White Paper & Resources

Healthcare Providers:

For additional information or samples, please visit www.wraser.com.  

Overview of Pain (This Section is NOT Intended to Treat or Diagnose):

What is pain?  The International Association for the Study of Pain defines it as:  An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.

More than half of Americans live with chronic or recurrent pain, with broad numbers saying it interferes with their activities, mood and enjoyment of life - sparking a vast search for relief, from mediation to bed rest, yoga or the palliative power of prayer.

According to to surveys, excluding minor annoyances, just under half of adults have experienced pain the last two weeks, and nearly four in 10 do so on a regular basis.  Six in 10 Americans rate their last experience with pain as moderate or worse, and for two in 10 - about 45 million individuals - it was severe.  Nineteen percent suffer from chronic pain, meaning ongoing pain that's lasted three months or more.  An additional 34 percent report recurrent pain; the rest say their usual pain experience is acute, or short-term.

Assessment of Pain Levels:

When assessing pain levels, physicians and/or nurses often ask how severe the pain is.  Pain is often described as none, moderate, severe, or excruciating.  Pain can also be measured on various scales (including picking a number between zero, for none, and 10, for excruciating).  The scale most commonly used is the Wong-Baker Rating Scale.  It is extremely difficult for individuals to determine the severity of their pain.  People experience pain differently and need different doses of medicine to relieve pain.  The most important rule of pain control: The right dose of pain medicine is the dose that relieves the pain.

People differ remarkable in their ability to tolerate pain.  One person cannot tolerate the pain of a small cut or bruise, but another person can tolerate pain caused by a major accident or knife would with little complaint.  The ability to withstand pain varies according to mood, personality, and circumstance.  In a moment of excitement during an athletic match, an athlete may not notice a severe bruise but is likely to be very aware of the pain after the match, particularly if the team lost.  

The ability to tolerate pain may change with age.  As people age, they complain less of pain, perhaps because changes in the body decrease the sensation of pain.  On the other hand, older people may simply be more stoic than younger people.

Helpful Facts:

• There are six common types of pain; acute pain, chronic pain, nociceptive (tissue) pain, somatic pain, viceral pain, and neuropathic (nerve) pain.
• 60% of all pain is located in just five areas; back, head, shoulder, legs and knee.
• Back pain is the most-cited pain across all pain groups, peaking slightly among chronic pain sufferers.  
• Half of Americans say their pain is the result of a specific medical condition or injury.  
• Acute pain results from disease, inflammation, or injury to tissue and generally is sudden in onset.
• The human spinal cord acts as a sort of relay center where the pain signal can be blocked, enhanced, or otherwise modified before it is relayed to the brain.
• Pain affects men and women equally.
• Pain is actually a helpful warning signal that something isn't quite right.
• The three types of pain receptors are: mechanical, thermal and chemical.
• Chronic pain is representative of disease itself and persists over a longer period of time than acute pain and is resistant to most medical treatments.

http://www.medicinenet.com/pain_management/article.htm

http://www.nlm.nih.gov/medlineplus/painrelievers.html

DEA Issues Proposed Rule Up-Scheduling Hydrocodone Combination Products from Schedule III to Schedule II:

Summary

On February 27, 2014, the Drug Enforcement Administration (DEA)proposed an up-scheduling for hydrocodone combination products under the Controlled Substances Act (CSA) from Schedule III to Schedule II.If the proposed rule is finalized, all of the entities and individuals who handle or prescribe hydrocodone combination products will be subject to the myriad regulatory controls governing Schedule II controlled substances.Interested persons may submit written comments to DEA before midnight Eastern Time on April 28, 2014. The comments submitted and the identifying information of the commenter will be made part of the public record.

Background

Under the CSA, controlled substances are classified into one of five schedules based on their potential for abuse, their currently accepted medical use, and the degree of dependence they may cause. Currently,single-entity hydrocodone products are classified in Schedule II, buthydrocodone combination products that contain 15 milligrams or less ofhydrocodone per dosage unit, or 300 mg or less of hydrocodone per 100milliliters, are classified in Schedule III.