Un­der­stand­ing and deal­ing with pain

The Star Malaysia - Star2 - - Bms Wellness -

PAIN can arise from dif­fer­ent ori­gins. Specif­i­cally, pain can be di­vided into no­ci­cep­tive, in­flam­ma­tory and neu­ro­pathic.

No­ci­cep­tive pain oc­curs af­ter tis­sue dam­age or in­jury, with­out dam­age or im­pair­ment in ner­vous sys­tem func­tion. 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. Once again, the ner­vous sys­tem is not im­paired.

Neu­ro­pathic pain arises as a di­rect con­se­quence of nerve dam­age or dis­ease af­fect­ing the nerve fi­bres. Ex­am­ples in­clude nerve in­juries, post-her­petic neu­ral­gia and toxic and metabolic pe­riph­eral neu­ropathies.

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 a com­plex dis­ease and in many cases, pa­tients suf­fer from painful con­di­tions caused by mul­ti­ple, co-oc­cur­ring mech­a­nisms. This mix­ture of pain types has been de­fined as the “mixed pain con­cept”.

Mixed pain is de­rived from both no­ci­cep­tive/in­flam­ma­tory and neu­ro­pathic ori­gins.

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

Of­ten, the neu­ro­pathic com­po­nent may go un­recog­nised, par­tic­u­larly with pain such as os­teoarthri­tis with a strong his­tory of be­ing as­so­ci­ated with purely no­ci­cep­tive/ in­flam­ma­tory mech­a­nisms.

Man­age­ment of mixed pain

The na­ture of mixed pain re­quires a com­bi­na­tion treat­ment which ad­dresses both the no­ci­cep­tive and neu­ro­pathic pain com­po­nents.

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

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

Each of these B vi­ta­mins has been found to have unique es­sen­tial roles, which con­trib­utes to nerve func­tion.

Vi­ta­min B1 is in­volved in en­ergy me­tab­o­lism, helps in main­tain­ing the myelin sheath cov­er­ing the axon of nerves and in the syn­the­sis of key sig­nalling mol­e­cules in the ner­vous sys­tem known as neu­ro­trans­mit­ters.

Vi­ta­min B6 is in­volved in the syn­the­sis of neu­ro­trans­mit­ters (key sig­nalling mol­e­cules in the ner­vous sys­tem).

Vi­ta­min B12 is in­volved in nerve cell mat­u­ra­tion and re­gen­er­a­tion, nerve cell me­tab­o­lism and for­ma­tion of nerve myelin sheaths.

Neu­rotropic B vi­ta­mins can be used in com­bi­na­tion with NSAIDs to re­lieve mixed pain.

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

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

A holis­tic ap­proach to pain man­age­ment ad­dresses the emo­tional and psy­cho­log­i­cal ef­fects of pain and can also in­clude com­ple­men­tary and al­ter­na­tive ap­proaches to pain con­trol.

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

As part of con­tin­u­ous ini­tia­tives to raise aware­ness on the im­por­tance of healthy nerves, Merck is pro­vid­ing nerve tests us­ing bio­th­e­siome­ter at se­lected phar­ma­cies na­tion­wide.

This ar­ti­cle is brought to you by Merck Sdn Bhd.

The in­for­ma­tion con­tained in this ar­ti­cle is not in­tended or de­signed to di­ag­nose, pre­vent, treat or pro­vide a cure for any con­di­tion or dis­ease, to as­cer­tain the state of your health or be sub­sti­tuted for med­i­cal care.

Merck en­cour­ages you to seek ad­vice from your doc­tor or health­care pro­fes­sional if you have any ques­tions or con­cerns aris­ing from the in­for­ma­tion in this ar­ti­cle.

■ For more in­for­ma­tion, e-mail ch.my@mer­ck­group.com

A holis­tic ap­proach to pain man­age­ment ad­dresses the emo­tional and psy­cho­log­i­cal ef­fects of pain and can also in­clude com­ple­men­tary and al­ter­na­tive ap­proaches to pain con­trol.

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