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Pain, like many other human experiences, is largely subjective. Depending upon a certain person’s medical history and life story, they may experience a painful incident, such as stubbing their toe or having a migraine, in an entirely different manner to a friend or family member. Because of this, pain can often be difficult to treat.

The good news is that our understanding of how pain works is improving every day. In the past few years, more attention has been drawn to painful conditions that specifically affect women, such as endometriosis; in this article from The New Republic, the writer argues that "Too often, a woman’s pain is not merely met with doubt, but suspicion", and explains the various ways in which women are now fighting back against this prejudice.

In addition to shifts in how we think about pain, we’re also seeing improvements in the field of pain management. Just recently, researchers designed a new compound which successfully treated neuropathic pain in animals.

For pain sufferers, in other words, things look set to improve over the next few years. In the meantime, one of the best ways to stay on top of pain symptoms is to be well informed. If you’d like to know more about pain management, read on for a guide to the various types of pain, and how they can be treated.

Acute Pain vs Chronic Pain 

The most common pain categories are acute and chronic. Acute pain is pain that comes on suddenly and is limited in its duration; chronic pain, by contrast, is more permanent in nature. Acute pain is more likely to be caused by damage to the body, while chronic pain is more likely to be caused by a long-term condition – although it can also arise as a result of injury.

Chronic pain can be resistant to medical treatment, and pain medication is not always sufficient. It’s believed that episodes of "breakthrough pain" are experienced by 70% of people who suffer from chronic pain (1). This is where the sufferer has a flare-up of pain, despite being on regular medication. Because chronic pain can be resistant to medical treatment in this way, it can lead to depression and anxiety, which can in turn worsen the symptoms.

Nociceptive Pain vs Neuropathic Pain

After the categories of acute and chronic, pain is most often categorised by whether it is nociceptive, relating to tissue damage, or neuropathic, relating to nerve damage (2).

Pain from tissue damage is more common than pain from nerve damage. You may experience nociceptive pain from injury to your bones, soft tissue or organs, or as a result of a disease. Pain from tissue damage can be acute or chronic, and is often sharp, throbbing or dull.

Neuropathic pain occurs when the nerves are damaged. People who suffer from neuropathic pain often experience a burning sensation and sensitivity in the affected areas. Other symptoms include pins and needles, difficulty sensing different temperatures, and numbness (3).

With both nociceptive and neuropathic pain, mental and emotional problems such as depression can worsen the pain symptoms. This is sometimes referred to as psychogenic pain.

Conditions that Cause Pain

There are a variety of conditions that can cause chronic pain or repeating episodes of acute pain. These include:

• Cluster headaches, sudden attacks of pain on one side of the head (usually around the eye)
• Complex Regional Pain Syndrome, which is usually triggered by an injury and causes severe, ongoing pain in the affected area
• Slipped disc, where the tissue between two vertebrae pushes out and causes back pain
• Arthritis, where the joints become inflamed and painful
• Sickle cell disease, which can cause a sudden episode of pain known as a "pain crisis"
• Endometriosis, a condition that affects women and causes chronic pain which is particularly acute when menstruating

These are just a few of the conditions that can cause ongoing pain symptoms. If you are suffering from pain and you aren’t sure of the cause, you should make an appointment with your GP as soon as possible.

Treating Pain

As we’ve discussed, pain isn’t always easy to treat. However, there are a huge number of different options available to try. To receive a free online assessment regarding your pain, visit our Pain Management Clinic. We can give advice on treatment options and prescribe a range of safe painkillers.

Sources:

(1) https://www.webmd.com/pain-management/guide/pain-types-and-classifications#1-2

(2) https://www.webmd.com/pain-management/guide/pain-types-and-classifications#2-3

(3) https://www.brainandspine.org.uk/neuropathic-pain

January 22nd - 28th is Cervical Cancer Prevention Week; a Jo’s Cervical Cancer Trust initiative which this year is focusing on the different ways in which women can take small steps towards reducing their risk. By understanding more about the symptoms of cervical cancer, and its risk factors, Jo’s Trust is hoping to lower cervical cancer rates in the UK through education, knowledge, and simple screening.

What is Cervical Cancer?

