea and vomiting can be prevented by suitable medicine.
• Loss of appetite: anti-pain medicine as well as illness itself lead to loss of appetite and reduced ability to digest. It is not necessary to force ourselves to eat at any cost. It is better to eat small amounts of our favorite foods more often during the day.
• Constipation: this appears most often with opioid pain treatment and must be treated continuously. Other medicine and lack of movement can cause this effect as well. Therefore it is better to prevent stool problems by regular usage of a mild laxative and sufficient liquid intake.
• Sleepiness: some medicine can cause sleepiness during the day. Occasionally memory disorders and a state of drowsiness can occur (mainly in older people). These problems are usually worst at the beginning of treatment and gradually disappear.

Fear of opiates

The most common fear among those who have to use anti-pain medicine based on opioids is the fear of developing a drug addiction. It is sometimes necessary to increase the dosage of these types of medicine gradually since they are administered for weeks to achieve the same effect as at the beginning of treatment. This phenomenon is called tolerance. It does not indicate psychological drug addiction (narcotism). If we treat pain with opioids no psychological addiction is created. When the need for treatment ceases, it is possible to reduce the dosage of the medicine or discontinue it.

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