For example, pain may be due to an injury or illness. But sometimes it is not possible to find the cause of the pain. Pain can suddenly come and go quickly, or be prolonged and last for months. It is important that you who have been in pain for a long time get the right advice and treatment and help to manage your pain.

Different types of pain

Pain can be divided into different categories:

  • Pain from damaged tissue, such as skin or muscle damage.
  • Nerve pain.
  • Psychogenic pain, caused by mental illness.
  • Pain without a clear cause.

Pain due to damaged tissue

Pain due to damaged tissue is called the type of pain you feel when any tissue in the body is damaged such as the skin, muscles and blood vessels. This type of pain is common and most have experienced it at some time. When you burn, for example, the tissue pain you feel. You do this even after surgery  or when you have an inflammation somewhere in the body.

Nerve Pain

Nerve pain is caused by injuries or disorders of the nervous system. Both direct damage to the nerve and pressure on the nerve cause you to experience pain.

In the case of nerve pain, you often experience disruptions in the sensation and altered sensation in the skin, for example. The pain can also radiate into an arm or leg. Sometimes the pain can come in attacks, like lightning. Nerve pain often persists for a long time and is more difficult to treat than pain in damaged tissues.

Examples of diseases and conditions associated with nerve pain are

  • disk hernias affecting the nerve
  • shingles
  • diabetes
  • multiple sclerosis, MS
  • stroke.

Phantom pain is a type of nerve pain

Phantom pain after amputation also belongs to the group of nerve pain. Phantom pain is pain that you feel from a body part that no longer exists. The pain is due to changes in the nervous system and also to some extent of damaged nerve fibers.

Cut off nerve threads that have started to grow again are often extra sensitive, and you can get hurt with just very light touch or without any touch at all.

Psychogenic pain

Psychogenic pain is pain that results from mental illness. The pain thus has its cause in a severe psychiatric diagnosis such as deep depression or severe post-traumatic stress. 

When it hurts for no apparent reason

Sometimes the doctor finds neither tissue damage nor nerve damage that can explain why the pain persists for a long time. This may be because you have changes that cannot be detected by, for example, x-rays or other examinations. Such changes that can occur in an injury or illness can cause long-term pain in, for example, back, muscles and joints, there is research to show.

Pain that has no visible, obvious cause can also be about an old injury that has healed but has not received proper treatment.

Pain conditions without any direct damage can be found, for example

  • whiplash injury or whiplash
  • fibromyalgia
  • pain in the neck and shoulders
  • long term back pain whiplash injury or whiplash

Sudden and long-term problems

The pain can come suddenly and go over quickly, but it can also be prolonged.

Sudden pain often has a clear cause

Sudden pain occurs when, for example, you get a back shot, strike a toe or operate. When the injury heals, the pain usually goes away.

Sudden pain can affect the body in different ways. If you suddenly get a lot of pain, you can start cold sweating, get pale, breathe quickly and superficially, get palpitations and high blood pressure. You may also feel ill and feel dizzy.

Prolonged pain can affect how you feel

Prolonged pain is pain that remains after the time it usually takes for an injury to heal, usually 3-6 months. You do not have to be in pain all the time for the pain to be called prolonged. It can also be about the pain that comes back again and again, such as migraine.

The term chronic pain can be misleading as it may sound like it hurts your whole life, but it doesn’t have to be. The long-lasting pain can be treated with certain drugs and other remedies. Evil may not be completely eliminated but can be relieved.

Examples of illnesses and conditions that can cause long-term pain are

  • muscular rheumatism
  • rheumatoid arthritis, RA 
  • arthritis 
  • nerve damage
  • multiple sclerosis, MS 
  • fibromyalgia 
  • headache
  • muscle
  • back pain.

The pain can sometimes also be due to a disability.

When and where should I seek care?

Contact a health care center if you

  • have long-term pain, that is, pain that has been going on for more than three months
  • if you need the advice to deal with your pain.

Search care directly to a clinic or emergency open reception on

  • you have severe pain, such as severe chest pain or abdominal pain, or if you have severe headaches
  • The pain comes suddenly or comes at intervals
  • you have pain and at the same time have other symptoms, such as fever.

What can I do for myself?

Move

Try to move as much as you can. Fitness and muscle training are good, such as walking, Nordic walking, swimming, cycling, skiing or group gymnastics. If you move too little, there is a risk that the pain will get worse over time. Physical activity that is gradually increased in intensity, a couple of times a week gives positive long-term effects on the functioning of the muscles, on your physical and mental health and also on the pain itself. 

Endorphins are the body’s own painkillers. You can increase the endorphins in your body by exerting yourself to stay warm and sweaty for 20 minutes.

Depression, anxiety and stress can make the pain more difficult to manage

How you feel affects how you respond to pain. For example, the pain may be more difficult to manage if you are depressed, anxious, sleep poorly, experience a lot of stress or have problems at home or at work.

