March 23, 2023
The Evolution of Pain Management
Since the dawn of time, there is one thing that has remained the same: pain. Humans have always experienced pain, and we always will. There is nothing more useful and treacherous than pain. In a sense, it teaches us what is hot, sharp, poisonous, and alerts our body of injury. But pain is dreadful to deal with on a daily basis.
However, managing pain is still a relatively new topic. The field of pain management has only been around since the 1960s, so it is evolving at record speeds. That’s not to say there haven’t been ways to treat pain, but historically, every method has been temporary or handled in either acute care or pain during death.
The History of Pain Management
In the 1600s, doctors treated patient’s pain by giving them opium. By the 1800s, ether and chloroform were introduced as anesthetics for surgery. This also caused doctors to question the ethics of performing surgery on unconscious patients. Patients, however, thought the use of medication was a godsend. Because patients would be under the influence of these anesthetics for longer, doctors could not resist the temptation to attempt more complex surgeries and procedures.
In the 1900s, morphine and heroin entered the scene as pain medications. This was also the start of doctor’s worrying about addiction while ultimately wanting to improve their patient’s quality of life.
Chronic pain became a topic worth mentioning, because it was previously treated acutely (injury or post-surgery pain) or relating to death. The idea that recurring pain in patients was an actual condition had been ignored, or the patients were considered delusional. Patients were referred to psychotherapy or neurosurgery if they refused medication for their pain.
By the 1970s, the field of pain management had been established, with a research journal and association – International Association for the Study of Pain. The concept of interdisciplinary teams were introduced and found to be effective at treating pain. In the 80s, well-known pain management physicians noticed a minor correlation between prescribed opioids and addiction, and pushed for the drugs to be used more in non-cancer pain patients. This lead to doctors prescribing the addictive drugs more liberally and with a backing from leading pharmaceutical companies, doctors did so guilt-free.
“The thing about opioids is they are very effective in interrupting and shutting off pain signals in the brain,” said Marcia Meldrum, a psychiatry and biobehavioral sciences researcher at UCLA. “They are very, very effective. But they are also very dangerous.”
That didn’t last long. It turned out to be a driving factor in the opioid crisis that we are dealing with today. Many patients still see drugs as being the only way to manage their pain.
The Field of Pain Management
The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional response associated with actual or potential tissue damage or described in terms of such damage.”
Since the field of pain management was introduced, it has been growing at exponential rates. With this knowledge, research, and advances in technology, a variety of non-medication treatments have emerged.
Pain is processed in six steps – transduction, inflammation, conduction, transmission, modulation, and perception. Understanding these stages is important for physicians to know the best methods of treatment for your pain.
- Transduction – Receptors in the body translate a physical pain or injury to the brain.
- Inflammation – Trauma triggers the damaged cells to release an inflammatory substance that causes the area of pain to become red, swollen, and a lowered pain threshold.
- Conduction – Pain signals are conducted along nerve fibers, which determine the quality of the pain
- Transmission – Where one nerve pathway ends, neurotransmitters transmit the signal between a synaptic gap
- Modulation – This adjustment of pain is performed by an extensive antipain (antinociceptive) system. The limbic system acts as a gatekeeper for pain or stress. When the spinal cord is overstimulated, the body can become hypersensitive to pain.
- Perception – When the pain signals finally reach the brain through the thalamus, they’re directed toward the brain region regulating sensation, autonomic nervous system, motor response, emotion, stress, and behavior. This determines the individual’s perception of pain.
Patients with chronic pain have reduced pain thresholds and therefore feel pain more intensely.
“Pain can make it impossible to live your life. You lose so much quality of life. So for many people, if the solution also means they may become somewhat dependent on a drug, they probably think, ‘Well, that would be better than this,’” said Meldrum. State laws have put a limit on opioid prescriptions so for many patients, they are unable to get their narcotic medications and in search of other ways to reduce their pain.
New Technologies for Treating Pain
New and innovative technology is emerging and thriving in the world of pain management, making it a very exciting time for pain doctors and their patients. Those suffering from chronic pain have options for managing their pain and better access to physicians who can treat them. The ability to treat pain without the use of medication is on the rise, a result of the opioid epidemic.
Neuromodulation is an alteration of the nerve activity by delivering electrical agents to a specific area. It can be used to treat chronic headaches to spinal cord injuries to urinary incontinence. It’s no wonder that with such a vast therapeutic scope, there is major growth in the industry. For each existing neuromodulation treatment, dozens of new ones are on the horizon. Experimental treatments to relieve pain are being tested and researched.
Stem Cell Therapy is rapidly growing as more research becomes more readily available. Stem cell therapy harnesses your body’s cells and systems to effectively treat diseases and conditions. Your own cells are injected to the affected area, assisting in healing damaged tissue, ligaments, and even bone, while minimizing the need for surgery.
The use of Ultrasound in the medical field is not new, but using it for the purposes of pain management is still a relatively new concept for physicians. Ultrasounds have the ability to scan deep structures that aren’t visible on X-Rays. Ultrasound-guided procedures allow physicians to place needles for nerve block injections or other injections with complete accuracy. This allows treatments to be much more effective.
Because technology is moving at rapid speeds, treatments will continue to evolve as the field of pain management grows. Studies are more readily available, physicians are continuing education to remain up-to-date on the latest techniques and conditions, and treatment methods are becoming more and more state-of-the-art thanks to technological advances.
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