Health Tips

Pain, as defined by the International Association for the Study of Pain (IASP), is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. 

Yet, regardless of the ‘big jargons’ we used to describe pain above, all of us know what pain feels like. Pain could be a way for our body to communicate with us what’s wrong with it, but when it becomes too much to bear, it can significantly impact our quality of life. 

Sadly, in many asian societies especially like the Malaysian’s, pain is overlooked and undertreated— we love to ask men who are in pain to “man up!”, and women who are in pain are often told “it’s all inside your head”. As a result, many Malaysians choose to delay seeking treatment for pain. 

But it doesn’t have to be this way. We hope this overview of pain and its treatment can help to kickstart conversations about pain management and encourage more Malaysians to seek medical help for their pain.

Classifications of pain

Whenever you complain of pain to your doctor, your doctor would attempt to classify your pain through history taking and physical examination. Classification of pain is important because it helps to illuminate the cause of pain as well as the appropriate treatment. 

There are many ways pain can be classified, below are a few common examples:

Duration

• Acute pain: pain that lasts for less than 3 months

• Chronic pain: pain that lasts for more than 3 months

Cause

• Cancer pain

• Non-cancer pain

Mechanism 

• Nociceptive pain

Nociceptive pain is also dubbed as physiological pain. It is caused by an obvious injury to the body (e.g. knife stab, sports injury). Nociceptive pain can feel sharp, dull, throbbing and well-localised in a certain area; it is relieved by rest and aggravated when the person moves. Nociceptive pain is how our body tells us that there’s something wrong with it and prompts us to do something about it (either through resting or removing the object that is causing the harm).

• Neuropathic pain

Neuropathic pain is an interesting one. Also called pathological pain, the causes that lead to neuropathic pain may not necessarily come from a tissue injury. It is often caused by nerve injury or an abnormality in the nervous system, thus causing the person to feel pain even though the body is not harmed. That being said, neuropathic pain is just as real to the person who suffers it, and medical treatment is available to reduce the pain. In contrast to nociceptive pain, neuropathic pain is often described as burning, shooting, stabbing, lancinating(piercing) and poorly localised (the person can’t pinpoint where the pain is at). Such pain happens spontaneously and even resting doesn’t relieve the pain. In addition to the pain, some people can also experience numbness, “pins and needles” and allodynia (pain due to a stimulus that does not normally provoke pain).

Quick glance at pain management

Pain is a subjective experience. Nonetheless, reporting your pain level can help your healthcare professional to determine the best way to address your pain. The Ministry of Health (MOH) pain scale is one of the most widely used pain scales in the country.

Image credit: http://pfhkunak.blogspot.com/2018/04/zahirkan-tahap-kesakitan-anda-dengan.html

Pain management is a highly specialized branch in medicine. In general, pain can be managed via pharmacological approach (painkillers) and non-pharmacological approach. If you or your loved ones suffer from pain, consult a doctor and find out the best option to manage pain.This is because the best pain management option may vary depending on the underlying causes of your pain. A painkiller that works for others may not necessarily work for you.

Pharmacological approaches (a.k.a painkillers)

Painkillers, or also known as analgesics, are available in various potencies and forms to help individuals coping with their pain:

1. Paracetamol

Paracetamol, or commonly known by the brand name Panadol, is the “weakest” painkillers of all. Nevertheless, paracetamol is usually sufficient for most of the mild pain cases. It is an over-the-counter medication, which means it is easy to access; and it also comes in various generic brands that are affordable to the general public.

2. Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are a group of medications that are commonly prescribed for pain and fever. They are more effective than paracetamol in treating mild to moderate pain. Examples of NSAIDs are ibuprofen, diclofenac, naproxen and mefenamic acid. Their generic brands are cheap and can be purchased via a doctor’s prescription or directly from a pharmacist. NSAIDs are available in pills, gels or patches.

Long-term use of NSAIDs, however, is associated with many negative health effects, such as increased risk of cardiovascular disease, kidney damage and gastric bleeding. Learn more about the adverse effects of NSAIDs in our two-part articles here.