If you are not in mental balance, it can, in turn, help the pain to last and be prolonged. You end up in a vicious circle. Think about which parts of your everyday life you feel good about and which parts you feel worse by and what, for example, make you stressed. Maybe you can change something to reduce stress.

Try to take control of the pain

Sometimes the cause of the pain cannot be treated. It may also happen that the evil is not alleviated by common methods in health care. Then you may need to learn more about pain management. Managing the pain is about taking control of your life, rather than letting the pain control.

Talk therapy can be a good support in your work in trying to deal with the pain.

Treatments for Pain

The treatment depends on the type of pain you have, for example, if it is pain that results from an injury in part of the body, if it is nerve pain or if it is pain with unclear origin.

There are many different treatment methods, including treatments that have been proven to produce long-lasting effects, for example

  • physical activity
  • psychological treatment, that is, cognitive behavioral therapy, KBT
  • electrical stimulation of nerves, tens
  • painkillers.

Other treatments have a more short-term effect, for example

  • relaxation and massage
  • acupuncture
  • cold or heat
  • nerve block.

No method will help in any kind of pain, the treatment must be adapted to each individual.

It is important that you and your doctor have realistic goals when starting pain management. The goal of pain management can be to get rid of the evil at rest, to get less pain or to get a better quality of life even though you are in pain.

Knowledge and participation are important

An important part of the treatment is to get better tools, everything from drugs to psychological methods, to get control of the pain.  

It is very important that you receive education and information and be involved in your own care in order to achieve good pain treatment. Relatives also need information about the pain and different treatment options.

Physical activity

It is easy to become sedentary and passive when you are in pain, but exercise causes the body’s own pain relief system to be stimulated. Among other things, endorphins are released into the blood while increasing blood circulation.

Exercise combined with Cognitive Behavioral Therapy (KBT) can reduce some types of long-term pain. You can also get a workout program that has been tested by a physical therapist, naprapathy or chiropractor.

Psychological treatment

Cognitive-behavioral therapy, KBT, in a therapist trained in pain management has been shown to produce good effects with or without concomitant drug therapy.

The goal of this type of treatment is not to remove the pain itself. Instead, you will learn different behaviors that will give you better control over the pain. It can diminish the feeling that it hurts.

Electrical stimulation of nerves, tens

Tens is a pain relief method that means that nerves under the skin are stimulated by electric currents, which causes the body’s own pain relief system to be activated.

If you have severe nerve pain, you can receive treatment with spinal cord stimulation instead of tens. Then a special electrode is operated against the spinal cord and the stimulation is done via a box under the skin.

Pain killers

There are several different types of both prescription painkillers and prescription painkillers. Which drug (s) you receive depends primarily on the type of pain it is about, how severe you feel it is and its consequences, such as sleep disorders.

The pain-relieving effect and side effects of different drugs can differ from one person to another. Therefore, you may have to try different medicines. The goal is for you to find a drug that works well against the pain without you having too severe side effects.

Relaxation and massage

Relaxation exercises usually relieve if you have aches that are due to muscle tension. When you are in pain, you tighten your muscles even more. Relaxation exercises then break the vicious circle that can easily arise.

Massage can also help with pain, but the effect is usually short-lived. Massage increases blood circulation in the muscles and the secretion of endorphins. In addition, the number of oxytocin increases, a hormone that contributes to a sense of calm and tranquility.

Stretching reduces stiffness and pain. Stretching also improves mobility if the muscles are rigid. Often it is good to first soften the muscles with heat to increase blood circulation and then gently tighten the muscles.

Read more: Relaxation for the shoulders, Relaxation for the whole body, Relaxation for the neck and Relaxation through breathing.

Acupuncture

Acupuncture can work to some extent against headaches, headaches, and temporary inflammations. Often several treatments are needed over a period of time. The pain relief usually comes directly and can last for a few days to several weeks.

Cooling or heat can relieve temporary pain

You can try to cushion temporary, mild pain with the help of cold or heat. If you suffer an acute injury, such as a sprain, cold can reduce the pain. For example, if you have menstrual pain or aches due to stiff muscles, it may be nice to have warmth. For example, you can use a heating pad.

Nerve block

Nerve pain can be blocked in various ways. It is called a nerve block, and can in some cases give longer pain relief. Nerve blocks are mainly used as anesthesia during and after surgery.

When you get a temporary nerve block, a local anesthetic is injected near the nerve. The effect lasts for up to a few hours.

The blockage can be repeated a few times, but should not be used as a regular treatment for a long time.

At a pain clinic, you can get treatment and advice about your pain

In some cases, you may receive a referral to a pain clinic. But then a doctor first needs to do an examination of your pain. At a pain clinic, people with different educational and professional backgrounds work together to help people who have long-term pain. Specialist physicians, nurses, physiotherapists, occupational therapists, psychologists, and curators can be included in the working group. Other occupational categories, such as specialist dentists, may also be included.

Such a cross-professional team can contribute to understanding your pain from different areas of knowledge. It can be especially valuable if you have pain that is difficult to diagnose.

