WHAT IS PAIN?
Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. There are many types of pain including acute pain, chronic pain and intermittent pain. If you never felt pain, you might seriously hurt yourself without realising it.
Acute pain is defined as short-term pain, chronic pain is defined as long-term persistent pain and pain that comes and goes is referred to as recurrent or intermittent pain.
Acute pain is like an alarm telling us something may be wrong. It may be a sign of a minor problem or a sign that something more serious is wrong. You may feel pain in one area of your body, such as your back, stomach, chest, or pelvis, or you may feel pain in multiple areas.
Chronic or intermittent pain is often associated with long-term conditions and is usually complex. It has many physical and psychological components and individuals may experience fatigue, anxiety, mood changes and depression, in addition to the pain they experience. As pain cannot be seen, therefore, can be hard to explain to someone exactly what it feels like and, therefore, can be hard for others to understand just how much it can affect everyday life.
There are many types of pain sensation, which can range from annoying to debilitating. It may feel like a sharp stab or dull ache. It may also be described as throbbing, pinching, stinging, burning, or sore.
TYPES OF PAIN
It may not be possible to cure pain, but there are ways to help treat it. Pain may be relieved by treatments, such as physical therapy and acupuncture, pain relief medicines or, in some cases, surgery may help.
Feeling pain from time to time is very common and everyone experiences pain differently. One way of categorising pain is under the classifications of acute, intermittent or chronic pain.
Acute pain usually comes on suddenly, often has a specific cause, like an injury, broken bone or dental pain, and often improves with treatment.
Intermittent pain is a reoccurring type of pain and sometimes can be severe enough to increase difficulty in performing everyday activities.
Chronic pain lasts longer than acute pain and can be caused by conditions like cancer, nerve pain or arthritis, but the exact causes of chronic pain are not always understood. In some cases, it is believed that chronic pain can be caused by underlying conditions, including chronic fatigue syndrome, endometriosis and fibromyalgia.
All types of pain can be debilitating. If you have chronic or intermittent pain, it's really important you speak to a GP to help identify the cause of pain to help find the right treatments to help you manage your symptoms. If you have mild to moderate acute pain and would like to consider pain relief options, speak to a member of the pharmacy team for advice.
A migraine is a headache that can cause severe throbbing pain, usually on one side of the head. Many people also experience nausea, vomiting and extreme sensitivity to light and sound. Migraine attacks can last from hours to days and the pain can interfere with daily activities.
For some people, a warning sign, known as an aura, happens before or with the headache. An aura can include visual disturbances, such as flashes of light or blind spots, or other disturbances, such as tingling on one side of the face, an arm or a leg and difficulty speaking.
Though migraines aren’t fully understood, experts think migraines are the result of abnormal brain activity affecting nerve signals, chemicals and blood vessels in the brain. It’s not known what causes this brain activity, but for many people there is a link to their genes. Migraines can be triggered by a stressful event, skipping meals, low blood sugar, alcohol intake, hormonal changes (such as periods or menopause), lack of sleep and the environment (lighting, temperature).
Many people who have migraines find that over-the-counter pain relief, such as paracetamol, aspirin, ibuprofen or sumatriptan, can help ease their pain symptoms.
If an over-the-counter pain relief medicine is not helping to relieve your migraine symptoms, your GP may recommend taking a type of medicine called a triptan and possibly anti-sickness medicine. Triptan medicines, including Sumatriptan, are a specific medicine for migraine symptoms. They're thought to work by reversing the changes in the brain that may cause migraine. You can also access prescription-only migraine treatments without the need to see your GP from Boots Online Doctor Migraine Treatment Service**. Anti-sickness medicines, known as anti-emetics, can successfully treat migraines in some people, even if you do not experience feeling or being sick. These are prescribed by a GP and can often be taken alongside pain relief medication and triptans.
If these medicines are unsuitable, or do not help with your migraine symptoms, you may want to consider acupuncture. Most GP surgeries do not offer this, so you may have to pay for it privately. If these other treatments are not effectively controlling your migraines, you may want to refer to a specialist pain clinic such as Leva*, which is available online via Boots Health Hub, for further investigation and treatment.
