With Pain

[Juliane Bari]

Painduring labor is caused by contractions of the muscles of the uterus and by pressure on the cervix. This pain can be felt as strong cramping in the abdomen, groin, and back, as well as an achy feeling. Some women experience pain in their sides or thighs as well.

Many parents-to-be attend childbirth classes where they learn different relaxation or breathing techniques for coping with pain. They're also taught online and in books. These methods help to increase comfort levels but don't make pain disappear. Relaxation strategies and medicine-free ways to handle pain during labor include:

Many women choose to use both relaxation/breathing techniques and medicine during labor and delivery. Some may start off planning to not use medicine, but change their minds as labor progresses. It can be a huge relief when pain is quickly eased and energy can be focused on getting through the contractions.

A variety of medicines can be used, depending on the situation and the facility. There are also different ways to give the same medicines. Talk to your health care provider about the risks and benefits of each type of medicine and the different ways you can get them.

Medicine that is inhaled (breathed in), called nitrous oxide: Commonly known as laughing gas, this can be breathed in through a mask before the start of a contraction. It doesn't relieve pain as well as opioids, but helps ease anxiety so moms can cope better with the pain.

Medicine that is given by injection into the spinal region: Medicines given this way affect only the lower body. This means fewer side effects than with medicines injected into a muscle or vein.

Local anesthesia: This is when numbing medicine is injected into a small area of the body to prevent pain before a procedure, such as an episiotomy or the repair of a vaginal tear. Local anesthesia also can numb the vaginal area during childbirth.

General anesthesia: This anesthesia, given by mask or IV, quickly causes a person to become unconscious (or "asleep") so they don't feel any pain. For childbirth, it's usually only used for emergency situations.

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The body has pain receptors that are attached to 2 main types of nerves that detect danger. One nerve type relays messages quickly, causing a sharp, sudden pain. The other relays messages slowly, causing a dull, throbbing pain.

Some areas of the body have more pain receptors than others. For example, the skin has lots of receptors so it is easy to tell the exact location and type of pain. There are far fewer receptors in the gut, so it is harder to pinpoint the precise location of a stomach ache.

If pain receptors in the skin are activated by touching something dangerous (for example something hot or sharp), these nerves send alerts to the spinal cord and then to part of the brain called the thalamus.

Pain medicines work in various ways. Aspirin and other NSAIDs are pain medicines that help to reduce inflammation and fever. They do this by stopping chemicals called prostaglandins. Prostaglandins cause inflammation, swelling and make nerve endings sensitive, which can lead to pain.

Medicines for chronic pain are best taken regularly. Talk to your doctor or pharmacist if your medicines are not working or are causing problems, such as side effects. These are more likely to occur if you are taking pain medicines for a long time.

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Thirty years into the opioid crisis, we still struggle to find other options for pain relief. This hour, TED speakers explain new understandings of how the brain interprets pain and new ideas to cope.

Phyllis loves playing with her grandchildren, working in the garden, and going to bingo games. But, at age 76, the constant knee pain from osteoarthritis is taking a toll. It keeps her awake at night and stops her from doing activities she enjoys. The pain's getting to be too much to handle, but she doesn't know what to do about it.

There are two kinds of pain. Acute pain begins suddenly, lasts for a short time, and goes away as your body heals. You might feel acute pain after surgery or if you have a broken bone, infected tooth, or kidney stone.

Pain that lasts for 3 months or longer is called chronic pain. This pain often affects older people. For some people, chronic pain is caused by a health condition such as arthritis. It may also follow acute pain from an injury, surgery, or other health issue that has been treated, like post-herpetic neuralgia after shingles.

Your doctor or nurse may ask you to rate your pain on a scale of 0 to 10, with 0 being no pain and 10 being the worst pain you can imagine. Or, your doctor may ask if the pain is mild, moderate, or severe. Some doctors or nurses have pictures of faces that show different expressions of pain and ask you to point to the face that shows how you feel. Your doctor may ask you to keep a diary of when and what kind of pain you feel every day.

Worrying about pain is common. This worry can make you afraid to stay active, and it can separate you from your friends and family. Working with your doctor, you can find ways to continue to take part in physical and social activities despite having pain.

Talk with your doctor about how long it may take before you feel better. Often, you have to stick with a treatment plan before you get relief. It's important to stay on a schedule. Sometimes this is called "staying ahead" or "keeping on top" of your pain. Be sure to tell your doctor about any side effects. You might have to try different treatments until you find a plan that works for you. As your pain lessens, you can likely become more active and will see your mood lift and sleep improve.

Some doctors receive extra training in pain management. If you find that your regular doctor can't help you, ask him or her for the name of a pain medicine specialist. A pain specialist may be a doctor, nurse, or anesthesiologist.

If you or a loved one is managing pain from cancer or other serious illness, ask to be seen by a palliative care specialist. These specialists are trained to manage pain and other symptoms for people with serious illnesses.

As people age, they are at risk for developing more side effects from medications. It's important to take exactly the amount of pain medicine your doctor prescribes. Don't chew or crush your pills if they are supposed to be swallowed whole. Talk with your doctor or pharmacist if you're having trouble swallowing your pills.

Mixing any pain medication with alcohol or other drugs can be dangerous. Make sure your doctor knows all the medicines you take, including over-the-counter drugs and dietary supplements, as well as the amount of alcohol you drink.

Sometimes, strong medications called opioids are needed to control pain. Opioid pain relievers are generally safe when taken for a short time as prescribed by your doctor, but they can become addictive, especially if they are misused. Regular use can lead to dependence. Never take opioids in greater amounts or more often than prescribed.

Becoming addicted to prescription pain medicine can happen to anyone, including older adults. Sometimes, these treatments are the only ones available that can help. But, sometimes other treatments can and should be tried first or can be used intermittently or simultaneously. So, ask your doctor if there is another medicine or a non-medicine alternative you can try. Tell your doctor if you or a family member has a history of alcohol or drug abuse.

Opioid addiction can be treated. If you or someone close to you needs help for a substance use disorder, talk with your doctor, or contact the Substance Abuse and Mental Health Services Administration at 1-800-662-4357.

In addition to drugs, there are a variety of complementary and alternative approaches that may provide relief. Talk to your doctor about these treatments. It may take both medicine and other treatments to feel better.

Some people with cancer are more afraid of the pain than of the cancer. But most pain from cancer or cancer treatments can be controlled. As with all pain, it's best to start managing cancer pain early. It might take a while to find the best approach.

One special concern in managing cancer pain is "breakthrough pain." This is pain that comes on quickly and can take you by surprise. It can be very upsetting. After one attack, many people worry it will happen again. This is another reason to talk with your doctor about having a pain management plan in place.

People who have Alzheimer's disease may not be able to tell you when they're in pain. When you're caring for someone with Alzheimer's, watch for clues. A person's face may show signs of being in pain or feeling ill. You may see a person frequently changing position or having trouble sleeping. You may also notice sudden changes in behavior such as increased agitation, crying, or moaning. Refusing to eat may be a sign that the person has tooth pain or other oral health issues. It's important to find out if there is something wrong. If you're not sure what to do, call the doctor for help.

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