Thursday, February 3, 2011

Understanding Your Pain To Avoid Painkiller Addiction

Pain is the main reason most people in the U.S. go to see their doctors. The onset of pain indicates two conditions: something has gone wrong in the body that needs correcting, or something is harmful to the body that needs to be avoided or removed. 

From very early childhood we know that fire burns and hurts, so we avoid putting our fingers in fire. We know that hitting our knees against a piece of furniture hurts, so we are careful when walking in the livingroom or office to avoid running into furniture.

So far so good for the one type of pain. The other type that is not fully understood by many people is pain from a medical condition. This pain may be mild or intense, but necessary for your survival. It is an early warning of a harmful condition in the body, if left uncorrected could lead to severe danger to your life.

In ordinary language, pain is a sensation that hurts. It can be steady and constant, throbbing or pulsating, or a pitching or a stabbing sensation. Acute pain is intense resulting from injury, and lasts for a short time. It ends with the healing of the injury.

On the other hand, chronic pain lasts for a longer period of time and may be mild or intense. Pain from surgery, sickle-cell and cancer are chronic pains that are often relieved only by painkillers.  You may be wondering how people managed their pain centuries ago when the powerful painkillers we have today were not available.

Well, medieval university-trained doctors are believed to have used opiates to relieve their patients pain. However, the extent to which opiates were used has not been fully established. The most likely pain remedies available to medieval patients would have been ice for local pain, bloodletting, laxatives, purgatives, astrological seals and the monitoring of food, drink and sleep; aimed at restoring the humoral balance, or what is today called homeostasis.

This would have meant medieval patients endured extended periods of pain before getting relief, if it came at all. Merely thinking about this will make you and I cringe, knowing how tormenting and disruptive intense pain is to the mind, and normal functioning of the body.

More than any other human experience, pain can literally drive a person crazy to where he or she is willing to do anything for a relief. In this regard, resigned acceptance of pain is a false remedy, because when experiencing an intense acute or chronic pain, the ability to remain steadfast in accepting pain will fall apart.

Consequently, understanding what pain is, and taking effective action to relieve it is the option of choice for today's men and women.

Pain may be classified as nociceptive, which comprises somatic and visceral pains, while non-nociceptive comprises of neuropathic and sympathetic pains.

Pain felt on the skin, joints, bones, muscles and ligaments are somatic pains. Somatic pain receptors are sensitive to temperature, vibration, stretch in muscles, and inflammation caused by cuts and sprain that damage tissue. Somatic pain is intense, localized and painful to touch and movement.

Pain felt in internal organs including the lungs, heart, bowels, spleen, liver, kidneys, ovaries, bladder and the womb are visceral pains. Visceral pain receptors are sensitive to inflammation, stretch and ischemic muscle cramps caused by lack of oxygen to the affected area. Visceral pain is vague deep aches, difficult to localize, as in upper and lower back pain, pelvic and abdominal pain.

Nerve or neuropathic pain is non-nociceptive. It originates from within the nervous system with no specific pain receptors. Pinched nerve or trapped nerve are neuropathic pain which comes from nerves between the tissue and spinal cord, or peripheral nervous system; and nerves between the spinal cord and the brain, or central nervous system.

Neuropathic pain is caused by nerve degeneration as in a stroke, multiple-sclerosis and oxygen deprived tissue. A torn or slipped disc resulting in nerve inflammation, or nerve infection like shingles can cause neuropathic pain.

Inflamed or infected nerves becomes unstable. They send muddled signals to the brain which interprets them as pain signals, and produces sensations such as numbness, tingling, and hypersensitivity to touch, temperature and vibration.

The other type of non-nociceptor pain is sympathetic pain. A fracture or soft tissue injury will cause sympathetic pain. The damaged nerves in the affected area will become unstable, and send random and abnormal signals to the brain which will interpret them as pain. Sympathetic pain can become extremely intense that the patient may not use the injured arm or leg resulting in muscle wasting, joints stiffness or osteoporosis.

As you have already noticed, we will feel no pain if we did not have pain receptors. These are free nerve endings through out the body that warn us of excessive pressure or temperature in the environment. The terminal ends of these pain receptors consist of unmyelinated nerve fibers mostly found in the epidermis and epithelial covering of mucous membrane.

Unlike pain receptors in the skin and mucous membrane epithelial covering, stimulation of pain receptors in the organs, the joints, the skeletal muscles and connective tissue requires extreme pressure and chemical changes in the body.

When pain receptors are stimulated, they release neurotransmitters that send a message about the stimulus through the nerves to the spinal cord and the brain.

The substance that stimulates pain receptors are called second messengers. The main second messengers are bradykinin, prostaglandins, histamine, serotonin, leukotrienes, and potassium. Painkillers that inhibit the release of second messengers will prevent the stimulation of pain receptors, and consequently provide effective pain relief.

Since pain may vary from mild to intense, the medical establishment has guidelines to measure pain levels to assist doctors prescribe the right pain medications for their patients. These guidelines include pain identification, location, intensity and radiation; aggravating and relieve factors of the pain; effect of the pain on patient's function and others.

For patients who cannot verbalize the intensity and location of their pain, as in the case of an infant, or a patient with dementia, dyslexia or autism, the doctor will find clues of the pain from observing the degree of the patient's restlessness, grimacing, moaning, groaning, crying, resistance to care, reduced social interactions, not eating and not sleeping.

When the intensity and location of pain have been determined, the next step is to provide a relief. Doctors are careful when prescribing painkillers for their patients, as these are powerful drugs with serious side effects. A misuse of painkillers can increase a patient's pain level, and in extreme cases be hazardous to the patient's life.

Effective over the counter painkillers on the market include: combination of aspirin and acetaminophen for head and muscle ache; ibuprofen for fever and muscle ache; naproxen sodium for arthritis, rheumatism, musculo-skeletal aches; and ketoprofen for arthritis.

With prescription painkillers the strongest include fentanyl for gunshot and fragmentation wounds; morphine sulfate believed to be the second strongest pain medication; as well as hydromorphone, hydrocloride, or dihydromorphinone; and oxymorphone.

As I have said before these over the counter and prescription painkillers are powerful drugs with serious side effects. They should be handled with care, and taken only under the supervision of your doctor. Not only do they cause serious health hazards when misused, they can also be addictive.

Talking about painkiller addiction, 2 million Americans use prescription opioid painkillers every year, according to the National Household Survey on Drug Abuse (NHSDA 2002). The problem with this is that medical practitioners have found that patients on prescription painkillers beginning at pain levels 2-3 after one year have seen their pain levels rise to 8-9.

In effect, the condition of patients on opioid painkillers gets worse the longer they remain on the medication. The explanation for this is opioid-induced hyperalgesia, a condition where the patient becomes increasingly sensitive to pain stimulus with increasing doses of painkillers. The natural reaction is to reduce the doses, but when this is done, the patient may suffer a withdrawal, with sensitivity to pain still remaining high.

At this point the patient is said to be addicted to opioid painkillers. Going forward, he or she will have two choices, either to seek pain relief from a more powerful painkiller, or search for an alternative to opioid painkillers.

An effective alternative to opioid painkillers may well be homemade juices from fruits, vegetables and herbs. Working with a dietitian, or a holistic physician, you could experiment with various combination of fruits, vegetables and herbs to find which one your pain responds to. It may take a while to find what works for you, but what do you care; homemade juices, especially from organic produce, taste delicious and wholesome.

If given a choice to relieve my pain, I will prefer to become addicted to homemade juices with no side effects than to opioid painkillers, and I think you would too, once you start juicing for good health.

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