If you have frequent or severe migraine symptoms, you should visit your GP - this could be your registered NHS GP or Livi GP* - for advice. Keeping a diary is useful and can help to identify the type of headache you’re having. It’s important to get a diagnosis so you can get the right treatment and, if appropriate, make lifestyle changes.
Sometimes, migraines may be a sign of a more serious condition, such as a stroke or meningitis, and should be assessed by a doctor as soon as possible. You should call 999 immediately if you experience:
- Paralysis or weakness in one or both arms, or one side of the face.
- Slurred speech.
- A sudden, agonising headache, unlike anything experienced before.
- A headache along with a high temperature (fever), stiff neck, mental confusion, seizures, double vision and a rash.
Many people get period pain during their menstrual cycle, the medical term for this pain is called dysmenorrhea. It's usually felt as painful muscle cramps in the stomach, which can spread to the back and thighs. It can be anything from dull achy cramps to intense spasms. Each period can vary, with some periods being more painful than others. Some women also get pelvic pain even when they do not have their period.
Period pain happens because chemicals called prostaglandins trigger muscle contractions in the uterus. These contractions can cause pain and inflammation. The level of prostaglandin rises right before menstruation begins.
During a period, the wall of the womb starts to contract more vigorously to help the womb lining shed as part of her period.
It's not known why some women have more period pain than others. It may be that some women have a build-up of prostaglandins, which means they experience stronger contractions.Painful menstrual periods can also be the result of an underlying medical condition, such as:
- Endometriosis - This is a painful medical condition in which cells similar to ones that line the uterus grow in other parts of the body, usually on the fallopian tubes, ovaries, or tissue lining the pelvis.
- Fibroids - Fibroids are noncancerous growths that can put pressure on the uterus and can make periods heavy and painful.
- Pelvic inflammatory disease (PID) - PID is an infection of the uterus, fallopian tubes, or ovaries often caused by sexually transmitted bacteria that cause inflammation and pain.
- Adenomyosis - This is a rare condition in which the tissue that lines the womb grows into the muscular womb wall, causing inflammation, pressure, and pain. It can also cause longer or heavier periods.
A type of contraception, called an intrauterine device (IUD) made from copper and plastic that fits inside the womb can also cause period pain. This most commonly happens during the first few months after it's inserted.
See a GP if you have severe period pain or your normal pattern of periods changes; for example, if your periods become heavier than usual or irregular. There is a range of over-the-counter pain relief products available to treat period pain, speak to your pharmacist if you need advice.
Sports injuries can be caused by accident, not warming up before exercising or even using equipment inappropriately and applying poor technique to your workout. Some sports injuries can also be linked to pushing yourself too hard. Exercise and sports injuries can affect any part of your body including bones, muscles joints and connective tissues, with ankles and knees being the areas most prone to injury.
When you injure yourself, you may experience pain, tenderness, swelling, bruising, and will also notice that the affected areas become stiff, and you are restricted with movement. These symptoms aren’t always noticeable as soon as you injure yourself, as sometimes they may take several hours to be felt after exercising.
If you feel pain whilst exercising, you should stop exercising immediately, whether it's a sudden injury or if it's pain that you have experienced before. If it's a sprain or strain, you should rest the affected part of the body for the first 48 to 72 hours to prevent further damage. An ice pack applied to the affected area regularly can help to reduce any swelling.
If your symptoms are not improving, you should speak to your GP who may be able to refer you to specialist pain treatment or support such as physiotherapy. If your symptoms are severe, you should phone NHS 111 or go to A&E. You can get help from NHS 111 online or call 111. It's available 24 hours a day, seven days a week. Online physiotherapy via PhysioFast Online* is available via Boots Health Hub.
There can be several causes of joint pain. Damage to the joints from injury or disease impacts the way in which we move and, depending on the cause, may cause significant pain. Joint pain is very common, particularly as we age and although it can occur in any joint, common joints affected are knees, hips, shoulders and hands. There are a number of medical conditions that can lead to joint pain including:
Osteoarthritis - the most common form of arthritis, which is caused when the protective cartilage on the ends of your bones breaks down. You may experience pain and stiffness in your joints, loss of flexibility and swelling around the joints. Osteoarthritis usually affects the knees, hips and small joints of the hands. Treatment can help manage the symptoms of osteoarthritis.
