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Understanding pain

Written by Dr. Sylvester Ikhisemojie
~Punch, Nigeria. Sunday, June 26, 2016.

Pain is an intense and unpleasant feeling which occurs at some part of the body usually as a result of injury or disease. It is frequently localised in some part of the body and that enables it to be easily characterised with the specific part of the body as a reference point. Occasionally, however, it may also be generalised. It is conveyed to the brain by various sensory neurons where it is interpreted and the level of its intensity determined. Pain can thus be definitely pointed out to relate to a painful finger for example or a painful ankle.

It may also refer to some emotional distress or mental condition such as when an individual has been publicly humiliated. This type of pain leaves one with deep psychological effects. Sometimes, pain may be specific in making reference to a particular condition such as childbirth or hunger or may refer to a situation in which real care or effort has been expended in bringing to fruition a particular situation such as in describing a painstaking operation.

This essay, however, is about those kinds of pain that are physically felt in relation to certain conditions or associations that may be related to injury or disease. This refers to particularly unpleasant situations like stomach pains or the pain of arthritis and the effects of a fracture occurring in any of the bones of the body. Pain is a frequent condition seen in various forms in all branches of medical practice. The treatment of the various types differs accordingly. Today in many western countries, the management of pain in its various manifestations has become a huge industry. In the United States for example, there are more than 80 million people who suffer pain in one form or the other and are thus in need of various types of medications to control their distress.

As a result, this has evolved into a huge pharmaceutical industry as well with the potential for the abuse of some of these medications. In many cases, such abuse has taken a malignantly dependent form with sad sequelae resulting. There may be addiction or the tragedy of loss from resulting misuse of such medicines. That is a problem even in those nations that have a strict regime of dispensing and procuring medications. In our country where one can obtain almost any drug without a prescription, and across any kind of counter no matter the place, one can imagine the potential for addiction and death.

Many of these deaths are not investigated of course, and the relatives of many of those people are none the wiser. Many remain blithely unaware of what their relatives may even be taking.

Pain is generally characterised into two broad types. There is acute pain which is the type that is associated with a sudden event. Such an event can be related to the fracture of a bone for example or to the distressing condition of a heart attack. Pain can also be chronic, which is a slow, insidious situation such as you may find in osteoarthritis. As you can appreciate from the very different nature of these two types of pain, the approach to their management is very different. In the acute type of pain, the situation is often an emergency while in the latter group, the chronic variant, the individual is condemned to a long period of taking various medications for the affliction. Very often, the pattern of treatment has to graduate from one form of medicine to another and often from one class of drug to a different type. A particular drug may have been effective at the start of the treatment and become less useful over time thus necessitating the switch to another drug.

At other times, one pain-relieving agent is insufficient and the problem would have to be treated with a combination of drugs. There are other common considerations as well such as the need to determine that a person is able to handle a particular drug without the risk of developing some other condition such as peptic ulcer. It becomes an entirely different thing when a person strolls casually into a pharmacy and buys a drug for the relief of pain simply because his friend uses the same medication for a similar kind of pain. Both of these two men have a different kind of internal makeup and would react differently to these medications.

Without a guide as to what to do, the one who has taken the medicine without a prescription is at risk for developing some serious injury.

The treatment of pain takes various forms as well. At the extremes of life, in childhood and among the very old, syrups are the drug forms of choice because they are easier to swallow due to their liquid nature. Among the growing populace and the physically productive group or essentially in all the ages in between, tablets and caplets and capsules are the various forms of medication that will be most commonly available. These are the usual medications often prescribed for mild to moderately severe pain on a long term basis. In the acute forms of severe pain as seen in association with a surgical operation or an accident victim, injections are usually administered in the intramuscular or intravenous or subcutaneous form. Sometimes, the drugs are administered as a suppository and inserted in the anus. Depending on what is being given, the route of administration is determined. That is not usually perceived as unduly dangerous because the person is still within the hospital and monitoring is easy.

In many cases, one dose is not enough even though that single dose may be an injection and an oral form is then prescribed as follow-up. The usual pattern though is to have the drug repeated at intervals of six, eight or even four hours depending on the severity of the pain. Sometimes, several different types of injectables are given at the same time to achieve maximum effect and reduce the side-effects from any one member of the combination. It is precisely these associations that eventually make the management of pain such a difficult undertaking with widely varying results. In countries like the United States, there is a recognition that this problem is a huge one and that has led to the development of pain clinics. These clinics are specifically established to manage pain only. Even in such sophisticated nations, care must be taken to separate the drug addicts who have become dependent on pain killers from those people who are in genuine pain and are deserving of the level of attention in tandem with their malaise.

