Managing pain

The experience of pain is caused by electrical impulses being transmitted from local damage receptors in the area of the body where the problem is, along the nerves to the spinal cord and then to the brain. There are receptors signalling damage all over the body. Once these nerve impulses reach the brain you feel pain and the message is relayed back from the brain to the site of damage and surrounding muscles and organs to take avoiding action such as to remove your hand from a hot stove.

There are two types of pain, acute pain which is caused by an immediate injury or illness and is short lived in nature and chronic pain which can go on for many years and is more difficult to relieve. Chronic pain is associated with a continual discharge of electrical activity at one or more levels of the central nervous system.

Pain is experienced in a huge variety of forms, it can include specific pain that affects specific parts of the body to general pain than may have a whole-body impact. In extreme instances sensitivity to being touched and extremes of temperature can be experienced as pain.

If you read widely about pain management you will find all manner of descriptions of pain that you probably never considered before. This section is not designed to make you an expert in pain management, but it will hopefully encourage you to think about how you can best manage pain.

Firstly, dont ignore any type of pain. Pain is your bodys way of telling you that something is wrong and sometimes forces you to rest. For example if you twist your ankle you will experience pain, swelling and possibly bruising making it impossible to place weight on the joint, this is your bodys way of making you rest until the joint has recovered. Similarly if you have a stress related headache, it is your bodys way of saying ease up.

Chronic pain is often complex. Sometimes it is difficult to pin-point the cause and, as a result, often difficult to manage. This can be the case with hepatitis C. Although a virus targets the liver hepatitis C is able to affect many systems of the body, as a consequence pain can take many forms, e.g. muscle and joint pain, abdominal pain, back pain, headaches, dry and sore eyes and skin, sensitivity to light and temperature.

In addition chronic pain, by its very nature, becomes part of everyday life and is, sometimes, overlooked or underreported yet, naturally, impacts on quality of life.

Keeping a pain diary, even for a short time, can be an opportunity to see clearly how pain is impacting on your life, which can be useful for you and your doctor. If you are able to record specific details about the pain then it is more likely that a cause can be identified or trends or patterns identified that will give some insight into how pain can be best avoided or managed. For example, if over time it becomes evident that the pain is worse after eating a meal you may want to consider adapting the type or quantity of food or timing of meals to see if that makes any difference. In addition by recording what you have tried to relieve any pain and how successful that was you may move closer to finding a solution. A further use of a pain diary is to record achievements despite feeling pain when putting into action the coping strategies described later. If you want to compile a pain diary you may find it useful to record the following:

• Where pain is felt
• When it occurs
• How it feels e.g., aching, stabbing, shooting, etc.
• How severe the pain is on a scale of 0-10
  0 being no pain and 10 being the worst pain imaginable.
• How often the pain is felt e.g., every couple of minutes/hours, constant
• How long the pain lasts, e.g. minutes/hours
• Does anything seem to trigger it or make it worse e.g. eating/temperature, specific foods, stress, movement
• Does anything make it better e.g. resting, heat/cold, bathing, medication, particular drinks or foods.
• What impact it has on your life, e.g. restricts physical movement, depression, etc.
• What you have tried to relieve it, e.g. painkillers, complementary therapy, etc.

Pain relief is about keeping pain under control and all part of managing hepatitis C. This can incorporate identifying triggers to pain and avoiding them, undertaking a treatment regime that reduces the severity of pain or using drugs or therapies that reduce pain or raise pain thresholds.
It can be divided into:

1. Specific treatment to try and eradicate the virus as the source of pain and symptoms
2. Painkillers
3. Alternative remedies for pain
4. Coping strategies & The Pain Gate Theory

1. Specific targeted treatment
Treatments to try and eradicate the hepatitis C virus and thereby the associated pain and symptoms is through conventional treatment - taking interferon and ribavirin. However, it is important to be aware that even clearing the virus with treatment will not necessarily relieve all your symptoms.

2. Painkillers
Painkillers are metabolised by the liver and in the case of hepatitis C even the recommended dose may be toxic to the liver (hepatotoxic). For this reason it is essential that prior to taking any painkillers, including over the counter medication, medical advice should be sought.

Taking an occasional painkiller will probably not cause problems, but prolonged use is best avoided as it can lead to significant liver damage. In addition codeine, which is now contained in the strongest over the counter medicines, is addictive if used continuously.

3. Alternative remedies for pain
Other, alternative or complementary approaches to pain relief include therapies, natural remedies and psychological interventions.

4. The Pain Gate Theory
This was discovered in 1965 by Dr Ronald Melzack & Dr Patrick Wall and written up in their book The Challenge of Pain in 1966. Basically it works on the theory that nerve gates in the spinal cord can open to allow messages signalling damage through or close to block their passage which means pain is not felt. The gate opens or closes in response to messages sent from the brain and therefore the messages that we are choosing to send out will have an impact on opening or closing the gate. The gate can also be closed by stimulating peripheral parts of the body i.e. arms or legs and this is how acupuncture and TENS machines seem to work.

Various things are recognised as opening the pain gate:
Overdoing things
Fear
Tension
Concentrating on the pain
Poor diet
Depression
Indecision
Stress
Tiredness
Anxiety
Poor posture

And things that are thought to close the pain gate are:
Laughing
Massage
Exercise
Hypnosis
Pacing your activities
Being enthusiastic
Rubbing the area that hurts
Meditation
Visualisation
Feeling joyful
Good posture
Relaxation
Distracting your attention from the pain
Having a positive attitude
Tens machine
Applying heat or cold to the area that hurts
Gentle movement (qi gong, tai chi)
Deep breathing
Music
Faith & prayer
A meaningful lifestyle including helping others

Many of these things work through the release of endorphins that damp down the electrical activity. Exercise is an especially good way of stimulating endorphins.

So the key to controlling chronic pain is often in our hands. By using these various strategies it is possible to bring into the play the pathways from the brain which close the gate. Thus putting into practice the old saying "Things only affect you as far as you let them". Putting these things into practice does not necessarily mean the pain will go away completely, rather what is happening is that you are gating off the emotional reaction to pain (suffering, anger, despair) and replacing it with a positive action and so learning to cope, despite continuing to feel pain.

The Pain Relief Foundation
Helpline Tel: 0800 665 544

The Chronic Pain Foundation
www.chronicpainfoundation.org

Further online help:
www.painsupport.co.uk

Books
Neville Shone - Coping successfully with pain (Sheldon Press)
Dr Ronald Melzack & Dr Patrick Wall - The challenge of pain (Penguin Books)
Margaret A. Caudill - Managing pain before it manages you - (Guildford Press)