Rheumatoid arthritis - an autoimmune disease that causes pain, swelling and stiffness in the joints. It is caused when the immune system, which usually fights infection, mistakenly attacks the cells that line the joints. Unlike the gradual wear down caused by osteoarthritis, rheumatoid arthritis affects the cells that line the joints, causing pain, stiffness and swollen joints which, over time, may lead to joint, cartilage and bone damage. Symptoms can include pain in one or more joints, often on both sides of the body, sometimes accompanied by fatigue or a low-grade fever.
Bursitis - a painful condition that affects the small, fluid-filled sacs that cushion the bones, muscles and tendons. When these sacs become inflamed, it is called bursitis.
Gout - a type of arthritis that often causes sudden severe pain in a joint, typically the big toe but may affect other joints too. Gout can affect anyone but is more likely to affect men. It is caused by the build-up of uric acid in the blood, which can cause sharp crystals to form around your joints. Risk factors for gout include obesity, diabetes, untreated hypertension and kidney disease.
In addition, viral infections, tendonitis and sports injuries can cause joint pain. If you have new or unexplained pain in your joints, you should visit your GP - this could be your registered NHS GP or Livi GP* - for advice. It is important to find out what is causing joint pain to understand the treatment options available and whether lifestyle changes are recommended.
To find out more about arthritis click here
Pain that affects the muscles, ligaments, tendons, nerves and bones is known as musculoskeletal (MSK) pain. Muscle tissue can become damaged with the wear and tear of daily activities. Trauma to an area, such as from an accident, fall or fracture, can cause musculoskeletal pain. Other causes of pain including consistently poor posture, repetitive movements and overuse injuries. Changes in posture may result in spinal alignment problems and muscle shortening, which can cause other muscles to be misused and become painful.
People with musculoskeletal pain sometimes complain that their entire bodies ache. Their muscles may feel like they have been pulled or overworked. Sometimes, the muscles twitch or burn. Symptoms vary from person to person, but the common symptoms are pain, fatigue and sleep disturbances. People with persistent pain often report a negative effect on their mental health, with feelings of anxiety and depression being common. This is because of the way the nervous system responds to pain.
The most common types of musculoskeletal pain include:
- Bone pain - injuries, such as bone fractures, cause bone pain. Rarely, a tumour may cause bone pain.
- Joint pain - stiffness and inflammation often accompany joint pain. For many people, joint pain gets better with rest and worsens with activity.
- Muscle pain - muscle spasms, cramps and injuries can all cause muscle pain. Some infections or tumours may also lead to muscle pain.
- Tendon and ligament pain - sprains, strains and overuse injuries can lead to tendon or ligament pain.
Maintaining strong bones and joints is important for preventing musculoskeletal pain. You can work to avoid musculoskeletal pain if you:
- Limit repetitive movements.
- Use good posture.
- Practise correct lifting techniques.
- Stretch regularly.
If pain interferes with your daily activities, you should visit your GP - this could be your registered NHS GP or Livi GP* - for advice. It’s important to get a diagnosis so you can get the right treatments and make any required lifestyle changes.
Nerve pain, or neuropathic pain, happens when there is a problem with the nerves themselves. This means that the normal process of detecting and sending messages about pain, as well as other types of sensation, is disrupted. As a result, you might feel pain even when there’s been no new injury to the body. Nerve pain is often described as a shooting or burning pain. It can go away on its own, but is often chronic. Sometimes it is constant and severe, sometimes it comes and goes.
Common causes of neuropathic pain include:
- Nerve pressure or damage after surgery or trauma.
- Certain infections, such as shingles, Lyme disease, diptheria, botulism and HIV.
- Certain types of cancer.
- Vascular malformations.
- Neurological conditions, such as multiple sclerosis (MS).
- Metabolic conditions, such as diabetes.
- Side effect of certain medications.
If you have symptoms of nerve pain, you should visit your GP - this could be your registered NHS GP or Livi GP* - for advice. It’s important to get a diagnosis so you can get the right treatments and make any required lifestyle changes.
