A specialist guide to pain management

What exactly is involved in the pain management specialty (how is chronic pain different from other pain)?  

Pain management is a speciality.  Pain managment generally refers to chronic pain, pain that people have been experiencing for weeks or month, that there is not an immediate treatment for.

There is difference between acute pain and chronic pain. Acute pain is the pain you feel when you have appendicitis, gallstones or a kidney stone or you break a bone. If  you think about the pain, you know why it is there and if you treat the cause, the pain will go away.

With chronic pain, the problem is that the pain is persistent. Often the acute treatment has already happened, the pain is already there or perhaps there is not a treatment for the pain which resolves it quickly.

With chronic pain, there is an effect of having the pain playing on the body and the mind for a prologned period of time. Sleep and emotions are disturbed and patients are unable to do the physical things they normally do and want to do.

What treatments are there for chronic pain?

With regard to looking at chronic pain holistically, doctors always look at lifestyle and surroundings.

For instance, if seeing people who are suffering from spinal pain and are spending a lot of time hunched over their laptop, working to deadlines, doctors must be aware that this may be a major contributor to their pain. They will look at this before medication and injection of needles.

Analgesic drugs may be considered. Examples include paracetomal, anti-inflammatories and opiods, which patients often use for acute pain. The problem with these drugs is that if you take them all the time for a chronic condition, often they have got side effects or problems with tolerances.

Other options include injections and more involved procedures. They can be very helpful for the right indication but it is very important that there is a careful assessment of what the pain is, what the mechanisms are of it and therefore what is more likely to respond to.

When should injections be considered?

In general, injections should be considered when there is a localised pain and where there is a good chance that the reason for that pain can be easily influenced directly by the injection.

It is also important that the doctors explain well to patients what the expected response to the injection should be, what the expected time frame for response should be, what they should do after the injection.  It is essential that whoever is giving the injection is technically very proficient.

When should spinal cord stimulation be considered?

Spinal cord stimulation is a very advanced and invasive procedure because for those people in whom it is effective, what they have at the conculsion of it is a permanent lead and battery system similar to people having a pacemaker for their heart.

It is unfortunately, not something that blocks all pain. The pains that it can wind down should not be there, that involve a wind up the pain nervous system.

It will be considered when there is nerve pain, disfucnctioning and where doctors think that there is central sensitisation in the spinal chord level to particular areas of the body. This pain can occur after an injury or when there is pain from diabetic neuropathy where lots of nerves have been affected by a disease.

Spinal chord stimulation should be considered where pain is localised to a region and where nerve pain and central sensitisation are really important components of that pain.

If someone has a very bad arthritic knee, they require a knee replacement because a spinal chord stimulator will not block pain from a very arthritic or fractured joint.