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Macaroni Health -The Source of pain and How it Should Be Managed?

Ortho On Call

By Patrick Parks, PAC September 12, 2014

Many of our patients throughout any given day ask this question, “What is the source of pain?”  Though the explanation can be complicated, the answer can be easily simplified.

The primary source of pain comes from the release of inflammatory cells into injured or diseased tissue. For instance, if your tonsils are inflamed from an infection, then the tonsils release inflammatory cells into the tonsillar and surrounding tissues to stimulate the sensory nerves, which in turn send a message to your brain that there is something going wrong in the tonsils. Unfortunately, the only message the tissue/sensory nerves send is pain. 

If you sprain your ankle, the joint and surrounding tissues release inflammatory cells, aggravating the sensory nerves in and around the ankle to let the brain know that the ankle sustained a traumatic event.  Again, the only message the brain receives is pain.

Now the next most important question asked is how can and how do we manage pain?  The first line treatment of most inflammatory events is to begin taking an anti-inflammatory medication.  What are some of the most common anti-inflammatory medications?  Over the counter ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn) are the two most common and very appropriate first line anti-inflammatory medications. These types of medications inhibit the release of inflammatory cells into injured/diseased tissues.  These medications are well tolerated but should be taken with food.  They should be used for only a short period of time, as they can have adverse effects on the liver, stomach, and kidneys; or there may be a serious, underlying problem that requires urgent or emergent care. There are many types of nonsteroidal, anti-inflammatory medications, both prescription and over-the-counter. Always seek medical advice if you have questions or concerns regarding NSAIDs (non-steroidal anti-inflammatory drugs).

Frequently, a patient’s pain cannot be managed with anti-inflammatory medications alone. We then incorporate an analgesic medication to assist in the pain management. Tylenol (acetaminophen), Tramadol, hydrocodone, oxycodone, etc., are all analgesic medications. Those have nothing to do with reducing inflammation but rather block the pain response at the brain level. Acetaminophen may be used for management of mild pain (bumps, bruises, fever, and headaches).  All other analgesics require a prescription.  Be cautious on giving acetaminophen, as it is very toxic to the liver in large doses. Usually, the amount of acetaminophen should be given to children according to their weight.  

Sometimes, a muscle relaxant is prescribed when muscles are injured. Again, these types of medications have nothing to do with fighting inflammation but rather relax bruised, strained, or spastic muscles.  The most common side effect of these medications is sedation (drowsiness), and they are most commonly prescribed with moderate-to-severe muscular pain. 

Hopefully, this brief explanation of pain management is helpful and better explains why we prescribe or recommend anti-inflammatory, analgesic, or muscle relaxant  medications.

 

Biography:

 

Patrick Parks, PAC is retired from the Army with 22 years of service, 11 years as a Special Forces Medical Non Commissioned Officer and 11 years as a combat trauma physician assistant. He has been a physician assistant for 23 years with fellowship training in orthopaedic surgery and orthopaedic spine surgery. Patrick has recently joined the team of Ortho On Call as a Physicians Assistant, the area’s first walk-in urgent care clinic designed specifically to treat acute orthopaedic-related injuries and conditions.