Pain is not a disease, but a manifestation of it. When can you manage it without the help of a doctor?

Pain can be perceived as a natural warning that something is wrong in our body. It serves to protect the body from damage or signals illness, injury, malfunction or other damage to various parts of the body.

It is important to distinguish that pain in itself is not a disease.

In most cases, it is an accompanying symptom or manifestation of disease or damage to the body.

Pain is caused by the activation of the nervous system. It is triggered by the irritation of a protein receptor in the affected area. The signal then propagates through the nerve pathways and reaches the central nervous system (spinal cord and brain). At this point, the signal is recorded and perceived as pain.

What types of pain are we familiar with?

There are several types of pain. Depending on the cause of the pain, you may experience several types at the same time.

Types of pain:

• Acute - sudden, lasting a few days to a maximum of 6 months.
• Chronic - long-term, lasting more than 6 months to several years
• Intermittent - recurring, with breaks in between
• Persistent - without interruption
• Localised - pain at a specific site
• Generalised - generalised, no site can be identified
• Nociceptor - with tissue damage
• Neurological - when nerve pathways are damaged

There are also several ways we perceive pain. We can describe it as stabbing, dull, throbbing, stabbing, pinching, burning, sharp and more.

Each person's subjective perception of pain leads to a different response to it. While some people have a relatively high pain threshold and tolerate it better, others perceive it more sensitively and are more vulnerable.

In addition to the physical aspect of a person's life, pain has a major impact on the psychological aspect. Severe, prolonged or recurrent pain leads to exhaustion, mental fatigue and a general weakening of the body.

This can result in a significant reduction in quality of life.

How to approach pain management?

The most effective way to prevent pain, or to manage pain that has already occurred, is to identify the cause of the pain. Once we know the cause of the pain, we focus on eliminating it. This, of course, will also bring pain relief.

In other cases where we do not know the cause of the pain or where eliminating the cause is a difficult and lengthy process, we treat the pain as a symptom.

Can I manage the pain at home or do I need to see a doctor?

The initial effort to relieve pain is in most cases up to the patient. Most often in the home environment and using proven methods, whether it is the use of medication or a non-pharmacological approach.

The most common type of pain encountered in everyday life is acute, short-term local pain. If you rationally assess that your pain is not severe, does not persist for a long time and does not indicate a serious injury or illness, there is probably no need to see a doctor.

When is it important to have your condition assessed by a doctor?

You should see a doctor if you experience any pain that is unexpected, severe, has no obvious cause or persists for a long time. Also, if the pain limits you in your daily activities, at work or during sleep.

Contact a doctor or seek medical attention immediately:

• If the pain is the result of an injury or accident that can cause significant damage to the body, including severe or uncontrollable bleeding, fractures, or head trauma.
• In the case of acute and sharp internal pain that may indicate a serious problem (e.g. a ruptured bowel).
• If the pain is localised in the chest, back, shoulders, neck, accompanied by breathing problems, dizziness, nausea, general weakness and pressure in the chest (heart problems or heart attack).

Pain can be relieved or treated in two ways - pharmacologically or non-pharmacologically.

Non-pharmacological approach to pain treatment

A non-pharmacological approach to pain management is a set of measures and activities that can help relieve pain without the use of medication.

A non-pharmacological approach to pain management can be used alone or as a complementary treatment to improve the effect of concomitant pharmacological treatment (use of medication).

Depending on the type of pain and the site affected, the following treatments may be used:

• Cold compresses, especially on affected areas with swelling and inflammation.
• Warm compresses or plasters, especially for muscle stiffness or cramps
• Restriction of activities that cause painful attacks
• Regular exercise and physical activity
• Rest and reducing stress levels
• Weight management and lifestyle changes

Massage, acupuncture, specialised exercises or meditation or surgery are also complementary treatments for pain. These activities should always be carried out under the supervision of a doctor or qualified professional.

Pharmacological approach to pain management

The pharmacological approach to treating pain involves the use of medication. Drugs called analgesics are used to control pain.

Currently, a large number of analgesics of different types, for different purposes and with different mechanisms of action are available on the market.

They can also be found in different dosage forms. The most common are tablets, capsules, effervescent tablets for oral solution, suppositories, creams, ointments or plasters.

Analgesics that are given by injection are usually in the hands of a doctor.

The dosage form influences the route and route of administration of the drug. It is crucial for the actual effect of the drug and the speed of onset of action. In terms of speed of onset of action, for example, effervescent tablets or liquid capsules are among the most rapidly absorbed oral dosage forms.

The nature and location of the pain is also crucial for the correct choice of dosage form.

Headache - tablets, capsules - systemic action.
Low back pain - cream, ointment, patch - topical action.

According to the mechanism of action we distinguish several basic groups of drugs with analgesic effect:

• anilides
• non-steroidal anti-inflammatory drugs
• salicylic acid derivatives
• pyrazolones
• and opioids

Examples of drugs with analgesic effect are given in the table below

Analgesics are often combined with other drugs to enhance and accelerate their effect.

In the case of paracetamol or ibuprofen, this is for example caffeine or guaifenesin. Medicines containing this combination are available directly on the market.

In addition, a combination of paracetamol and ibuprofen can also be found, which enhances the analgesic effect. Medicines intended for the treatment of colds often combine an analgesic with a decongestant such as pseudoephedrine.

Which analgesics can I choose from at the pharmacy?

When treating minor pain, the patient is in the position of self-medicating.

These medicines have been used in practice for a long time, which confirms their safe and effective use even without medical supervision. That is why they have been granted the status of over-the-counter (OTC) medicines.

Among OTC analgesics, the most commonly encountered are drugs containing paracetamol, ibuprofen, dexibuprofen, naproxen, diclofenac, acetylsalicylic acid and propyphenazone.

