Pain

The Secret of Great Health Care

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Pain

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Pain is an unpleasant sensation or experience that is linked to real or potential tissue damage. There are two broad categories or pain: nociceptive pain and neuropathic pain.

Nociceptive pain is usually related to tissue injury. Neuropathic pain is nerve pain. I will not bore you with a detailed discussion of these two types of pain, but the most common type of pain is nociceptive pain. Almost any disease process can cause pain.

This section will look at pain caused by minor muscle or bone injury and low back pain and how it can be treated with non-prescription medications.

Who needs to see a doctor

The following groups of people need a doctor

Severe pain

Increasing pain

Changing character of the pain

Significant stomach pain

Deformed joint – swelling

Inability to move a joint

Associated nausea, vomiting, diarrhea or fever

Back or stomach pain

Pain in the last trimester of pregnancy

Pain associated with weakness in the limb

Treatments
Treatment involves identifying the cause of the pain and tying to treat its underlying cause. While the underlying cause is being treated, the management of pain is important, with over-the-counter medications. Self-management of pain is appropriate for those who have a self-limiting condition that does not meet the criteria for "who needs a doctor".

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Over-the-counter products
Like fever, there are three main types of oral over-the-counter medications for the treatment of pain: aspirin (ASA), acetaminophen (APAP), and nonsteroidal anti-inflammatory drugs (NSAIDs) which include ibuprofen and naproxen sodium.

Topical products are also available for the management of pain. Topical agents work directly in the soft tissue and nerves just below the soft tissue. They should be applied no more than 4 times a day. Do not use heating pads on top of the rubs.
Topical pain medications are useful for minor pain. They work by counter irritation. This means that they produce a less severe pain to counter the effects of the more severe pain. These medications distract the body from the more severe pain in the muscles, joints or tendons.

These products come in a variety of vehicles including cream, ointments, gels, lotions and patches. Ointments have greater potency, but are greasy and not tolerated as well. Patches do not allow one to rub in the medication, which may be one of the beneficial effects of the medication,

Rubefacients cause the blood vessels to dilate and blood to pool. This is accompanied by an increase in the skin temperature. These products give a feeling of cold or heat over the painful area resulting in a soothing of the underlying pain.

Camphor and menthol products excite the nerves and make them feel cold and then warm which will decrease the pain sensation.

Some products contain a product that is similar to aspirin. These include products such as: Aspercreme, BenGay, Flexall, and Sportscreme.

Capsicum – an ingredient in Cayenne peppers - depletes a substance called substance P in the nerves, which is believed to cause pain. It blocks this chemical, which is believed to deliver pain messages to the brain. Studies are variable on this product, but some studies in arthritic patients have shown nice results in regards to reduction of pain. It is recommended that this product is applied while using disposable gloves and avoid contact with the mouth, eyes or nose.

Which is the most effective topical product? The answer to this question is not known. No research compares the products. These products are likely not as potent as oral medications, but may provides some relief. They can be used in combination of with oral products.

Topical products are not associated with too many side effects. Irritation to the skin is one of the more common side effects. It may cause the skin to burn and get red. Severe allergic reactions – which present with hives, swelling of the lips, breathing troubles – are rare. If this happens seek emergency care immediately.

To purchase products discussed in this chapter visit The Drug Store.

Some topical products are available by prescription. A pharmacist can make products that contain NSAIDs. These may be options for people who cannot take the side effects of oral NSAIDs and have localized pain. These products provide only short-term relief.
Patches with lidocaine are available by prescription and work by blocking the transmission of pain impulses.

What to do

Do you need to see a doctor (see list above). If you have any of the criteria for "who needs to see a doctor" – visit a health care provider.

How did you injure your self? (Use new pain worksheet to evaluate your pain)

If pain occurred from muscle/joint injury or over exertion than use RICE therapy (table 2)?

Add non-prescription pain medications (see previous chapter) to help with pain. Theoretically NSAIDs are more effective because they have anti-inflammatory effects, but in reality they are equally effective choices. Routine pain medication should be given for 1-3 days.

The addition of topical products is an appropriate strategy for those who do not get relief from oral medications

If pain remains after 10 days or pain is worsening after the initial injury follow up with your doctor.

Table 2: RICE therapy

RICE therapy is an acronym that describes four steps to help in the management of an acute muscle or joint injury. Rest the injured areaIce – apply ice to any injury up to 48 hours after the injury. Ice is applied for 10-minute intervals four times a day. You may use heat after the first 24-48 hours. Compression – wrap the injured area with elastic support or bandageElevate the injured area above the heart.

Over the counter products, medical supplies and health products can be found at: CWI Medical – Medical Supplies and Health Care Products or at The Drug Store.

Topical Pain Medications

Product	Medication	Directions
BenGay – Vanishing Scent	Menthol 2.5% - Topical analgesic	12-years-old and older apply to affected area 3-4 times a day
BenGay – Ultra Strength	Camphor 4%; Menthol 10%; Methyl Salicylate 30% - Topical analgesic	12-years-old and older apply to affected area 3-4 times a day
BenGay – Ultra Strength – pain relieving patch	Menthol 5%	12-years-old and older apply to affected area 3-4 times a day
Flexall – Maximum Strength	Menthol – topical analgesic	12-years-old and older apply to affected area 3-4 times a day
BioFreeze	Natural Menthol USP – 3.5%	2-years-old and older apply to affected area 3-4 times a day
IcyHot Gel	Menthol 2.5% - Topical analgesic	12-years-old and older apply to affected area 3-4 times a day
IcyHot Balm – Extra Strength	Menthol 7.6% and Methyl Salicylate 29%	12-years-old and older apply to affected area 3-4 times a day
Mineral Ice	Menthol 2%	2-years-old and older apply to affected area 3-4 times a day
ActivOn – Joint & Muscle	Menthol 4.127%	12-years-old and older apply to affected area 3-4 times a day
ActivOn – Arthritis	Histamine Dihydrochloride 0.025 and Menthol 4.127%	12-years-old and older apply to affected area 3-4 times a day
Tiger Balm Ultra	Camphor 11% and Menthol 11%	12-years-old and older apply to affected area 3-4 times a day
IcyHot – Cream	Menthol 10% and Methyl Salicylate 30% - Topical analgesic	12-years-old and older apply to affected area 3-4 times a day
Capzasin HP	Capsaicin 0.1% - Topical analgesic	18-years-old and older apply 3-4 times a day
Myoflex	Trolamine Salicylate 10% - pain reliever	2-years-old and older apply to affected area 3-4 times a day
Sportscreme	Trolamine Salicylate 10% - pain reliever	10-years-old and older apply to affected area 3-4 times a day
IcyHot Patch	Menthol 5% patch	12-years-old and older apply to affected area for up to 8 hours – up to four times a day