Pain relief in the rheumatic and other disorders.

When severe pain is present, so usually is fear. Whether the pain results from a traffic accident, a sports injury, an arthritic exacerbation or a coronary thrombosis, an explanation of what is going on carries considerable reassurance, for uncertainty and fear of the unknown aggravates and increases the pain. I remember well a frightened lady being admitted with acute dorsal backache, the pain of which was not controlled by 6-hourly injections of morphine. She feared she had metastatic malignant disease in the spine, which indeed she did have, but in a calm and reassuring atmosphere and with excellent nursing staff she was maintained only on mild sedation and simple analgesics. For some patients the knowledge that injections are given for serious conditions adds to their anxiety. The pain of metastatic malignant disease is often helped considerably by NSAIDs or simple analgesics. Almost all pains have several components and therefore different therapeutic approaches.