3. Opioids

Opioids are usually reserved for moderate to severe pain. However, not all opioids are created equal — there are weak and strong opioids. Examples of weak opioids are tramadol and dihydrocodeine (DF118), whereas morphine, fentanyl and oxycodone are examples of strong opioids. Opioids are highly controlled substances due to its potential for abuse, hence it is strictly reserved for individuals whose pain can’t be treated with medications we mentioned above. One of the most common side effects of opioids are nausea and vomiting, which can be troubling for some individuals and require supportive treatment. Long-term use of opioids can also lead to constipation.

An uncommon but life-threatening side effect of opioid treatment is respiratory depression, in which the individual can go unconscious and stop breathing. Opioids are available in various forms, such as injections, pills and patches. In some scenarios such as post-operative pain control, individuals can be given patient controlled analgesia (PCA), i.e. patients can control their own opioid delivery based on the degree of pain via a computerized syringe pump.

4. Adjuvants

Adjuvants are non-painkiller medications that can help with pain as well. Surprise, surprise— some of the medications that seem to have nothing to do with painkillers can indeed, help to manage pain.

• Steroids

In a traditional sense, steroids are not the typical painkillers, but its powerful action in reducing inflammation indeed helps to reduce pain. However, steroids regimen can be tricky to handle, and its use requires the supervision of healthcare professionals. For example, you cannot stop taking your steroids abruptly, as sudden withdrawal of steroids can lead to hypothalamic-pituitary-adrenal (HPA) axis suppression. Long-term use of steroids is also associated with many adverse effects, such as increased blood sugar level, osteoporosis, lower immunity and weight gain. We wrote a detailed article on the side effects of steroids here.

• Antidepressants 

Long-term pain is accompanied frequently by anxiety and depression. Thus, it is not surprising that the use of antidepressants and other psychoactive drugs is a routine component of pain management. Antidepressants such as tricyclic antidepressants (TCA) are effective analgesics in headache, facial pain, low back pain, arthritis and, to a lesser degree, cancer pain.

• Antiepileptics

Medications that are used for epilepsy can play a role in pain management as well! Antiepileptics such as carbamazepine, sodium valproate, gabapentin and pregabalin are useful for neuropathic pain, migraine and cluster headache. 

• Antispasmodics (e.g. hyoscine butylbromide) — for pain related to smooth muscle spasm

• Bisphosphonates (e.g. alendronate) — for bone pain caused by osteoporosis or cancer

• Antibiotics — for pain that caused by infection

• Skeletal muscle relaxants (e.g. baclofen) — for muscle spasm

Your healthcare professionals rely on various expertise and tools to manage your pain, such as the World Health Organization (WHO) pain ladder.

Image credit: https://www.practicalpainmanagement.com/resources/who-pain-ladder-do-we-need-another-step

Non-pharmacological approaches

Besides medications, the following methods are also useful for managing pain:

• Physiotherapy, such as Rest, Immobilisations, Cold compression, Elevation (RICE), heat/cold pack, strengthening exercise

• Psychological approach

• Traditional or complementary medicine, such as acupuncture and aromatherapy

• Occupational therapy

A word from DOC2US

If you have any questions related to pain, you can consult our professional doctors and healthcare professionals on DOC2US. DOC2USs is a mobile application that allows you to talk to a doctor or any healthcare professionals via text chat at any time and from anywhere. For better communication, you can even send our online doctor images or voice messages related to your medical inquiry.

Download DOC2US app on Apple App Store, Google Play Store and Huawei App Gallery; or use our web chat at https://web.doc2us.com/

Note: DOC2US is not for medical emergencies. In the event of urgent medical conditions, please call 999.

Disclaimer: As a service to our users and general public, DOC2US provides health education contents. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

References

1. Pain - Clinical Pharmacy and Therapeutics 2018

2. Ministry of Health Malaysia - Pain as the 5th Vital Sign: Guidelines for Management of Pain in Adult Patients

3. Surgical and Emergency Medicine Services Unit, MOH - Pain Management Handbook

Cover image credit: Photo by Klara Kulikova on Unsplash

Written by

Ms Joyce Toh