PAIN


A SORE SPOT FOR SCOTLAND


THE INTERNATIONAL ASSOCIATION FOR THE STUDY OF PAIN (IASP) DEFINES PAIN AS:


‘…AN UNPLEASANT SENSORY AND EMOTIONAL EXPERIENCE ASSOCIATED WITH ACTUAL OR POTENTIAL TISSUE DAMAGE OR DESCRIBED IN TERMS OF SUCH DAMAGE’¹


P increasing age3


ain is a major health problem which increases in both prevalence and impact with . Approximately ten


million people in the UK suffer from some form of pain on a daily basis. As much as 20 per cent of all GP consultations involve pain2


.


Although the cost of pain to the NHS per annum is unknown, recent data reported an average cost of four billion pounds each year is spent on treating pain in adolescents’ alone2


.


Astonishingly, British businesses lose approximately 9.4 million working days to employee absenteeism with work-associated back pain2


. If not


managed appropriately, pain can have a signifi cant effect on quality of life, not only for those affl icted but also their close family and friends. Often pain cannot be cured completely, however with the provision of support and correct treatment, suffering can be limited6


.


Classifying pain aids the selection of appropriate treatment. It is classifi ed clinically as mild, moderate or severe. This classifi cation is not always reliable as it is dependent on


20 - SCOTTISH PHARMACIST


the person using it; different people have different pain thresholds1


.


The temporal classifi cation of pain describes it in accordance with its duration; acute pain diminishes over time and lasts under twelve weeks. Chronic pain lasts anything above twelve weeks. Pain can also be described in relation to the body’s physiological functions; this is termed as neurophysiological classifi cation and it is branched into nociceptive and non- nociceptive bodily functions1


.


Nociceptive pain is that which is transmitted following stimulation of some of the millions of nociceptors the body contains. Some nociceptors respond to extremes of temperature, others to chemicals such as that produced from a wasp sting, and others to injury1


is felt along the left arm following myocardial infarction1


.


Non-nociceptive pain, or neuropathic pain, is that which results from nerve damage or problematic nerves7


, 1. It


is estimated that seven per cent of the UK suffer from chronic neuropathic pain. It can result from surgery, trauma or medical conditions such as diabetic neuropathy. Patients will describe this type of pain as burning, stabbing, tingling, radiating, electric shock or paraesthesia. Associated symptoms can include allodynia, where stimuli that should not normally induce pain do. Fatigue, depression, decreased concentration, anxiety and sleeping diffi culties can also be problematic1,7


.


Nociceptive and neuropathic pain can co-exist8


. . Somatic nociceptive


pain is that which is localised to one area; a patient can pinpoint the exact point on the body where the pain is occurring. Somatic pain usually has an external cause; an example would be a stab wound1. Visceral nociceptive pain is more diffuse in nature and has an internal cause. At times it can be referred pain such as that which


The World Health Organisation established an analgesic ladder as a model for treating cancer pain back in 1986. Today, this model is used as a pain management framework that can be applied to any form of pain, acute or chronic. Step one of the ladder states that paracetamol used in combination with a NSAID (if appropriate) is ideal for the treatment of mild pain. Step two outlines the treatments for mild to moderate pain and stipulates the addition


of a weak opioid such as codeine, dihydrocodeine or tramadol to the paracetamol and NSAID combination. Step three treats moderate to severe pain and looks to discontinue the weak opioid and begin a strong opioid, such as morphine. Adjuvant drugs may be used at any step of the ladder; although not analgesic in their mechanism of action, they may have analgesic effects on certain types of pain1


. Unlike chronic


. An example of such a drug is diazepam, often prescribed to enhance muscle relaxation1


pain which steps up the analgesic ladder, patients with acute pain usually begin with step three and work down the scale until the cause of the pain desists1


.


Many patients have a poor opinion of paracetamol because it is widely available at fuel stations and local superstores and it is inexpensive. However, paracetamol is a very effective drug when taken regularly for both pain and temperature reduction1


. It should be recommended


as fi rst line treatment for any type of pain. It’s mechanism of action is not known exactly despite the drug having been on the market for over 50 years1. Reports suggest that it inhibits prostaglandin production and in doing so it interferes with the transmission


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