At some pain clinics, you may also receive pain rehabilitation, often in groups, where there are several elements such as pain education and various physical activities. There you will learn more about pain, and how you can affect it in different ways.

It is important that you understand the information

In order for you to be active in your care and to make decisions, it is important that you understand the information you receive from the healthcare personnel. Ask questions if you don’t understand. You can also ask to have the information printed so that you can read it peacefully.

You also have the right to get help from an interpreter if you have a hearing loss.

What happens in the body?

The pain warns that something is damaged

The pain is a built-in protective reflex. It warns that something is damaged or about to be damaged in the body. It makes you react so that hopefully nothing serious can happen.

Pain is a complicated phenomenon and can be described as an unpleasant physical or emotional experience.  

The brain talks about that and where it hurts

The pain receptors found throughout the body respond to heat, cell damage, inflammation, and mechanical pressure. Furthermore, when you have inflammation, substances are formed in the inflamed body part which causes you to get more pain.

The pain signals start when the pain nerves are stimulated. In the spinal cord, the pain pulses are switched to new nerve pathways, which transmit the pain signals to the brain, but also directly to the body’s muscles.

That the muscles get the information directly becomes evident, for example, when you pull away from the hand that was placed on a hot plate even before you consciously felt that it hurts.

In the brain, the pain pulses first reach the brain’s pain center. From the pain center, the signals then pass to the cerebral cortex and it is only when they have reached there that you become fully aware of the pain and where on the body it hurts.

The sensitivity of the pain system may increase if the pain is not treated

Whatever the cause of the pain, it is important that you get the right advice and treatment. Otherwise, there is a risk that the pain system will change and become more sensitive to pain impulses. Other parts of your nervous system, in addition to the damaged area, can be affected when you have been in pain for a long time.

In some cases, the spread of pain may increase with time and cause the entire pain system to become hypersensitive.

Investigations

At the medical exam, you can answer a number of questions, for example

  • where you are in pain
  • how long you have been in pain
  • how the pain started
  • if you have had similar pains in the past
  • if you are in pain all the time or if the pain comes and goes
  • whether the pain has increased or decreased since it began
  • if the pain disturbs or hinders night sleep
  • what relieves the pain, such as stillness, movement or medication
  • if the pain changes when, for example, you eat, move, exert yourself or are subject to mental stress.

To describe how it feels, you can use words such as grinding, drowning, intense, spasmodic, cutting, chopping, stabbing, stinging, burning, peeling, pounding, pulsating or radiating in the arm or leg. It is good to talk about what you yourself think the evil is due to.

If possible, it’s best not to take pain medication before going to a doctor. It is more difficult for the doctor to find out what the pain is due to if it has been suppressed.

The pain is estimated with the help of a pain ruler

Different people experience pain in different ways and it can be difficult to describe. You can estimate for yourself how intense the pain is by using a so-called Visual Analog Scale, VAS, on a pain ruler. 

The pain ruler has a removable portion that can be set along a line, where one end of the line indicates “no pain”, and the other end “worst possible pain”. When you have set the removable part to show the severity of the pain, the doctor turns on the ruler. Instead, there are numbers along the line such that “no pain” corresponds to the number zero and “worst possible pain” corresponds to the number ten.

You can also describe your pain experience with words, but it is usually easier to show on a ruler how bad you are. The pain reliever is also used to see how painkillers work.

Good to write pain diary

At the doctor’s visit, you can also draw in a figure where you are in pain and what kind of pain you are experiencing. The figure can also be used during treatment to see how the pain is affected.

It is also good if you have written up at home when on the day you are in pain, how it feels and in what situations you are in pain. If you bring your pain diary to the doctor, it is easier to describe the pain.

The doctor examines and suggests treatment

At the doctor’s, you may also undergo a  physical examination. Sometimes supplementary examinations are needed, such as x-rays or sampling.

Based on the conversation and the examination, the doctor then makes a diagnosis and gives suggestions for treatment.

Living with pain

Prolonged pain can affect how you feel. Especially if you are in pain for a long time, the pain can affect the physical and mental performance, sleep and sex life. This, in turn, can arouse feelings of despondency and hopelessness. The pain can also cause concern that something is seriously wrong.

The relationship with relatives and workmates can be affected not only by the impaired ability to cope with chores at home and at work but also by the fact that you feel mentally worse by the pain itself.

With the help of understanding, good and adapted pain relief and pain management, your quality of life can be improved even if it may take some time.

You can also try to do things that you think are fun and stimulating, even that can be soothing. Even if you get more hurt from something you do, it is very rarely harmful. 

Advice to related parties

It can be difficult to be close to a person who has severe pain. It can be difficult to know how to best help and support. Sometimes, as a relative, you may take over all the tasks in the home. It may not always be the best, as it can make anyone who has the pain feel even more “worthless”.

It is good if you who are related can join in with a doctor’s visit or visit with other therapists. Then you can gain more understanding of the long-term pain yourself and gain more insight into how to best support.

Ehtisham Nadeem

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