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Pain Management
Pain is a sensation that is transmitted from an area of tissue damage or stress along the sensory nerves to the brain. The brain interprets the information as the sensation of pain.
Substances that decrease pain either interfere with the ability of nerves to conduct messages, or alter the brain’s capacity to receive sensations.
Pain may be a symptom of an underlying pathological condition, such as inflammation. It may also be due to other causes, such as bruising, infection, burns, headaches, and sprains and strains. Use caution when treating pain without understanding its cause—this may delay diagnosis of conditions that could continue to worsen without medical attention.
What are the symptoms of pain?
Symptoms of pain include discomfort that is often worsened by movement or pressure and may be associated with irritability, problems sleeping, and fatigue. People with pain may have uncomfortable sensations described as burning, sharp, stabbing, aching, throbbing, tingling, shooting, dull, heavy, and tight.
Medical Treatments
Over the counter nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin (Bayer®, Ecotrin®, Bufferin®), ibuprofen (Advil®, Motrin®, Nuprin®), and naproxen (Aleve®), as well as acetaminophen (Tylenol®), are commonly used for mild pain.
Prescription strength medications include:
- Ultram (or its generic Tramadol) - used to relieve moderate to moderately severe pain, Tramadol also may be used to treat pain caused by surgery and chronic conditions such as cancer or joint pain.
- Celebrex - a nonsteroidal anti-inflammatory drug (NSAID) which relieves pain and inflammation (swelling). Celebrex is used to treat pain, swelling and stiffness due to arthritis. This drug works by blocking the enzyme in your body that makes prostaglandins.
- Ultracet - a combination medicines containing opioid analgesics (nar-KOT-ik an-al-JEE-zicks ) such as Tramadol (TRA-ma-dole) and acetaminophen (a-seat-a-MIN-oh-fen ) which are used to relieve pain. An opioid analgesic and acetaminophen used together may provide better pain relief than either medicine used alone. In some cases, you may get relief with lower doses of each medicine.
- Fioricet (or its generic Butalbital) - this medication is a pain reliever and sedative. It is used to relieve mild to moderate pain and tension headaches.
Some severe painful conditions might require surgical treatments to disrupt the pain signal.
Lifestyle changes that may be helpful
Body weight may be related to pain tolerance. One study indicated women who are more than 30% above the ideal weight for their age experience pain more quickly and more intensely than do women of ideal weight.1 No research has investigated the effect of weight loss on pain tolerance.
Exercise increases pain tolerance in some situations,2 3 in part because exercise may raise levels of naturally occurring painkillers (endorphins and enkephalins).4 Many types of chronic pain are helped by exercise,5 6 7 though some types of physical activity may aggravate certain painful conditions.8 People who want to initiate an exercise program for increasing pain tolerance should first consult a qualified health professional.
Nutritional supplements that may be helpful
Certain amino acids have been found to raise pain thresholds and increase tolerance to pain. One of these, a synthetic amino acid called D-phenylalanine (DPA), decreases pain by blocking the enzymes that break down endorphins and enkephalins, the body’s natural pain-killing chemicals.9 10 DPA may also produce pain relief by other mechanisms, which are not well understood.11
Vitamin B12 has exhibited pain-killing properties in animal studies.29 In humans with vertebral pain syndromes, injections of massive amounts of vitamin B12 (5,000 to 10,000 mcg per day) have reportedly provided pain relief.30 Further studies are needed to confirm the efficacy of this treatment.
Herbs that may be helpful
As early as 1763, use of willow bark to decrease pain and inflammation was reported.42 Its constituents are chemically related to aspirin. These constituents may decrease pain by two methods: by interfering with the process of inflammation, and by interfering with pain-producing nerves in the spinal cord.43 No human studies have investigated the pain-relieving potential of willow bark, and questions have been raised as to the actual absorption of willow bark’s pain-relieving constituents.44 The potential pain-reducing action of willow is typically slower than that of aspirin.
Other herbs that have been historically used to relieve pain (although there are no modern scientific studies yet available) include valerian, passion flower, American scullcap, Piscidia erythrina, and crampbark (Viburnum opulus).
Holistic approaches that may be helpful
Acupuncture has been shown to decrease pain by acting on the enkephalin-based, pain-killing pathways.59 In 1997, the National Institutes of Health (NIH) stated that acupuncture is useful for muscular, skeletal, and generalized pain, as well as for anesthesia and post-operative pain. The NIH statement was based on a critical review of over 67 controlled trials of acupuncture for pain control.
References
1. Pradalier A, Willer JC, Dry J. Pain sensitivity in obese individuals. Ann Med Interne (Paris) 1982;133:528-31.
2. Guieu R, Blin O, Pouget J, Serratrice G. Nociceptive threshold and physical activity. Can J Neurol Sci 1992;19:69-71.
3. Fordyce W, McMahon R, Rainwater G, et al. Pain complaint—exercise performance relationship in chronic pain. Pain 1981;10:311-21.
4. Schwarz L, Kindermann W. Changes in beta-endorphin levels in response to aerobic and anaerobic exercise. Sports Med 1992;13:25-36 [review].
5. Ferrell BA, Josephson KR, Pollan AM, et al. A randomized trial of walking versus physical methods for chronic pain management. Aging (Milano) 1997;9:99-105.
6. McCain GA. Nonmedicinal treatments in primary fibromyalgia. Rheum Dis Clin North Am 1989;15:73-90.
7. Kottke TE, Caspersen CJ, Hill CS. Exercise in the management and rehabilitation of selected chronic diseases. Prev Med 1984;13:47-65 [review].
8. Cowan P, Lovasik DA. American Chronic Pain Association: strategies for surviving chronic pain. Orthop Nurs 1990;9:47-9 [review].
