Managing and Controlling Pain

Medical techniques 

Sarafino (2006) highlighted four types of chemicals that can help to reduce or eliminate pain:

1. Peripherally active analgesics – these inhibit the production of certain neurochemicals that are produced as a result to, for example, tissue damage. Common drugs used would be ASPIRIN or PARACETAMOL.
2. Centrally active analgesics – these act directly on the central nervous system, therefore they are good to reduce short-term acute pain. Examples would be MORPHINE or CODEINE.
3. Local anaesthetics – these can be applied locally to the site of pain to give almost immediate relief as they block the nerve cells at the site. An example would be NOVOCAINE.
4. Indirectly acting drugs – these are used for other conditions but can also help in pain management. For example, anti-depressants can relieve pain as well as sedatives.

Surgical techniques to reduce or eliminate pain:

• Cutting or creating lesions in the pain fibres at the site of damage so that the sensation can no longer be conducted or felt.
• Disrupt the conduct of pain from periphery fibres to the spinal cord. 
• Interrupt pain sensations from the spinal cord upward to the brain

It is useful to note that all these techniques – both surgical and medicines – are good to a certain extent because they cause side-effects and can quite expensive if health services in the country do not provide them for free or with a discount. Also, drugs can create an addiction as the body may feel withdrawal symptoms, mostly with more important chemicals such as morphine.

Psychological techniques – cognitive 

A variety of cognitive strategies can be used to help alleviate and control pain. Sarafino (2006) noted some of them:

• Attention diversion – patients focus on something that is not linked to pain to take away the attention from it. The distractions need to be interesting for the patient and they need to believe that the technique will relieve the pain for it to work effectively.
• Non-pain imagery – patients create a mental scene away from the pain and the therapists guide them through it and encourage the use of a variety of senses. This is very effective for mild or moderate pain.
• Pain redefinition – patients need to substitute realistic thoughts about pain for ones that arouse feelings of fear/threat. There are two types:

1. Coping statements – emphasis on the person’s ability to tolerate and control the pain.
2. Re interpretative statements – designed to negate unpleasant aspects of pain.

Also, Cognitive Behavioural Therapy (CBT) can be used and it involves finding out the patient’s thinking behind pain, the emotions and the behaviour as a result of it. The therapist can provide them the techniques above to change their thoughts from negative to positive.

Alternative techniques 

• Acupuncture – ancient Chinese practice of inserting fine metal needles under the skin in the areas chosen depending on the source of pain. They are ‘twirled’ or stimulated electrically to provide alleviation to the sensation of pain.
• Transcutaneous electrical nerve stimulation (TENS) – electrodes are placed on either side of the site of pain and the electrical current conducted through them reduces the feeling of pain.