Whenever you open a medical text on pain, it divides pain into acute and chronic. This is a more complicated way of talking about time. When you have been involved in an accident, whether on the sport field or in a traffic accident, there’s every hope you will make a complete recovery. That means controlling the pain while the wounds heal and the bones knit back together. As time passes, the pain will fade naturally. Towards the end, you can stop using painkillers and carry on with life more or less as before. But there are some injuries or diseases where the underlying cause is not going to give in. No matter what the surgeons try or the drug companies devise, there is no cure. Without a cure, the pain is going to continue. Faced with this, the best doctors have taken a strategic decision. They have to treat the pain as if it was a disease or disorder in its own right. In all the better hospitals and larger clinics, specialist pain management teams are being put together. This draws an interesting range of people into the same group so that the following services can all be made available:
- liaison with the specialists treating the underlying cause;
- surgery or similar less invasive procedures aimed at relieving the pain;
- physical therapy, counseling and other conventional support services;
- alternative therapies such as acupuncture, massage, magnetic and electrical treatments; and
- the use of different types of drugs.
The constant problem is diagnosis and treatment. Are the specialists absolutely certain as to the underlying cause and have they exhausted all reasonable options for treatment? If so, it comes down to balancing benefits and costs. Pain is a highly subjective feeling. Some people respond with melodrama when in pain. Others are stoic, sitting quietly and calmly while perhaps feeling great pain. The final group can become incapacitated. They can simply give up, take to their beds and become invalids. Or they can sink into depression. So pain management begins with a review of all that has gone before, making judgements about how well the person is standing up to the pain and so identifying the best options for future treatment.
During this time, the most usual painkiller is Tramadol. This is an effective and safe way of controlling moderate to severe pain in most cases, i.e. no matter whether there is a clearly identified cause for the pain. If the review turns up errors or omissions in the previous course of treatment, remedial action will follow. If there is no suggestion of error, the only options are conventional and alternative approaches supported by painkillers. Time will have passed during the review so the team will be able to ask the patient for an opinion on how well the Tramadol is working. It is possible this drug will be sufficient for longer term use in combination with physical therapy and cognitive behavioral therapy. But if the patient reports an unacceptable level of pain, the doctors must abandon Tramadol and experiment with something stronger over the short term. The difficulty is that the stronger painkillers are more addictive and so should only be used in short bursts. The aim should be to gain time for the cognitive behavioral therapy to teach coping strategies so that the less powerful drugs may resume.