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Pain and fever alleviation

PAIN RELIEVE

Dear Guest!

Below you can inform yourself in the following topics:

  • What is pain?
  • Types of pain
  • Agents approved for pain relieve
  • Pain of the musculoskeletal system
  • Pain alleviation for tumor patients
  • Neuropathic pain
  • Headache
  • Stomach ache
  • Pain relieve using non-pharmaceutical methods

What is pain?

Pain is an unpleasant sensory and emotional experience accompanied by tissue damage (or the risk of it). Sensing pain is a complex phenomenon. It implies the perception and the accompanying sensation, and is influenced by other factors as well, e.g. anxiety.

The role of acute pain is to induce a protective reflex in the human body, e.g. when stepping on a nail, we raise our foot, or even, to detect and timely treat a cardiac infarct in case of chest pain.

If you experience sudden intensive stomach or chest pain, immediately see a doctor or call the ambulance.

Chronic pain however, causes needless suffering, stress. Pain is usually a symptom, with a cause that needs to be detected. If causal treatment is not possible (e.g. replacement of the ragged hip-joint is not an option for a specific reason), we need to prevent chronic pain to become a separate disorder by modifying central nervous mechanisms. The WHO states, that every patient has the right to live pain-free. This needs to be our goal in cases of chronic pain.

Types of pain

Pain may be categorized in different ways, here are some examples:

  • According to duration since present: acute or chronic
  • Based on severity: mild, moderate, or severe
  • Based on physiology: visceral, neuronal (neuropathic), somatic (meaning evolving from the skin, muscles, joints)

Agents approved for pain relieve

Several pain-killers are available on the market, many of these are also prescription-free. It will be decided based primarily on pain severity which of these should be chosen, thus pain treatment will be gradual. For the treatment of mild to moderate pain so called non-opioid, non-steroid anti-inflammatory (NSAID) pain-killers are used. A number of these is available prescription-free in pharmacies.

It needs to be emphasized, that, though these may be available under different brand names, the effective agent may be the same, thus the patient, while believing to take something different, might easily overdose.

These agents belong to different types, some reduces fever, and their anti-inflammatory effect differs as well. The most common side effect is hyperacidity, which may lead to gastric mucosa impairment, and even gastric ulcer. This is exactly why patients chronically taking NSAID-s should also be taking gastro-protective agents.

Due to other side-effects and interactions between the different medications, the physician needs to be aware of the chronic administration, even if the medication is prescription-free.

The next step is the administration of low-potential opioids. Opioids are defined as opium derivates, agents in some way extracted from poppy-seeds (of course many are produced synthetically nowadays). These can and are worth to be combined with the agents mentioned in the step before, since their effect adds up, thus a lower dosage will be enough, with fewer potential side-effects, accordingly.

Opioids are always prescribed by the doctor, you should never take such medication from the medicine cabinet of anyone you know!

The high-potential opioids are used to relieve severe acute pain and pain of tumor patients, they are also known as narcotics. Unfortunately, their repeated administration leads to tolerance, thus the dosage needs to be increased to reach the same relieving effect in course of time. Often physical tolerance develops, with the following symptoms occurring after discontinuation: runny nose, lacrimation, yawning, cold shivers, fever, dilated pupil, irritability, vomiting. Side-effects are sedation, nausea, constipation. Opioids are administered in form of pills, capsules, as well as injection, and recently the so called modified active agent release formulas became available, as well as patches and pills absorbed in the mouth. Benefits of the formers are their sustained effect, while the latter are very rapidly acting.

Chronic, primarily neuropathic pain in many cases doesn’t respond to opioid pain-killers, calling for agents, which originally were not developed for pain alleviation, such as antidepressants and anti-epileptic (i.e. anticonvulsive) agents.