9. Ehrenpreis S. Analgesic properties of enkephalinase inhibitors: animal and human studies. Prog Clin Biol Res 1985;192:363-70.
10. Guisti P, Carrara M, Cima L, Borin G. Antinociceptive effect of some carboxypeptidase A inhibitors in comparison with D-phenylalanine. Eur J Pharmacol 1985;116:287-92.
11. Walsh NE, Ramamurthy S, Schoenfeld LS, Hoffman J. D-phenylalanine was not found to exhibit opiod receptor mediated analgesia in monkeys. Pain 1986;26:409-10.
12. Ehrenpreis S, Balagot R, Comaty JE, Myles SB. Naloxonr reversible analgesia in mice produced by D-phenylalanine and hydrocinnamic acid, inhibitors of carboxypeptidase A. In Bonica JJ, et al., eds. Advances in Pain Research and Therapy, Vol. 3. New York: Raven Press, 1979.
13. Ehrenpreis S. Pharmacology of enkephalinase inhibitors: animal and human studies. Acupunct Electrother Res. 1985;10:203-8.
14. Balagot RC, Ehrenpreis S, Kubota K, Greenberg J. Analgesia in mice and humans by D-phenylalanine: relation to inhibition of enkephalin degradation amd enkephalin levels. In Bonica JJ, et al., eds. Advances in Pain Research and Therapy, Vol. 5. New York: Raven Press, 1983
15. Mitchell MJ, Daines GE, Thomas BL. Effect of L-tryptophan and phenylalanine on burning pain threshold. Phys Ther 1987;67:203-5.
16. D’Alessandro R. D-Phenylalanine does not affect nociceptive, flexion reflex thresholds in normal humans. Anesth Analg 1983;62:857-8.
17. Budd K. Use of D-phenylalanine, an enkephalinase inhibitor, in the treatment of intractable pain. In Bonica JJ, et al., eds. Advances in Pain Research and Therapy, Vol. 5. New York: Raven Press, 1983.
18. Donzelle G, Bernard L, Deumier R, et al. Curing trial of complicated oncologic pain by D-phenylalanine. Anesthesie, Analgesie, Reanimation 1981;38:655-8 [in French].
19. Balagot RC, Ehrenpreis S, Kubota K, Greenberg J. Analgesia in mice and humans by D-phenylalanine: relation to inhibition of enkephalin degradation and enkephalin levels. In Bonica JJ, et al., eds. Advances in Pain Research and Therapy, Vol. 5. New York: Raven Press, 1983.
20. Walsh NE, Ramamurthy S, Schoenfeld LS, Hoffman J. Analgesic effectiveness of D-phenylalanine in chronic pain patients. Arch Phys Med Rehabil 1986;67:436-9.
21. Sicuteri F. Enkephalinase inhibition relieves pain syndromes of central dysnociception (migraine and related headache). Cephalalgia 1981;1:229-32.
22. Kitade T, Minamikawa M, Nawata T, et al. An experimantal study on the enhancing effects of phenylalanine on acupuncture analgesia. Am J Chin Med 1981;9:243-8.
23. Takeshige C, Mera H, Hisamitsu T, et al. Inhibition of the analgesia inhibitory system by D-phenylalanine and proglumide. Brain Res Bull 1991;26:385-91.
24. Kitade T, Odahara Y, Shinohara S, et al. Studies on the enhanced effect of acupuncture analgesia and acupuncture anesthesia by D-phenylalanine (first report)—effect on pain threshold and inhibition by naloxone. Acupunct Electrother Res 1988;13:87-97.
25. Kitade T, Odahara Y, Shinohara S, et al. Studies on the enhanced effect of acupuncture analgesia and acupuncture anesthesia bu D-phenylalanine (2nd report)—schedule of administration and clinical effects in low back pain and tooth extraction. Acupunct Electrother Res 1990;15:121-35.
26. Leiberman HR, Corkin S, Spring RJ, et al. Mood, performance and pain sensitivity: changes induced by food constituents. J Psychiatr Res 1982;17:135-45.
27. Shpeen SE, Morse DR, Furst ML. The effect of tryptophan on post-operative endodontic pain. Oral Surg Oral Med Oral Pathol 1984;58: 446-9.
28. Seltzer S, Dewart D, Pollack RL, Jackson E. The effects of dietary tryptophan on chronic maxillofacial pain and experimental pain tolerance. J Psychiatr Res 1982-83;17(2):185-6.
29. Hanck A, Weiser H. Analgesic and anti-inflammatory properties of vitamins. Int J Vitam Nutr Res Suppl 1985;27:189-206.
30. Hieber H. Treatment of vertebragenous pain and sensitivity disorders using high doses of hydroxocobalamin. Med Monatsschr 1974;28:545-8 [in German].
41. Lin DZ, Fang YS. Modern Study and Application of Materia Medica. Hong Kong: China Ocean Press, 1990, 323-5.
42. Hedner T, Everts B. The early clinical history of salicylates in rheumatology and pain. Clin Rheumatol 1998;17:17-25.
43. Cherng CH, Wong CS, Ho ST. Spinal actions of non-steroidal anti-inflammatory drugs. Acta Anaesthesiol Sin 1996;34:81-8.
44. Robbers JE, Tyler VE. Tyler’s Herbs of Choice: The Therapeutic Use of Phytomedicinals. New York: Haworth Press, 1999, 200-4.
58. Rybarczyk B, DeMarco G, DeLaCruz M, Lapidos S. Comparing mind-body wellness interventions for older adults with chronic illness: classroom versus home instruction. Behav Med 1999;24:181-90.
59. U.S. Department of Health and Human Services. Public Health Service. Acupuncture. NIH Consensus Statement 1997;15:1-34.
* The information presented on Sun Pharmacy is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.
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