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Managing pain

What is pain?

The sensation of pain is caused by electrical impulses which are transmitted from local damage receptors in the area of the body where the problem is, along the nerves to the spinal cord, and then to the brain. Once these nerve impulses reach the brain you begin to feel pain. A message is then relayed back from the brain to the damaged area and the surrounding muscles and organs to take preventative measures, such as removing your hand from a hot stove.

There are two types of pain, acute pain which is caused by an immediate injury or illness and is relatively short lived, and chronic pain which can go on for many years and is more difficult to relieve. Chronic pain is associated with a continual discharge of electrical activity at one or more levels of the central nervous system.

Pain is experienced in a huge variety of ways. It ranges from specific pain that affects specific parts of the body to general pain than may have a whole-body impact. In extreme instances sensitivity to being touched and extremes of temperature can be experienced as pain.

Managing pain

This section is not designed to make you an expert in pain management, but will hopefully encourage you to think about how you can best manage pain.

Firstly, don’t ignore any type of pain. Pain is your body’s way of telling you that something is wrong and sometimes forces you to rest. For example, if you twist your ankle you will experience pain, swelling and possibly bruising making it impossible to place weight on the joint. This is your body’s way of making you rest until the joint has recovered. Similarly, if you have a stress related headache, it is your body’s way of telling you to ease up.

Chronic pain is often complex. Sometimes it is difficult to pin point the cause. As a result it is often difficult to manage. This can be the case with hepatitis C. Although the virus targets the liver, hepatitis C is able to affect many of the body’s systems. As a consequence the pain can take many forms, from muscle and joint pain, abdominal pain, back pain, headaches, dry and sore eyes and skin, to a sensitivity to light and temperature.

In addition chronic pain can become such a part of everyday life that it is sometimes overlooked or underreported. Yet, naturally, it can severely affect your quality of life.
Keeping a pain diary, even for a short time, can be an opportunity to see how pain is impacting on your life. It can also be a useful tool for you and your doctor. If you are able to record specific details about the pain then it is more likely that a cause can be identified or patterns revealed that will give some insight into how the pain can be avoided or managed.

For example, if it becomes evident that the pain is worse after eating a meal you may want to consider adapting the type or quantity of food you eat, or the timing of meals to see if it makes any difference. In addition, by recording what action you have taken to relieve any pain and how successful it was may also help you find a solution. If you want to compile a pain diary you may find it useful to record the following:

  • Where pain is felt.
  • When it occurs.
  • How it feels e.g., aching, stabbing, shooting, etc.
  • How severe the pain is on a scale of 0-10.
  • How often the pain is felt.
  • How long the pain lasts.
  • Does anything seem to trigger it or make it worse?
  • Does anything make it better?
  • What impact it has on your life.
  • What you have tried to relieve it?

Pain relief is about keeping pain under control and is an important part of dealing with hepatitis C. This can incorporate identifying and avoiding triggers to pain, undertaking a treatment regime that reduces the severity of pain, or using drugs or therapies that reduce pain or raise the thresholds.

Pain relief can be loosely divided into four separate categories:

1. Specific treatments to try and eradicate the virus as the source of pain and symptoms

Treatment to try and eradicate the hepatitis C virus and the associated pain and symptoms is through conventional treatment of interferon and ribavirin. However, it is important to be aware that even clearing the virus with treatment will not necessarily relieve all your symptoms.

2. Painkillers

Painkillers are metabolised by the liver, but in the case of hepatitis C even the recommended dose may be toxic (hepatotoxic). For this reason it is essential that prior to taking any painkillers, including over the counter medication, medical advice should be sought.

Taking an occasional painkiller will probably not cause problems, but prolonged use is best avoided as it can lead to significant liver damage. In addition codeine, which is now contained in the strongest over the counter medicines, can be addictive if used continuously.

3. Alternative remedies for pain

Alternative or complementary approaches to pain relief include therapies, natural remedies and psychological interventions.

4. Coping strategies & The Pain Gate Theory

The Pain Gate Theory - This was discovered in 1965 by Dr Ronald Melzack & Dr Patrick Wall and published in their book The Challenge of Pain in 1966. This works on the premise that nerve gates in the spinal cord can either open to allow through messages signalling damage, or close to block their passage, which means that pain is not felt. The gate opens or closes in response to messages sent from the brain. Therefore the messages that we are choosing to send out will have an impact on opening or closing the gate. The gate can also be closed by stimulating peripheral parts of the body, like the arms or legs, and this is how acupuncture and TENS machines seem to work.

Various things are recognised as opening the pain gate:

  • Overdoing things
  • Fear
  • Tension
  • Concentrating on the pain
  • Poor diet
  • Depression
  • Indecision
  • Stress
  • Tiredness
  • Anxiety
  • Poor posture

Things that may help to close the pain gate:

  • Laughing
  • Massage
  • Exercise
  • Hypnosis
  • Pacing your activities
  • Being enthusiastic
  • Rubbing the area that hurts
  • Meditation
  • Visualisation
  • Feeling joyful
  • Good posture
  • Relaxation
  • Distracting your attention from the pain
  • Having a positive attitude
  • Tens machine
  • Applying heat or cold to the area that hurts
  • Gentle movement (qi gong, tai chi)
  • Deep breathing
  • Music

Many of these things work through the release of endorphins that reduce the body’s electrical activity. Exercise is an especially good way of stimulating endorphins.

The key to controlling chronic pain often lies in our own hands. By using these various strategies it is possible to stimulate the particular pathways to the brain which close the gate. Putting these things into practice does not necessarily mean the pain will go away completely though. All that is happening is that you are closing off the emotional reaction to pain (suffering, anger, despair) and replacing it with a positive action. This enables you to cope better, despite continuing to feel the pain.