Just Be Grateful It Works

Medical science is a wonderful thing when it's working well. So if you break a bone, doctors are very good at splinting it (or covering you with plaster to stop you moving around too much) and waiting for it to knit back together again. The mechanics of how to deal with this situation are well understood. But if you ask doctors about why it hurts, no-one can really explain how the pain system works. For the record, the word "pain" comes from the Greek for penalty. Pain is a type of punishment for your body failing. As to the nervous system, there are nerve endings all over your body and when a stimulus passes a threshold, this is interpreted as pain. Under normal circumstances, the pain will be localized, i.e. there will be pressure or an injury that triggers the sensation. But there is also "referred pain" which is where pain from one part of the body is felt in a different part, e.g. pain from the gallbladder is often felt in the right shoulder because the nerves are distributed by the same root in the spinal column. This is confusing when it comes to diagnosis.

When the stimulus generates the pain message, it is transmitted to the brain. This depends on the neurotransmitters, yet it is still not certain how everything works together. One thing is clear. Pain is pain, and it does not matter whether it is classified as acute or chronic, i.e. short-term or likely to last a long time. The real difference is that the cause of acute pain is often clear, e.g. you broke a bone, so you know it will heal. But the causes of chronic pain may not be clearly identified. Nevertheless there are a number of approaches to deal with the problem. There are drugs from the pharmaceutical companies. You start with aspirin for the less serious pain and work up to the seriously powerful opiates that will knock you out and kill all but the most severe of pain sensations. The majority of the drugs come in a pill or capsule, but there are also topical creams you can rub on to the affected parts of your body and, in the more extreme cases, there are injectable versions that deliver the drugs close to the point where they will do the most good.

Holding the middle ground is tramadol. This is a opioid, i.e. it has the same general effect as an opiate, but is synthetic rather than produced from a natural substance. This drug is now the first response used by doctors for moderate to severe pain. It's not completely clear how or why it works except that it affects the levels of neurotransmitters. The brain therefore becomes less aware of the pain. This gives relief and, if the pain is acute, you have greater peace while the cause of the pain is treated and heals. For chronic pain, tramadol is equally effective but there are two issues. The first is you should not take too high a dosage over too long a time. This can be habit-forming. The second problem is psychological. The acute patient knows the pain will stop fairly soon. It is harder to maintain a good quality of life if the pain is chronic.Medical science is a wonderful thing when it's working well. So if you break a bone, doctors are very good at splinting it (or covering you with plaster to stop you moving around too much) and waiting for it to knit back together again. The mechanics of how to deal with this situation are well understood[...]

What is This Thing Called Pain?

Someone wise once said that everything that happens to you throughout your life represents ten percent of your experience. The remaining ninety percent is how you respond to those events. So, if you are injured or suffer from a disease and the result is pain, you could give in and be an invalid or you could respond positively. Just talking about pain in terms of the central nervous system misses the point. You cannot separate pain from the emotions. Some may react to pain with despair and depression. Others may fight to make their lives better despite the pain. All this requires an answer to the question, "What is this thing called pain?" The first part of the answer distinguishes between acute and chronic. When you are injured, have some type of inflammation or a disease, the pain is said to be acute if the cause has been diagnosed and treatment will produce a cure, i.e. the pain is not going to last long. Chronic pain becomes a disease in its own right, i.e. it comes to have a existence independent of the cause. The psychological response to knowing the pain is going to persist often makes it seem worse and can make it resistant to treatment.

Chronic pain can be caused directly by an injury or disease, or it may be a side effect or complication following surgery, caused by drug interactions, etc. Always liking to produce lists, doctors have classified pain into the following categories:

Nociceptive where you feel a sensation in a specific location. This may be somatic and so felt in the joints, bones, muscles and ligaments, or visceral which is felt in the internal organs such as the heart, lungs, liver and kidneys. The latter can be more difficult to localize because the pain simply comes from inside the body.

Non-nociceptive may be neuropathic, i.e. pain generated by the nervous system and not tied to a specific location in the body. When the nervous system is damaged, the messages become more difficult to interpret and the brain is often confused by random effects. The result is unpredictable feelings of tingling, numbness, pins and needles and other unpleasant symptoms. Alternatively, there may be sympathetic pain where the skin and tissue around an injury become unusually sensitive and restrict movement.

No matter which variety of pain you may have, there are a range of analgesics or painkillers available to relieve any suffering. The less powerful drugs are the nonsteroidal anti-inflammatory drugs (NSAIDs) which reduce swelling and inflammation in the joints and elsewhere. The more powerful deal with moderate to severe pain with tramadol being the most commonly prescribed because it is less likely to cause dependence than the opiates. Tramadol works by changing the way in which the neurotransmitters carry messages in the nervous system. Because of this, it is equally effective no matter what the cause of the pain, i.e. localized or arising from the nervous system itself. The messages are not carried to the brain or not clearly interpreted as being pain messages. Thus, you can have a reasonably good quality of life even though the source of the pain remains active in your body.Someone wise once said that everything that happens to you throughout your life represents ten percent of your experience. The remaining ninety percent is how you respond to those events[...]