Cancer pain has many different causes and can be felt short-term or chronically, as a sharp, dull or burning sensation. The pain can be intermittent or continuous and can be caused by the cancer itself or, sometimes, as a result of certain cancer treatments. Many people with cancer do not experience pain, but for those who do, it can impact them physically and emotionally. It is important for someone with cancer pain to seek support from healthcare professionals and loved ones.
Common types of cancer pain include:
Nerve or neuropathic pain - caused by nerve damage or pressure on your nerves as a result of the cancer or cancer treatments. The pain is often described as burning or shooting and can come and go.
Soft tissue pain - can often feel muscular or like it is coming from an organ. It is often described as achy or throbbing.
Bone pain (as a result of bone cancer) - can often start with tenderness in the affected area or progress to a more persistent level of pain.
Referred pain - when pain that is felt in one part of the body is actually caused by pain in another part of your body.
If you are experiencing cancer pain, it is really important that your GP finds the type and source of your pain, so that you can find the best solution possible. You can read more about cancer-related pain and management on the Macmillan website. You can also book a free consultation with a Boots Macmillan Information Pharmacist, who can provide support for you and your loved ones. Boots Macmillan Information Pharmacists can help with:
- Understanding the different types of cancers, diagnoses and treatments.
- Answering any questions you may have about medication, or potential side effects.
- Providing advice about lifestyle and the effects of cancer.
- Guiding you to more specialist information and support.
Physiotherapy can help to improve movement and function for people suffering from pain as a result of injury or illness.
Physiotherapy is usually delivered by chartered practitioners called physiotherapists or, in some cases, osteopaths or occupational therapists. Practitioners take a holistic approach to treatment that involves the patient directly in their own care.
Physiotherapy can be helpful for people of all ages with a wide range of health conditions, including problems affecting the:
- Bones, joints and soft tissue – such as back pain, neck pain, shoulder pain and sports injuries.
- Brain or nervous system – such as movement problems resulting from a stroke, multiple sclerosis (MS) or Parkinson's disease.
- Heart and circulation – such as rehabilitation after a heart attack.
- Lungs and breathing – such as chronic obstructive pulmonary disease (COPD) or cystic fibrosis.
A short course of physical therapy may help to manage back, joint and soft tissue-related pain through manipulation, stretching and pain relief exercises alongside education and advice.
Physiotherapists, such as the team at PhysioFast Online*, which is a private online service available via the Boots Health Hub, can give you advice on the right type of exercise and activity.
While it can feel counter-intuitive, exercise and continuing to work if you can be key to managing persistent pain, also known as chronic pain.
Being inactive, for example, lying in bed for long periods can make back pain last longer causing your body to stiffen up, weakening your muscles and bones and making your pain feel much worse.
The NHS recommend a combination of factors to support chronic pain management including:
- Staying at work
- Physical therapy
- Pain relief medication
When looking at physical activity levels, try to be active as much as you can and choose an exercise that won't put too much strain on yourself. Good options may include:
- Using an exercise bike
Being active and doing some gentle stretches as part of your lifestyle may help. Exercise also releases endorphins, which are often called the feel-good hormones, and can help to reduce the feeling of pain. If you haven't exercised for a while and/or are not sure what exercise would be suitable for you, speak to your GP.
For pain resulting from headaches or period pain, and acute pain such as sports injuries, different pain relief medicines may be considered and some can be used in combination if needed. Medications, such as paracetamol***, ibuprofen*** or aspirin***, can reduce your pain temporarily. Other opiod-containing medications, including codeine*** and dihydrocodeine***, can be effective in treating acute pain. However, they should only be used if paracetamol or ibuprofen have not been effective and they can be addictive, so should only be used for a maximum of three days when purchased over the counter. For some types of pain, including joint and muscle pain, topical pain relief products which include gels and creams may provide pain relief.
It's important to take any medication as directed and only if it's suitable for you. Speak to a member of the pharmacy team for advice. You must not exceed the stated dose.
