Illness, injury and the other insidious conditions make a strongly unpleasant bodily sensation or mental suffering which are usually termed as pain, as per the dictionary. Drugs used to reduce pain are called pain-killers.Brain and spinal cord are included in the Central Nervous System. (CNS) Peripheral nerves stem from and lead to CNS. The brain processes the pain message and coordinates an appropriate response. Endorphins are natural pain killers in the body.Chronic pain in the cancer patients or patients suffering from neuropathy or nerve damage requires palliative care and the drugs used only alleviate the pain. Such drugs do not have curative properties. Patients suffering from incurable diseases lament due to excruciating pain. Palliative care is essential for them as a philanthropic measure as it helps to lead a peaceful life till the end. Recent developments in this field are the result of benevolent attitude of the government as well as the non-government organizations. Such services are gratis and palliative care drugs are provided with the aids received from various sources. Unresolved pain is thus alleviated. Other types of pains like injury, headache etc. are classified as acute pain or nociceptive pain transmitted by nociceptors. A pain message is transmitted by peripheral nerves to the central nervous system. Such PNS cells are called nociceptors which are distributed throughout the body. Nociceptive means sensitive to pain or causing pain. Nociceptors respond to different stimuli. Doctors say that headaches may indicate Stage I or Stage 2 hypertension. Blood pressure is measured in millimetres of mercury. (mm Hg) The systolic number is 120 and the diastolic is 80 in ideal condition. Angina is caused by fat deposit. The build up of plaque narrows the coronary arteries. So we have high blood pressure due to coronary artery disease. Such pains are alleviated by proper treatment. Non-steroid anti inflammatory drugs (NSAIDs) alleviate pains due to arthritis. Cortico steroids are also used. Disease modifying anti-rheumatic drugs (DMARDs) also reduce pains and inflammation. Allergic reactions, muscle cramps, ulcers, abdominal cramps, liver disease, kidney disease, coagulation disorder, heart disease etc. occur when NSAIDs are used indiscreetly. Long use of acetaminophen causes kidney and liver damage. Arthritic pain is due to joint damage. Strengthening the muscles on the front and back of the thigh helps knee and hip joints. Gentle exercises help reduce arthritic pain. Narcotics may reduce the pain, but there is a possibility of addiction.Cirvical spondylosis too causes pain to the neck which may radiate to shoulders and shoulder joints. Headaches and spinning sensation make life more miserable. Light massage and neck exercises are advisable as they do not have the side effects of drugs. Hot and cold packs also help to a certain extent. Life style modification will help to reduce such pains. Thalamus is a specific region of the brain. The nociceptor first transmits its signal to nerve cells in the spinal cord. From there the pain message is sent to the thalamus. An appropriate response is required for every kind of pain. Endorphine, the natural pain killer, helps a great deal. But pain has to be enhanced as a response. Prostaglandins in the body enhance the pain and the response may be inflammation. Usually the cause of pain is treated. Surgical procedures, pharmacological therapies etc. help to repair injuries. Analgesics reduce the pain. Asperin, narcotics acetaminophen etc. handle intense pain. Antidepressants, anticonvulsants, corticosteroids etc. are also used by doctors for pain management.Pain management without side effects is made possible with the help of Yoga, acupuncture and acupressure. In some cases, surgical procedures also help. Correcting the injury, electrical stimulation and disconnecting the nerve are other techniques judiciously used.Palliative careChronic pain management is the aim of palliative care centres. The aim is to stop pain sensations of the patients suffering from incurable diseases. Narcotics are often used to handle intense pain effectively. Opiates or opiods relieve the cancer pain. Doctors and volunteers do great service to terminally affected patients.(The writer is a retired Principal interested in the techniques of pain management.)
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