In any healthcare setting, 30-40 per cent of patients are there because of pain. Pain may be the main complaint or may be associated with some other ailment. Pain is a protective mechanism of the body that informs a person that something is wrong somewhere and needs to be relieved. Persons who suffer from loss of pain sensation, such as those with diabetes or leprosy, frequently develop chronic limb ulcers and wounds due to an inability to withdraw from injury-causing substances. Sensation of pain travels from the peripheral nerves to the brain centre, perceiving pain. The limbic system in the brain adds to the emotional aspect of pain. This decides the response of a person to pain; some cry even in trivial pain, and some tolerate even severe pain quietly. From infancy to old age, a person can suffer from acute or chronic pain depending on the underlying cause. Acute pain anywhere in the body is commonly caused due to injury or inflammation. Chronic pain is mostly due to chronic inflammation, degeneration, or malignancy. Pain arising from any limb or peripheral part of the body is fairly well localised and is aggravated by movement of the affected part. Visceral pain arises from some inner organ, like the stomach or intestines. This type of pain is felt in the abdomen and is commonly associated with nausea, vomiting, or a bloating sensation. In contrast, pain occurring due to affected nerves is like a severe burning sensation. It is localised to the affected nerve. It may be acute, as in herpes zoster, neuralgias, or chronic, as in diabetic peripheral neuropathy. Pain is also a very common feature of psychosomatic disorders. Mimicking pain in any part of the body is common for a malingerer or a person who stands to gain something by pretending to be sick from it. Diagnosis of the cause of pain is made by clinical examination, relevant investigations. Mild pain can be managed easily by non-pharmacological measures like fomentation by heat or cold. Local application of painkiller medicine is also useful. Painkiller medicines are used for pain relief in moderate to severe pain as tablets or injections. Non-steroidal anti-inflammatory drugs (NSAIDS) are most commonly used for this purpose. People buy them as over-the-counter pills as well. While they reduce pain and inflammation, they also cause gastritis directly, which may manifest as burning pain in the abdomen, nausea, and or vomiting. They are known to increase blood pressure. Repeated use can cause kidney damage and failure. Liver failure can occur due to paracetamol. Antispasmodic drugs containing atropine, hyoscine are used to lessen visceral pain. One needs to be careful with these kinds of drugs because they can cause and aggravate constipation and even lead to paralytic ileus, a condition where the bowels fail to move at all. Many of the conditions causing visceral pain are corrected by surgery, as in the case of gallbladder or kidney stones. Relief in neuralgic pain is provided by some anti-epileptic drugs. Use of painkillers like aspirin, Ibuprofen, etc., should be restricted. If used for a long time, they tend to produce gastric ulcers and kidney failure. Some people use sedatives like diazepam to get rid of pain. But they only make a patient “sleep off” pain and are addictive over time. One need not become overly anxious upon experiencing pain somewhere. It is a signal from the body alerting one to be cautious and set right anything wrong. Dr Rachna Pande is a specialist in internal medicine.