Cervical cancer occurs when cancerous cells develop in the cervix, and it’s more common than many people think. In fact, cervical cancer is the 13th most common cancer in women (1), and around 3000 new cases are diagnosed each and every year in the UK (2). Sadly, despite high survival rates – women diagnosed with Stage 1 cervical cancer have an 80-99% 5-year survival rate – 3 women lose their lives to the disease every day (3). Many women don’t realise that they have cervical cancer until a later stage.

Improving Awareness

The Jo’s Trust Cervical Cancer Prevention Week is designed to help women become more aware of the signs and symptoms of the disease. The ultimate aim is to improve awareness of the different ways that women can minimise their risk of developing cancer, and take simple measures to ensure that if they do have the disease, the cancer is diagnosed during the early stages for the highest chance of survival.

Here in the UK, many women are not taking advantage of the available screening methods for cervical cancer. There are a number of screening methods available, but one of the most well known techniques is cervical screening, or the ‘smear’ test. Each year, 5 million women in the UK aged between 25-64 are invited for cervical screening (4), although an estimated 1,250,000 won’t make an appointment (5). These statistics are worrying, as it’s believed that regular smears could prevent 75% of cervical cancer cases.

It’s Time to be Proactive

Cervical Cancer Prevention Week is the perfect time for women to be brave, be proactive, and take control. A good starting point is to learn more about the causes of cervical cancer, and how to reduce risk factors. There are many different aspects that can contribute towards the development of cervical cancer, such as chlamydia, smoking, family history, and the use of oral contraceptives, although 99.7% of cervical cancers are caused by the human papillomavirus infection, or HPV (6), which can affect cells.

HPV isn’t always linked to cervical cancer. In fact, HPV is very common and, in many cases, the body is able to successfully fight off the virus without causing any long lasting damage. However, there are some specific forms of HPV – HPV 16 and HPV 18 – which are present in around 70% of cervical cancer cases (7), suggesting that these are typically ‘high risk’ forms. Fortunately, women can determine if they are considered high risk for these forms of HPV by taking a quick and simple HPV screening test at home.

Sharing Knowledge

The Jo’s Trust campaign is also encouraging women to share their knowledge, and ensure that younger girls are growing up armed with the information they need to help protect themselves from disease. The HPV vaccine is now available on the NHS for free for girls aged between 12 and 18, and protects against 4 different types of HPV: HPV 16 and HPV 18, which are most commonly associated with the development of cervical cancer, along with HPV 6 and HPV 11, which can contribute to genital warts.

Reduce Your Risk

Through small lifestyle changes, such as using condoms and stopping smoking, and through regular screening including quick at-home HPV tests, and NHS cervical screening every 3 years (for women aged 25 - 49) or every 5 years (for women aged 50 - 64), women all across the UK can give themselves the best chance to protect themselves from cancer, or catch the disease early to improve their survival rate.

Staying Safe in the Bedroom

Christmas and New Year is a time for revelry and fun, with plenty of food and drink... as well as more private activities. The downside to the increased sexual activity at this time of the year is the corresponding rise in the number of sexually transmitted infections, which then have to be treated in the first few months of the New Year. We are already starting to see an uptick in patients presenting with symptoms of an STI. The most common bacterial sexually transmitted infection encountered by us is chlamydia trachomatis.

Chlamydia

Chlamydia is a potentially serious infection that can result in infertility in women, as well as the potentially lethal condition known as ectopic pregnancy, if it is not detected and treated as soon as possible.

Chlamydia will normally take around 14 days to appear in a test result but it can produce a positive result earlier. Any negative result prior to 14 days will need to be repeated at the appropriate juncture.

Testing

Not everyone who contracts the chlamydia infection will experience obvious symptoms, and screening tests can be done from self taken vaginal swabs or urine samples. 

If a woman is experiencing urinary symptoms then it is probably a better idea to test for chlamydia with a urine sample, rather than a vaginal swab. Urine samples need to be collected at least two hours after the last time urine was passed to ensure an accurate result. 

Sexually active people below the age of 25 should be tested once a year for the infection or every time they acquire a new sexual partner, or in the event of experiencing any symptoms such as pain during urination, painful sex, abdominal pain, or abnormal discharges or bleeding from the vagina. The rest of us need to be tested when we change sexual partner or experience symptoms.

Treatment

The good news is that chlamydia can be effectively treated either with a single one gram dose of azithromycin or a twice daily seven day 100 mg course of doxycycline. Both of these treatments come with their own advantages and disadvantages.

