What is the worst pain you can experience?
It is generally accepted that kidney stones and childbirth are the worst pains to be encountered. However, of the everyday pains we can encounter, migraine is thought to be the worst, with period pain and backache following closely behind.(1)

Is pain a sign of weakness?
No. Everyone suffers pain to some degree during their life. It is your body's way of telling you something is wrong and trying to protect you from further damage. It is caused by tissue damage or stress stimulating the nerves, which send signals to the brain.

Is pain hereditary?
Pain is a very personal and individual experience. Whether it is hereditary is an ongoing debate but recent research suggests that the threshold at which the body responds to pain may be inherited. (2)
Other pain thought to be hereditary is migraines, with the genetic factor being responsible for 70% to 80% of suffering. (3)
Although not hereditary, cluster headaches are found to affect people with certain physical traits, namely being male, aged 20-40 years, tall, muscular, a ragged facial appearance, square jutting or dimpled chin and hazel eyes! (4)
Cluster headaches are repeated episodes of intense migraine pain.

Can you feel pain from internal organs?
Yes. What is interesting however is that the pain from internal organs can sometimes be referred to another part of the body. For example toothache is felt in the ears, and a pain in the upper left arm could indicate a problem with your heart. As with any pain, if it persists should be checked by your GP.

Does a happier fitter person feel less pain?
Although pain needs a physical stimulus to the nerves, pain is partly psychological. Therefore the extent to which pain is felt can be affected by moods and feelings. For example, if we are tired, we tend to feel pain more easily. In contrast a study in Pittsburgh (5) showed that people with a varied and active social life are less prone to catching a cold and therefore feeling the associated aches and pains. Other studies have shown that physical fitness may improve pain tolerance.(6)

Which sex feels more pain?
There is an ongoing debate as to who suffers more pain. At the American Association of Advancement of Science 2000 meeting it was proposed that women suffer more pain and that men and women may respond differently to pain, with different pathways in the brain being activated.

What is a hangover?
A hangover is the result of the body being unable to breakdown all the alcohol in the blood stream. As a result the liver, which is responsible for removing toxins from the body, breaks down alcohol to a halfway stage (ethanol). It is this by-product that leaves us with the typical headaches, sickness and dehydration.

Can different foods cause headaches?
Yes and one example is caffeine, which stimulates the central nervous system. In some people this can help them function more efficiently, in others they may encounter a headache as a result of too much caffeine. Caffeine can be found in coffee, tea, cola and chocolate.

Why are periods painful?
Hormones released by the body cause the uterine muscles to contract resulting in "cramps". The subsequent pain may be spasmodic - a pain in the lower back or congestive - a dull ache prior to the period.

Pain Relief

Is it best to ignore pain and just get on with it?
No. Pain is your body's way of telling you something is wrong and trying to protect you from further damage. You need to identify the cause of the pain and, where possible, remove it. Once the cause has been identified there is no point in suffering pain. In fact, using pain relief can actually help prevent the symptoms worsening (it blocks the "vicious circle"(7) effect from making the pain worse - see What is pain?).

Can you distract yourself from the pain - is there such a thing as mind over matter?
Pain is both a physical and psychological phenomenon, so to a limited extent you can have an effect on the amount of pain you can endure. For example, a study in the US found that thinking of your favourite sexual fantasy could increase your tolerance towards pain. (8) However, it is widely accepted that if you fail to treat pain, the intensity continues to increase although the severity of the cause may remain the same (the vicious circle effect). (7)

Do pain relievers just hide the pain rather than cure the symptom?
Pain relievers do relieve the pain, but they can also reduce fever (paracetamol, aspirin and ibuprofen) and decrease swelling and inflammation (ibuprofen).

Are all pain relievers the same?
No. There are three main active ingredients used to relieve pain

• Aspirin, which also helps to reduce fever.
• Ibuprofen, which can help reduce fever and reduce inflammation and swelling
• Paracetamol, which also helps to reduce fever

Choosing the right product for the right pain can make a big impact on recovery. Children until 12 years should NOT be given aspirin.

Can you mix different types of pain relievers?
Yes, however, whenever taking pain relievers read the label and instructions carefully. Doing so should inform you as to the active ingredients, enabling you to avoid taking more than the stated dose of any one type. If the pain is so severe that one type of pain reliever is insufficient it is advisable to check with a pharmacist, doctor or ring NHS direct.

Are OTC (over the counter) pain relievers safe?
Yes, as long as you read the labels, follow the instructions, do not exceed the stated dose and do not take the pain relievers for extended periods of time (e.g. more than a few days). If you require stronger pain relief or the pain is persistent seek advice from a healthcare professional.

Are pain relievers addictive?
The pain relievers that are available over the counter are not addictive in the doses recommended.

Can you become so tolerant to pain relievers that they no are longer effective?
If you use pain relievers over an extended length of time (longer than recommended on the label), you may start to build up a tolerance to some of the active ingredients. This however does not effect your immune system in any way.

Does the format of the pain reliever affect the strength? Are dissolvable pain relievers weaker?
No. The strength of the product is not affected by the format, and each has its benefits. Dissolvable pain relievers are absorbed quickly into the system, tablets are felt by many to be more convenient and some people prefer topical treatments, i.e. those applied directly to the skin e.g. for sports injuries.

Can pain relievers go off, like food?
All medicines have a use by date on the packaging.

Can children be given pain relief medicines?
Children under 12 should NOT be given aspirin, but there are many specially formulated products for children from 3 months old. Whatever age, please ensure that the correct dosage is used and if in any doubt contact a healthcare professional.

Complementary Therapies

Is relaxation better than any pain reliever?
In some cases such as stress-related headaches, relaxation can help treat a headache. However, most people will agree that if stress is causing the headache it is extremely difficult to suddenly switch to "relaxation mode". Many people find that taking a bath can help as the warm water can ease tightness in muscles.

Does rubbing a dock leaf onto a nettle sting help alleviate the pain, and are there any other plants that can help to ease other
types of pain?
Yes rubbing a dock leaf onto a nettle sting releases a natural antihistamine, which helps to relief the irritation. However, merely rubbing the site of the sting would also help. There are other plants that alleviate irritation such as the oil from Evening Primrose, which can be used to treat eczema.

What other techniques work to relieve pain?
Very often headaches may be caused by dehydration. In such a situation, more water needs to be consumed. Massage can also help. Unfortunately when a situation has developed to the stage when there is a clear constant pain, it usually means that a pain relief remedy is required to prevent the pain becoming worse.

References:
(1) The Oral Analgesics Market Report 1996-1997
(2) JAMA Migraine Information Centre
(3) www.headaches.org
(4) National Institute of Neurological Disorders
(5) The Cold War, Malcolm Newall, Rosendale Press 1996
(6) health-news.co.uk 10-03-2000
(7) E-mail correspondence with Dr Chudler
(8) Daily Mail 01-02-2000

For further information please contact:

Karen Kelshaw
Consumer Health Information Centre
tel: 020 7421 9314
fax: 020 7421 9317
email: karen.kelshaw@pagb.co.uk

Pam Prentice
Doctor Patient Partnership
tel: 020 7383 6144
out of office hours: 0780 3399826
email: pprentice@bma.org.uk

Marianne Smith
Doctor Patient Partnership
tel 020 7383 6828
fax: 020 7383 6966
email: msmith@bma.org.u