2007: Issue 1

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2007 > Aches and Pains > Pain Management

Pain Management

pain diagnosis and management

New Approach in the Fight Against Pain

The fast - growing medical specialty of pain management brings a variety of resources and approaches to helping acute and chronic pain sufferers.

Simply put, pain is the body’s way of telling us that something is wrong. Pain helps prevent a bad injury from becoming worse; when you put your hand over a burning candle, the intense pain is your body’s way of telling you to take your hand away!

For most people, pain is a fleeting encounter that goes away when the healing process ends. But for others, pain can last months, even years, even when there’s no apparent medical problem to cause it.

Thanks to years of medical research and a greater understanding of how people deal with pain, the emerging field of pain management is helping millions of pain sufferers in Thailand and around the world.


Sometimes doctors cannot find a specific condition or physical cause for pain, despite repeated tests. But this doesn’t mean the pain isn’t real. Pain is a very subjective and unpleasant personal experience. Understanding the basics may be the key to maintaining a balanced and healthy outlook.


Acute pain can be sharp or mild; it may begin suddenly, subside quickly or last for long periods. This kind of pain often serves as a warning signal of a severe problem in your body such as a broken bone or burn. Acute pain normally disappears when the cause is treated or has healed.

Chronic pain is persistent pain which lingers, sometimes long after an injury has healed. You may experience physical effects like tense muscles or a lack of energy along with emotional effects such as anger or anxiety. Headaches, lower back pain and arthritis all feature here. Chronic pain may be neuropathic caused by injury to a nerve and characterized by symptoms such as electrical, shooting, burning, pins-and-needles, piercing or stabbing sensations. Cancer often causes chronic pain and suffering, requiring careful symptom control to maintain a patient’s quality of life.
Some people have a heightened sensitivity to pain, while others may experience physical pain as a result of mental or emotional conditions such as depression.


During a recent interview with Better Health, Dr Chomchai Vichitrananda-Kleosakul, a board-certified anesthesiologist and one of Thailand’s leading pain management specialists, talked about the role and importance of pain management.

“Pain management is emerging as a new specialty. Once a patient has undergone a second or third medical opinion and there is still no clear explanation for the source of their pain, the patient’s doctor will usually ask a pain medicine specialist to evaluate the patient’s condition. Here we look at the person, his lifestyle and the current medical problem. We take a team approach involving multiple medical specialties. In many cases we include a psychologist in the process to help deal with the mental and emotional impact of the patient’s suffering.”

Pain management is proving an important part of the treatment process for a variety of situations and medical conditions. Patients dealing with severe cancer pain and cancer treatment are among those most in need of a pain management strategy. Those recovering from serious injuries and major operations, along with patients with chronic back or joint pain, are also finding that specialized attention to deal with pain is both necessary and beneficial for improved outcomes and faster recovery.
Pain medicine specialists consider a wide variety of treatment options for each patient’s particular situation. The most common options include:
  • Medication: Over-the-counter pain relievers and medicated creams or gels are often sufficient to relieve pain. For more severe pain, doctors typically prescribe a stronger medication such as morphine or codeine, or an antidepressant, anticonvulsant or muscle relaxant.
  • Injection therapy: A combination of medications is injected directly into the affected area to help reduce pain, inflammation or nerve root irritation.
  • Electrical nerve stimulation: This process can help block or mask pain and reduce swelling, irritation and muscle spasms.
  • Surgery: Most painful conditions can be treated non-surgically but effectiveness may diminish over time. In some cases where severe pain has not responded to other treatments, surgery to correct the cause of the problem is necessary.
  • Physiotherapy: Stretching and strengthening exercises can improve your strength and flexibility. An individually-tailored program prescribed by physical rehabilitation specialists will achieve the best results.
  • Alternative treatments: Acupuncture, relaxation, ultrasound, biofeedback, whirlpool therapy and deep muscle massage may be recommended as part of a pain management program.
  • Counseling: Support from a counselor or psychologist often helps patients deal with feelings of anger or sadness that can aggravate pain and may lead to depression.


Pain assessment and diagnosis is the first step in the pain management process. The doctor will examine the patient and assess his or her medical history.

Pain is one of the important vital signs, like blood pressure, heart rate and temperature.
A variety of tests are available to help determine the cause of the pain and to rule out the possibility of specific conditions. They include:

  • CAT scan: These use X-rays and computers to produce a cross-section image of the body.
  • MRI: Magnetic Resonance Imaging uses a large magnet, radio waves and a computer to produce images of the body without the use of X-rays.
  • Differential nerve block: Some pain is complex and may have multiple causes. Nerve blocks can be used to focus on separate possible pain sources, identify what is contributing to the pain and help in developing an optimal treatment plan.
  • Myelogram: As in discography, a contrast dye is injected into the spinal canal. This test is typically used in conjunction with an X-ray.
  • EMG: This procedure allows doctors to evaluate the relationship between muscle response and signals from the brain, spinal cord or peripheral nerves.
  • Bone scans: Bone scans are used to diagnose and monitor infections, fractures and other bone disorders.
  • Ultrasound imaging: Ultrasound uses high-frequency sound waves to produce images of organs and tissues inside the body.


Doctors can help treat pain only after a patient comes forward for help. “In the past, people invariably tried to cope with their pain for long periods before deciding to seek treatment,” Dr. Chomchai explained. “Now we know clearly that pain isn’t good for the body, that it causes further stress, impacts our sleep and our daily routines and quality of life. We all suffer from common aches and pains, but if the pain escalates or causes nausea, vomiting, fever, numbness or weakness, it is time to seek medical help.”

Dr. Chomchai stressed the importance of the patient taking an active role in the pain management process. The most important steps to a successful outcome are:

  • Keep a positive attitude
Build your life around wellness, not pain or sickness. Surrounding yourself with positive people, eating a balanced diet, finding ways to relax and following your treatment plan can make all the difference.
  • Don’t focus on pain
Focus your thoughts on happier things, such as favorite hobbies and enjoyable activities. When you can’t avoid thinking about the pain, think of it differently.
“People should remind themselves that it’s natural that our bodies lose some flexibility as we get older,” Dr. Chomchai said. “The tension of daily life can build up over the years. But unavoidable pain from injury or illness is different.”

Positive “self-talk” may also help. Research has shown that positive self-messages can lead to a decrease in pain. Rather than saying “I don’t feel like exercising today,” try “I know I’ll feel better after exercise and have an easier time falling asleep.”
3. Change your “pain habits”

Do you finish a bottle of pain medicine faster than you used to? Do you spend more time in bed? Do you talk about your pain a lot of the time? “Most patients want a quick fix, often through medication, but they soon return to the activity that is causing them pain,” Dr. Chomchai explained. “It’s an on-going cycle, so we can’t promise a pain-free life if patients aren’t willing to make positive changes.”

It’s easy to slip back into unhealthy habits, but the effort required to actively manage your pain is almost always paid back many times over in less pain and a better quality of life.

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