Pain of the musculoskeletal system

Pain related to degeneration of the spine, joint abrasion, inflammation is very common. Hypoxia due to vasoconstriction may be similarly painful, as well as pain resulting from varicosities, these not being defined as musculoskeletal in the narrow sense. It is important to detect the cause of pain, since it may be the first sign of a tumor, and, even a cardiac infarct may present itself in form of musculoskeletal pain (e.g. shoulder pain).

In cases of known, diagnosed musculoskeletal pain it is elemental, to protect the aching body part. Besides resting the different stabilizing devices, special shoes come into play. In cases of such pain thermal bath treatment, physiotherapy, and massage may be useful, while some rheumatologic impairments dispose of special treatment methods. For pharmaceutical therapy the above mentioned non-steroid anti-inflammatory drugs are used. It needs to be noted, that, in cases of chronic administration, the patient always has to be provided gastric protection, due to the gastric hyperacidity caused by these agents, thus impairing the gastric mucosa. This is exactly why it is important to talk to your treating physician in such cases.

In severe cases strong opioids may be needed as well.

Additionally, the administration of muscle relaxing agents may be useful.

In case of inflammatory pain the doctor may prescribe steroids. Steroids are quite intense anti-inflammatory drugs, however, they have several potential side-effects, and therefore, it is important to consult a specialist about the relevance of their administration.

Pain alleviation for tumor patients

A pain-free life is a fundamental human right. Tumor patients often have to suffer for weeks in lack of proper pain alleviation due to the numerous misbelieves related to narcotic pain-killers (opioids). Tempering excruciating tumorous pain has to be mandatory. Opioid pain-killers may be administered in several ways (oral, sub-dermal, as a patch, intra-rectal, etc.)

Most important side-effects:

  • breathing deficiency
  • constipation
  • nausea, vomiting
  • itching
  • urinary blockade
  • neural impairment
  • sedation
  • brain function impairment
  • delirium, hallucination
  • seizures

These can be prevented and well treated under a specialists’ supervision. It is not acceptable to let the patient suffer from the tumorous pain because of the risk of potential side effects, though it might occur, that the otherwise effective opioid treatment has to be discontinued due to side-effects.

Neuropathic pain

A very specific type of pain, though it can be caused by several disorders. Characteristics are:

  • burning sensation
  • occurs in form of crisis, stabbing, splitting
  • a not painful stimulus provokes pain as well (allodynia)
  • the pain often occurs later than the time of impairment
  • excessive reaction as compared to the severity of the painful stimulus (hyperalgesia)

Out of the countless number of its causes we will list a few below, with the common background of the lesion of any structure of the nervous system.

Impairment of a structure of the peripheral nervous system:

  • Traumatic lesion (operation or amputation)
  • herpes zoster
  • neural impairment due to hypoxia
  • pressure of nerves
  • diabetes or other metabolic disturbance, alcoholism, sometimes neural impairment related to autoimmune diseases, so called polyneuropathy

Impairment of the central nervous system:

  • cerebral infarct (stroke)
  • multiple sclerosis
  • spinal cord lesion
  • a space-occupying alteration, tumor

Several medications are used in the efforts to reduce neuropathic pain, which do not belong to the group of classic pain-killers. Such are anti-epileptic drugs, different antidepressants. These, however, have several well-known side-effects
amitriptiline: sedation, dry mouth, constipation, memory and concentration deficits, low blood pressure, cardiac arrhythmias, sweating, weight gain
carbamazepine: sedation, dizziness, balance problems, liver and bone marrow impairment
Based on the cause of pain, electric stimulation therapies (e.g. TENS) and neurosurgical interventions may also be considered in cases of neuropathic pain.

Headache

Stomach ache

Pain relieve using non-pharmaceutical methods

Neural blockades: Allows reducing types of pain, which can’t be controlled by any other method. The gist of a neural blockade consists of injecting local anesthetics and/or alcohol into a certain area of the nerve-tract, as in dentistry.
Psychotherapy: In many cases the pain is related to mental exhaustion, anxiety, depression
Physiotherapy
Massage
Cooling (chilling acute traumatic pain)
Heating salty cushion, infra-light