Which Painkilling Remedy is Best?
Pain is not just pain. Therefore, an effective treatment for pain starts with determining which type (tissue or nerve pain) and group (acute, chronic, cancer) of pain it is. Next, the psychological (anxiety, depression) and social (incapacity to work) consequences of the pain should be treated.
The treatment of pain takes pace in cooperation with the doctor. Acute pain, where the cause is known – for example shoulder pain after a blow, you can however treat by yourself for a few days but if the pain does not disappear again quickly, you should seek a doctor. Prolonged or returning pain should always lead to contact with the doctor. It is a known fact that daily use of painkilling medication, for e.g. returning headaches, can lead to headache by itself.
Acute pain
The treatment of acute pain has two purposes:
1) To soothe here and now and restore the damaged function as quickly as possible.
2) To prevent that acute pain becomes chronic.
The treatment of acute pain is relatively simple. The cause of the pain is known and there is effective painkilling medication. If, however, the treatment is not satisfying it is because of wrong choice of painkilling remedies.
What is most important about treatment of acute pain is to make the pain disappear as fast as possible. It is not a good idea to endure the pain of a shoulder for several day, in part it can lead to chronic pai and in part the pain prevents sensible use of the arm. It is far better to take as much painkilling medication as to make the pain disappear. The longer time you experience pain, the greater the risk for it developing into chronic pain. Which painkilling remedy to choose depends to a great extent on what type of pain it is.
Tissue pain
Light acute tissue pain is treated with weak painkilling remedies, while strong pain is treated with the strong painkilling remedies.
Nerve pain
Usually, nerve pain is treated with painkilling remedies from the last group – other painkilling remedies.
Chronic pain
This is pain that lasts longer than expected – typically, the pain has been there for months. It can be pain that persists after the triggering damage to the body has healed or pain where it is not possible to prove that the body has been damaged.
Chronic pain is often a combination of physical, psychological and social conditions. The one condition that dominates the individual patient – whether it is the physical pain itself or the psychological and social conditions – is what the treatment first and foremost is targeted against.
Chronic pain is difficult to treat with painkilling remedies. Often, part of the painkilling remedies only has a lighter effect, and therefore it can take time before the individual patient finds the right treatment for pain. Light to moderate pain is treated with painkilling remedies from the weak group, while strong pain is treated with the strong painkilling remedies.
In the case of treatment of chronic pain and cancer pain, the so-called ‘ladder principle’. This means that the doctor first tries weak painkilling remedies and thereafter takes a step up to stringer medication if the previous step was not sufficiently effective.
Here is an example of the ‘ladder principle’ for treatment of chronic pain
1st step Arthritis remedies and/or paracetamol – possibly both.
2nd step Tablets or mixture with strong painkilling remedies + paracetamol/arthritis remedies.
3rd step Patch treatment – strong painkilling remedies. Change between the different strong painkilling remedies. Strong painkilling remedies administered directly into the spine through a catheter.
4th step Strong painkilling remedies administered under the skin through a small plastic catheter. Controlled through a pump by the patient. Strong painkilling remedies administered directly into the vein.
In the case of patch treatment, the remedy is absorbed through the skin. The benefit of patch treatment in relation to other string painkilling remedies is fewer side effects – especially a smaller tendency to constipation.
Chronic pain, where it is psychological or social conditions that dominate, demands a special treatment with emphasis on physical and mental activation, social measures (rehabilitation) and psychological aid, together with pans that prevents an abuse of medication.
Often, we see a mixture of tissue and nerve pain. The doctor’s choice of painkilling remedy depends on which of the two types of pain dominate.
Cancer pain
You begin with different combinations of weak painkilling remedies and if that is not sufficient, you are supplemented with strong painkilling remedies – following the ‘ladder principle’.
If there is a daily need for strong painkilling remedies, they are administered as depot medication. By administering depot medication, you make sure that there is painkilling medication in the body at all times. In that way, you achieve that the patient has painkilling medication in the body 24 hours of the day and does not experience breakthroughs of pain. However, it is far from possible always to prevent breakthroughs of pain, even when using depot medication. In most cases, you supplement with painkilling remedies that have quick effect and short duration. Typically, a cancer patient with strong pain is treated with regular depot medication. Furthermore, the patient has strong medication with quick effect ready for use if there is a breakthrough of pain, for example in that case of increased physical activity.
The treatment of pain with cancer patients is like walking a tightrope between effect and side effect. It is almost always possible to administer enough medication to take the pain away from the patient, but it can be at the expense of unacceptable side effects (befuddled, hallucinations). As a starting point, the doctor will strive to remove the pain from the patient when resting. How much painkilling medication to administer in addition to this depends on the patient’s wishes concerning activity and experience of side effects. Acceptable control of pain can be achieve with up to 9 out of 10 patients with pain caused by cancer.
A lot of people with cancer are, aside from pain, bothered by nausea, anxiety and uneasiness that require a different type of medication.