Ask the doctor

Dear doctor, my dad has been complaining of pain in his left hand and the back of his neck. He has been to the hospital and was given radiklo-100 and some other pain relieving drugs but the pain still persists. He is 54 years old. What should do sir? Thank you.

There are various possible causes of the pain which your dad has. If all he got after visiting the hospital are the medications you have mentioned above, I believe he has probably not been given the required level of attention this problem requires. He needs a thorough physical examination and a neurological evaluation of the left arm. He will require to have X-rays taken of the neck as well before the cause of these complaints can be identified. Following that, he will then be able to get the sort of treatment that will eliminate the pain. He needs to be seen by an orthopaedic surgeon.

Dear doctor, I am asking this question for the fourth time and I am yet to receive an answer. May the Lord bless you real good for the work you are doing for the people. My question is: do sex-enhancing drugs, I mean aphrodisiacs, both the orthodox and the herbal, contribute to problems of prostate enlargement and prostate cancer? Thank you.

Amen and thank you very much. I did reply you directly since you had wished to remain anonymous. However, it is important to state that there is no evidence that aphrodisiacs play any role in promoting an enlargement of the prostate. That development alone is actually something which occurs with age whether you take aphrodisiacs or not. The only difference is that such age-related growth in the size of the prostate occur say different speeds in various people so that while some have symptoms, others do not. As for prostate cancer, that is a different kettle of fish. The use of aphrodisiacs would conceivably lead to a more active sex life. As that happens, the release of semen becomes more frequent and this is thought to actually help prevent the development of cancer of the prostate.

Dear doctor, I noticed I have a swelling on the back of my hand. The swelling does not pain me except on some occasions and it comes and goes. I was advised to be applying a lot of pressure to it so that it can disappear. That has not happened over the past eight months now. What is it sir? What can I do to treat it? (this reader also sent pictures via whatsapp) 

There is no way this kind of swelling will go away by the application of pressure. It is called a ganglion cyst. The treatment of preference is by operation designed to remove the cyst. It is a collection of cells and tissues that are broken down from certain other tissues of the body. Various other types of treatment have been tried in the past but the most consistently successful is its removal. Therefore, see your doctor for advice.

Dear doctor, I have a painful corn on my right foot. I understand that wearing tight-fitted shoes is the cause. Please what treatment do you recommend because it is really making me uncomfortable? 

There are various things you can do to deal with this very annoying problem. The first one is expensive in that you may have to change your entire range of shoes to a size that affords you some more space so that your feet can breathe. More specifically, you will require to use any of the available keratolytic agents such as collomack, several drops of which can burn off the corn over a period of time. If you use that agent but do not obtain less tight-fitting shoes, the corn will return.
Dear doctor, I frequently feel some strange sensation in my feet like I am scared or so. I want to know what I can use for it but whenever I have sex, I don't feel it for two or three days. Should I continue having sex every day? Thank you. 

Well, I have never come across this particular association as it seems to be in your case. But apparently, you have discovered the antidote and you should therefore use it as frequently as you deem fit. However, it does not have to be a daily effort since as you say, sex gives you relief for two or three days. You can space out sex to take advantage of the days of respite from the strange feeling in your feet. But if you have the motivation to do it daily, there is no problem with that as far as I can see.

Dear doctor, I have been using bactroban cream on my private part for some time now but if I stop the cream for one or two days, itching with an odour occurs. Is there any drug I can take for a permanent solution? Thanks.

Bactroban contains an antibiotic. Most organisms that will cause you to itch in that part of the body are fungal. So essentially, you have not only been using panadol to treat malaria, you have probably changed the natural balance of organisms there. That is why you would itch as soon as the usage of the cream was stopped. Any drugs I recommend for you now would probably be useless without first knowing which kind of organisms are now present there. To know this, you will have to visit your doctor. Let him examine you and take a swab for laboratory tests to determine which organisms are there. That is the only way to know what drugs you can use.

Dear doctor, I need an urgent reply because I am worried. I saw my menses last month and since then I have not engaged in any form of sexual activity. I was therefore expecting to see a normal flow this month but I am yet to see it. Could I possibly be pregnant although I have used a pregnancy test strip and it was negative?

It is not something to fret about. You menstruated last month and did not engage at all in any sexual activity, so you cannot be pregnant. Now, depending on your age, however, your period can occasionally behave like this. It may be delayed or actually fail to report in a particular month. It does not always mean that something is wrong. Just stay calm and if after three months it does not come, then see your doctor.

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