Depending on the type and site of pain, the effectiveness and strength of these analgesics vary. The basic indications for each analgesic are summarized in the following sections of this article.

Prescription analgesics

On the other hand, we have prescription analgesics. These are equally effective and safe drugs, but their use must be under the control of a physician for various reasons.

For example, they are available in a dosage form that requires a physician or health care professional to administer (injectable dosage forms). There are also drugs with complex dosages, drugs with dosages that must be tailored to the individual patient's needs, newly discovered drugs, addictive drugs (opioid analgesics), and others.

What are the most common indications for each analgesic?

Do you know what type of analgesic will manage a particular type of pain?
The most common examples of...

Paracetamol

In addition to its analgesic effect, paracetamol also has an antipyretic effect. This means that it reduces elevated body temperature.

It is used to relieve mild to moderate pain.

For example:
headache and toothache
muscle and joint pain (unless inflammation is present)
menstrual pain

Ibuprofen

Ibuprofen, like paracetamol, has an antipyretic effect and is also anti-inflammatory. It belongs to the group of non-steroidal anti-inflammatory drugs.

It relieves:
pain that is accompanied by inflammation
headache, toothache
spinal pain, muscle pain
some nerve pain
menstrual pain
it is also used for migraine

Dexibuprofen

To treat mild to moderate pain.

Muscle pain
cold pain
spine pain
headache and toothache
menstrual pain

Naproxen

Its anti-inflammatory effect is also used in the treatment of pain.

It is used for:
headache and toothache
muscle, joint and spine pain
post-traumatic and post-surgical pain
gynaecological and menstrual pain
migraine

Acetylsalicylic acid

At a dose of 500 mg, it is used for mild to moderate pain.

Headache and toothache
muscle and joint pain, spinal pain
menstrual pain

Acetylsalicylic acid also has an antipyretic and anti-inflammatory effect.

A dose of 100 mg is used to prevent blood clots.

Propyphenazone

headache and toothache
cold pain
postoperative pain
menstrual pain
and migraine

Propyphenazone is only available on the market in combination with another analgesic (e.g. paracetamol).

Interesting article:
Headache: sometimes harmless, but when is it a serious problem?

Diclofenac

Diclofenac is used to treat inflammatory and painful conditions.

For example, spinal pain,
tendon, muscle and joint injuries.

It is also very often found in the form of ointments, creams and gels intended for topical use.

Metamizol

Metamizole is currently only available in prescription medicines.

It is used on the advice of a doctor to treat severe acute or persistent pain or to control fever.

Opioid analgesics (anodynes)

Opioids are among the analgesics with the strongest effect.

They are used to treat acute, severe, severe pain and pain in the terminal stages of disease (e.g. cancer).

Opioids are strictly controlled under a doctor's supervision.

The use of opioids is strictly controlled and always under the supervision of a doctor. This is mainly because of the risk of serious side effects and the possible development of dependence and tolerance associated with their use.

Codeine, which belongs to the group of opioids and is used in combination with other drugs to control dry irritable cough, can be found in over-the-counter medicines. Codeine has only a weak analgesic effect and has a lower risk of side effects.

Pain in pregnancy

Pregnant women are in a special category in pain management. They must think not only of themselves but also of their unborn child when managing pain.

Pain in pregnancy can arise for a variety of reasons. It is caused by acute conditions such as injury or infection, or by pre-existing health problems and illnesses of the mother.

In addition, we also recognize pain caused by the pregnancy itself.

The treatment of pain in pregnancy is an important aspect, especially in the case of persistent and prolonged pain. It can have a significant impact on the psychological health of the woman and thus potentially adversely affect the course of the pregnancy.

The first choice of treatment for pain in pregnancy should be non-pharmacological treatment and the introduction of appropriate regimens. We have mentioned these in the section on non-pharmacological treatment.

Pharmacological treatment should be chosen during pregnancy if the woman's condition requires it and there is no other choice but medication.

In pregnancy, the use of many drugs is contraindicated.

At the same time, keep in mind that in pregnancy the use of many drugs is contraindicated or the possibility of taking them depends on which trimester of pregnancy you are in.

Many drugs cross the placental membrane into the blood of the fetus and can adversely affect its development.

Any treatment with analgesics in pregnancy should be consulted with a doctor in advance. The doctor will decide on the type of medication, the duration of use and will make follow-up checks on the woman's health.

The doctor will also find out the cause of your pain, not just treat the symptom itself.

The table lists the possible uses of analgesics in pregnancy

Read also: Are you pregnant and have a headache?

Of the combination products, paracetamol + caffeine can be taken in pregnancy. However, use should be only once or for a short time.

Pain and breastfeeding

The choice of analgesic during breastfeeding depends primarily on the properties of the drug - the biological half-life.

Biological half-life = the time it takes for a drug to lose half of its effect.

The shorter the biological half-life of a drug, the more appropriate it is to use during breastfeeding.

If a woman takes an analgesic with a short biological half-life (e.g. 2 hours) just after breastfeeding, most of the drug is no longer present in the body when she breastfeeds again.

It is generally recommended that a woman should not breastfeed for 3 hours after taking the medicine. If the medicine is contraindicated during breastfeeding, breastfeeding should be discontinued for 24-72 hours (depending on the properties of the medicine).

The table shows the possibilities of using analgesics during breastfeeding

Keep these basic rules in mind when using analgesics in pregnancy and while breastfeeding:

• Strictly follow the dosage.
• Use the medication only once or for a short time.
• Consult your doctor.
• Take into account the possible occurrence of side effects.

When taking any medicine (not only analgesics) during this period, it is necessary to assess the medicine, especially in terms of safety for the woman, the fetus and the baby.