Pain serves a useful and vital purpose in life, but at times, understanding it can be tricky. How can we distinguish between mild, moderate and severe pain? What should we do if the sensations do not go away after medication?

Dr. Kevin Yip tells you how we can manage pain better.

Pain is one of the most effective ways your body has to communicate with you. It is pretty much like a free alarm; when it goes off, the noise is designed to not only grab your attention and alert you to the fact that there is an emergency, but to also make you respond as quickly as you can to the situation at hand.

However, sometimes the pain system – like a fire alarm – can malfunction. Maybe the fire that tripped the alarm has already been taken care of but you just can’t quite figure out how exactly to stop that infernal ringing. Or maybe there’s a false alarm every few days – there’s no smoke, no fire, and nobody can quite figure out what’s causing the alarm to go off.

Take, for instance, phantom limb symptom, a condition where the patient still experiences pain and other sensations in a limb even after it has been amputated. The patient can see and therefore know for a fact that the limb is no longer attached to the body and, thus, there can be no possible way for any nerves to convey sensation to the brain; but yet, inexplicable, the patient can still feel pain radiating from the place where the limb used to be.

Like fire, pain is a good servant but a poor master. So what can we do when it starts getting out of hand?

Pain Scale

The first step is to understand how pain is measured. Medical professionals tend to use something known as the pain scale, where they get the patient to rate the feeling of pain from a scale of 0 to 10 with 10 being the worst and 0 being no pain at all. This allows both doctor and patient to not only know if a treatment is working. If, for example, the pain was 7 before treatment and it drops to a 3 after a 30-minute treatment, ,the treatment can be said to be fairly effective.

Mild Pain

Acute mild pain is possibly the most common form of pain that we experience on a daily basis, from knocking into furniture to twisting your ankle and having a headache. The best way to deal with this level of pain is, well, to simply tough it out. Most forms of mild pain will disappear on their own in time, as soon as the original cause of the pain is removed.

In an event that the cause is unknown, ambiguous or difficult to treat, one may consider using low doses of over-the-counter analgesics (commonly known as painkillers) to manage the pain. This would most frequently be paracetamol or, as it is more commonly known by its local name, Panadol.

Paracetamol is available at pharmacies and may be obtained over the counter without a prescription. While generally safe to use, one should stick to the recommended dosage of no more than 1,000mg per single dose and a maximum dose of 4.000mg per day for an adult; overdosing on paaracetamol may cause kidney, brain and liver damage that may eventually prove fatal.

Another common analgesic that you may wish to consider is ibuprofen, a commonly used NSAID (non-steroidal anti-inflammatory drug). Ibuprofen is usually used when the cause of pain is inflammatory in nature, such as from a sprained ankle or injured finger, as all NSAIDs are known to help reduce the swelling associated with inflammation While officially an over-the-drug that can be purchased at any pharmacy without a prescription, you may have to ask the pharmacist for it as it usually kept behind the counter.

Moderate Pain

Moderate pain tends to be sufficiently disruptive to a person’s life that, if it is not immediately addresed, can often prove incapicitating over time. In such situations, one may wish to see a doctor to makes sure that the pain is not a sign of something more serious and at the same time, get a prescription for some stronger analgesics.

Combination analgesics are the next step in pain management and are used when the aforementioned analgesics have proven to be ineffective. A combination of painkiller is exactly what it sounds like: a combination of two mild analgesics which are known to work better when used together at the same time. This combination usually comprises of a common analgesic (like paracetamol) mixed with a mild opioid (like codeine) into a single tablet, but at times, the doctor will prescribe these drugs separately and instruct the patient to take them together.

Due to the presence of the opioid in the drug, combination analgesics must usually be obtained through a doctor. This is because opioids, by themselves, are Schedule III drugs and thus are only available with a prescription; correspondingly, any combination containing an opioid will therefore also require  prescription to obtain.

It should be noted that many stronger painkillers have been known to cause stomach irritation or pain, which is why doctors tend to prescribe another drug like an antacid or a proton pump ibhibitor (such as omeprazole) to help the patient settle his/her stomach. Should you experience any symptoms like a stomach ache, diarhhoea or bloody stools, stop taking the painkillers and see your doctor immediately so that he/she may be able to either change the painkillers you are on or prescribe a different course of drugs to help your body adapt to the analgesics.

Severe Pain

If oral medication does not work, or if the patient is in much pain that he/she rates it at 7 or higher on the pain scale, doctors may start looking at intravenous means of getting analgesics directly into the patient’s body. This is the fastest way a drug can enter a patient’s body, causing the analgesic to take effect almost immediately upon entering the bloodstream.

The most famous of intravenous analgesics is, of course, morphine. The most powerful opioids, morphine is commonly held to be the gold standard against which all other analgesics compared against. However, due to its high potential for addiction, it is reserved for patients who suffer from severe pain, and even then used only sparingly.

Most hospitals give patients who require morphine a clicker, allowing the patient to automatically inject themselves with a small dose of of the drug whenever the pain becomes too much to bear. If pressed too many times within a short period of time, however, the clicker will lock itself, preventing the patient from introducing too much morphine into his or her own body.