PAIN

A complex interaction of physiological and psychological responses, pain is the third most common reason to visit a GP. Pain is broadly of two types, nociceptive and neuropathic.

Nociceptive pain Pain caused by actual or potential tissue damage, e.g. a cut, burn or other injury, arthritis, or pressure, e.g. from a tumour; activated or damaged nerve endings send pain messages to the brain. Tends to be sharp or aching.

Neuropathic pain Pain caused by a problem with one or more nerves; pain messages are sent to the brain in the absence of injury or tissue damage. Often described as burning, stabbing or shooting; may be painful pins and needles, or electric-shock like sensations; a light touch may be felt as painful (allodynia), mild discomfort as severe pain.

Chronic pain Pain may become persistent or ‘chronic’ when treatment is not entirely effective, as in diabetic neuropathy, osteoarthritis, or the cause is not entirely clear, e.g. postoperative and low back pain. Nearly one person in seven has chronic pain, 20% for more than 20 years.

Assessment and management

Pain experienced by patients is often not well recognised or assessed. As a result pain is often under treated. Use of a pain rating scale allows evaluation of response to treatment.

Nociceptive pain is eased well by 'traditional' analgesics (paracetamol, non-steroidal anti-inflammatory drugs [more suitable for musculoskeletal pain], codeine and morphine [opioid drugs, more suitable for moderate to severe pain]. Neuropathic pain is less likely to be helped by conventional analgesics, but other types of drug such as tricyclic antidepressants and anticonvulsants can help. When total pain relief is not possible, the aim should be to minimise the effect of chronic pain on the patient’s quality of life. Referral to a pain clinic may be appropriate