Knowing how to deal with pain

PAIN is necessary for us to understand something is wrong or damaged within our body. It signals us to take protective actions.

However, pain is also the most common reason people seek medical care and ongoing pain can have negative consequences with an impact on overall health and quality of life.

Patients suffering from severe pain frequently experience social isolation, dependence on caregivers and often suffer from impaired relationships with friends and family.

Compared to healthy people, pain sufferers are four times more likely to get depression or anxiety.

Understanding the complexity of pain

Pain can be divided into nociceptive, inflammatory and neuropathic pain.

Nociceptive pain is caused by tissue damage or injury, without a damage or impairment in the function of nervous system.

Examples include burns, sprains, bone fractures, and bruises.

Inflammatory pain is associated with the immune system responding to tissue injury, such as in an infection or from joint inflammation in people with rheumatoid arthritis.

The nervous system is also unimpaired in this type of pain.

Neuropathic pain arises as a direct consequence of nerve damage or disease affecting the nerve fibres.

Examples include nerve injuries, post-herpetic neuralgia (persistent nerve pain that occurs at the site of a previous attack of shingles caused by the chickenpox (herpes zoster) virus), and toxic and metabolic peripheral neuropathies (for example, nerve damage cause diabetes).

Characteristics of neuropathic pain include burning, stabbing, tingling, pins and needles, as well as spontaneous (pain arising without stimulus) and abnormal responses to non-painful or painful stimuli.

Pain is complex and in many cases, patients suffer from conditions caused by multiple, co-occurring mechanisms.

This mixture of pain types has been defined as the “mixed pain concept”.

This is derived from both nociceptive/ inflammatory and neuropathic origins.

In many common conditions, such as lower back pain and osteoarthritis, pain can have both nociceptive and neuropathic components.

Often, the neuropathic component may go unrecognised, particularly in osteoarthritis with a history of being associated with nociceptive or inflammatory mechanisms.

Management of mixed pain

The nature of mixed pain requires a combination treatment addressing both the nociceptive and neuropathic pain.

Neuropathic component of mixed pain could be adequately managed with medicine indicated to relieve neuropathic pain and medicine such as non-steroidal anti-inflammatory drugs (NSAIDs) help to relieve nociceptive or inflammatory pain in mixed pain.

Alternative treatment option such as neurotrophic B vitamins (B1, B6 and B12) are available to target the underlying cause of the neuropathic pain which is nerve damage.

For example, a combination of a NSAIDs called diclofenac and neurotropic B vitamins (B1, B6, and B12) helps improve lower back pain and shorten treatment period compared to taking diclofenac alone, as reported in studies published in scientific journals.

While NSAIDs targets the nociceptive and inflammatory pain mechanisms, the neurotropic B vitamins nourish and help regenerate nerves.

Holistic approach to pain management addresses emotional and psychological effects of pain, and can also include complementary and alternative approaches to pain control.

Consult a doctor for examination and diagnosis of pain, for a proper treatment plan based on your condition.

Merck is also providing a nerve test using biothesiometer at selected pharmacies nationwide to raise awareness on the importance of healthy nerves. This article is by Merck Sdn Bhd.

For more information on the event, e-mail to ch.my@merckgroup.com.