Doxycycline should not be used in pregnancy.

Anyone who receives any form of treatment should make sure they are tested again from 6 weeks after treatment commenced, in order to make sure the infection has been cured and to avoid the possibility of false results. 

All recent partners from within the last three months should also be given treatment irrespective of their own chlamydia test results. You and your current partners should be simultaneously treated with antibiotics, while abstaining from sex during treatment, even with a condom. 

Long-term complications from a chlamydia infection are much more likely in people who contract the infection numerous times, so anyone who is infected should take additional precautions in the future, in order to make sure that it does not happen again. The use of condoms is vital, and is the only method to protect against infection – but it is not 100% effective and regular screening is still recommended.

The Online Clinic is pleased to announce that we are able to offer a generic version of Cialis at a significantly reduced price.

Tadalafil has been one of the most popular treatments for erectile dysfunction because of its relatively long half-life, allowing men more spontaneity than with other erectile dysfunction treatments. Up until now, we have had to prescribe this medication as Cialis as it was still on patent.

Tadalafil as a generic is only available at the 10 mg and 20 mg (on demand doses). If you are using Cialis as a daily medication then we will still have to prescribe as branded Cialis.

If you are already receiving ED medication from The Online Clinic then you can login to request a review of your treatment. If you have not used us before, you can register below.

Antibiotics: Mixed Messages for Patients

Scientific discoveries are happening all the time, and sometimes a new piece of research will come along to dispel everything we thought we knew.

The most recent debate to crop up regards antibiotic resistance. All approved guidance currently relating to antibiotic use tells us that finishing a course of antibiotics is vital, even if we begin to feel better within a couple of days. Now, experts have begun to argue something very different.

A team of UK researchers published a short opinion piece in the BMJ (formerly the British Medical Journal) in July, claiming that there is not enough evidence to suggest that cutting short a course of antibiotics contributes to antibiotic resistance.

One of the researchers, Professor Martin Llewelyn, suggested that long courses were "outdated" and that there is now plenty of evidence that short courses of three to five days work just as well. In his opinion, antibiotics should be prescribed on a case by case basis, tailored towards each patient and their specific infection, and not simply administered in the same way every single time.

While these researchers are not putting forward the idea that patients be allowed to judge themselves when they stop a course, there is concern amongst the medical community that this sort of guidance could end up causing confusion.

Not enough research has been done into the "stop when you feel better" model of antibiotic use, and for that reason Public Health England has recommended that patients continue to follow the advice of their prescribing doctor.

Correct Antibiotic Use

As well as taking the full course of antibiotics that you have been prescribed (whether or not you begin to feel better before the end of the course), there are a few things you can bear in mind if you wish to avoid contributing to antibiotic resistance.

The first thing to know is that antibiotics are only an appropriate treatment in the case of a bacterial infection. They have no effect upon viral infections. The common cold and flu are two types of viral infection, which cannot be treated with antibiotics. 

If you become unwell with a cold, you may be tempted to visit your doctor and ask for antibiotics, but it is always best to wait the infection out, resting at home and taking over-the-counter cold treatments. You should typically only visit your GP if your cold has not cleared after three weeks, or if the symptoms are getting noticeably worse.

The flu tends to be more serious, and you should visit your doctor if you fall into a certain at-risk group such as being over 65 or pregnant. Bear in mind, however, that antibiotics are not an appropriate treatment for the flu, and that the best way to avoid it if you are in an at-risk group is to get the annual flu jab.

Avoiding Infection

If you want to avoid taking antibiotics, one of the best things you can do is to protect yourself against bacterial infections. You can prevent germs from spreading by following the kinds of hygiene tips set out by the NHS here.

Another way to avoid infection is to always practise safe sex. Many STIs are bacterial, which means they should be treated with antibiotics. The problem is that STIs such as gonorrhoea have begun to develop antibiotic-resistant strains, which can be very difficult to treat.

To avoid STIs, you should always:

• Use condoms during penetrative sex when you aren’t sure your partner is free from infection
• Use dental dams and condoms during oral sex
• Avoid sharing sex toys unless they have been cleaned or covered in a new condom

You can read more about the risks associated with specific sexual activities here.

Remember that it’s important to get tested regularly if you’re engaging in any risky sexual behaviours. Getting diagnosed early makes treatment easier and reduces the risk of complications; it will also stop you from passing the infection on to others.