“Take two aspirins and call me in the morning.” If only resolving pain were as simple as this age-old joke about the benefits of a few pain relievers and a good night’s rest. In reality, the situation for patients suffering from chronic or acute pain is much more difficult. It’s a complex equation that includes the patient’s perception, overall health, the source of the pain and the many options available to treat it.
Fortunately, medical professionals such as Eric Schwenk, M.D., FASA, in the Department of Anesthesiology at Thomas Jefferson University, are on the pain management front lines helping patients improve their quality of life. Dr. Schwenk treats acute pain in hospitalized patients at Jefferson Health.
“While the complete elimination of pain is not realistic, we’re able to help patients experience a significant reduction in their symptoms and improvement in function,” said Dr. Schwenk. “We return them to their lives with a manageable level of pain, so they can enjoy things like dinner with their families or a walk around the neighborhood.”
Understanding the Different Types of Pain
In general terms, pain is either acute or chronic. Acute pain is pain that lasts a finite period of time, usually days to weeks, and may result from trauma, an accident, surgical incision, infection or several other etiologies. Chronic pain is pain that, according to one definition, lasts for longer than 12 weeks and in some cases may never truly resolve. Low back pain is a common form of chronic pain; it can start as acute pain from an injury but then linger and evolve into one of the most common sources of chronic pain.
If you’ve ever seen a physician for pain, you’ve likely been asked to rate your pain on a scale from 0 (no pain) to 10 (the worst pain of your life). This traditional scale is a useful tool for doctors to judge the severity of your pain and if it’s improving or getting worse.
“However, the number doesn’t tell the whole story and we still have to get more information,” said Dr. Schwenk. Since pain is subjective and some patients consistently report high numbers, reliance on that scale might have contributed to the rise in the opioid crisis.
“You have to find out the quality of the pain; there are different pain subtypes—sharp, burning or dull, aching pain are typical ways patients describe their pain,” said Dr. Schwenk. Determining the quality of the pain can help doctors identify the source and the best potential treatment for it. Blood pressure, heart rate, facial expression and the patient’s answers all factor into how a physician judges and manages pain in addition to observing his or her function.
Pain Management and Opioids
When patients think of pain management, opioids usually come to mind. Given the momentum and impact of the opioid crisis, this understandably makes most people a little nervous and sparks the inevitable thought of “will I become addicted?” However, physicians themselves are well aware of these issues and work to minimize these risks for patients.
For patients with substance use disorder, and for those who are unable to tolerate opioids for other reasons, there are different classes of drugs that can be used to improve pain and reduce side effects. In most cases, treatment involves a combination of different medications, as well as non-medical treatments like physical therapy, massage, acupuncture, and counseling, to effectively treat pain.
This does not mean that opioids cannot or should not be used for some types of pain. “Opioids can be effective at treating pain related to cancer and for providing relief in palliative patients with serious, terminal pain,” said Dr. Schwenk. Reserving opioids for pain not effectively treated with other classes of drugs is a reasonable goal.