Chronic pain cannot be treated with over-the-counter medicines. Chronic pain is complex and different treatments may work better for different people. A combination of complementary treatments, such as physiotherapy and cognitive behavioural therapy, alongside certain medications, is often considered to effectively manage chronic pain.
Neuropathic pain cannot be treated with over-the-counter medicines. It is a type of pain associated with damage to the nerves and includes things like sciatica and pain after spinal surgery. Pain relief medications to help with this type of pain are normally available by prescription only. They usually take time to work and more than one type may be needed.
It is advisable to discuss your pain with your GP or pharmacist before taking any new medicines. If pain is impacting your day-to-day life, you should see your GP to help them understand your pain level and any medication you are currently taking so that they can best support.
Managing chronic pain can be difficult and make you feel not like yourself or even anxious and depressed. Living with chronic pain can feel isolating, particularly if you feel that treatment options aren't working or if others around you struggle to empathise.
Chronic pain affects your body, your emotions and feelings and impacts what you do. Physical limitations caused by pain can be difficult and frustrating, especially when no cure is available for the condition. This can lead to worry and frustration. Some people experiencing chronic pain find it useful to seek help from a counsellor, psychologist or hypnotherapist, to discover how to deal with their emotions in relation to their pain.
Cognitive behavioural therapy (CBT) is a type of talking therapy that can help you manage challenges by understanding how you think, respond and behave. CBT is a practical therapy focusing on current problems rather than the past. It can help you become aware of how connected our bodies and minds are and how they respond to each other.
Therapy can help you manage difficult life events such as depression, anxiety, trauma and feeling low. If you are registered with a GP, you may be able to access CBT and other talking therapies on the NHS. Alternatively, you can explore the services available on the Boots Health Hub, such as on-demand talking therapy from SupportRoom.*
Heat increases the flow of blood to the area it is applied to. Applying heat to an area often works best for muscle stiffness or period pain.
Cold therapy slows down blood flow, reducing swelling and pain. It’s often best for short-term pain, like that from a sprain or a strain.
Either hot or cold therapy may soothe aches and pains caused by conditions like osteoarthritis, rheumatoid arthritis, back pain, fibromyalgia and neck pain.
You can use:
- A hot/cold compress that can be microwaved/frozen.
- A bag of frozen vegetables wrapped in a tea towel.
- A cloth or small towel soaked in hot or cold water.
Always be careful when using hot or cold therapy to make sure the product you are using is not too hot or too cold before using it, as this may cause burns or blistering.
TENS machines are reusable, drug-free devices which help to temporarily relieve minor aches and pains. They can be used to treat muscular or joint pain, arthritis, sports injuries and more. TENS machines can be used alone, or alongside traditional pain relief such as paracetamol, as an additional way to help manage your pain.
TENS stands for Transcutaneous Electrical Nerve Stimulation. Simply put, this means a mild (and non-painful) electrical current is emitted from the pads controlled by the TENS machine, to intercept the pain signals being sent to your brain, and in turn helps provide temporary relief from mild aches and pains. These electrical impulses may also also stimulate the production of the body's natural painkillers - endorphins, which act directly at the site of pain.
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FREQUENTLY ASKED QUESTIONS
The aim of a Pain Management Programme is to improve your quality of life despite your pain, rather than reduce your pain. PMPs are usually delivered through a series of sessions, either in-person or virtually. Speak to your GP to see if there are any courses available locally or, alternatively, you could access the Leva Pain Management Programme*, which is available via the Boots Health Hub.
*Subject to availability. Charges may apply.
**Access to prescription-only treatment is subject to an online consultation with a clinician to assess suitability. Subject to availability. Charges apply.
***Always read the label.
†Subject to availability and clinician approval. Charges apply.
‡Advantage Card must be linked to an Advantage Card account at the time of purchase to be eligible for this offer. Normal Advantage Card terms and conditions apply. Excludes in-store orders. No Price Advantage at airport stores.
Being in pain, acute or chronic, dull or sharp, can affect your day-to-day life, so knowing how to manage it and when to seek medical advice is important. For some types of pain, Boots can help with your pain management with our range of products and services. Explore our advice on pain management and learn some tips and recommendations on how to manage certain types of pain from our pain management specialists.