Pain
The International Association for the Study
of Pain defines pain as an unpleasant sensory and emotional experience
associated with actual or potential tissue damage. Receptors in skin,
muscles and other body tissue called nociceptors trigger a series of events
beginning with an electrical impulse that travels to the spinal cord and up
to the brain. Chemicals in the brain and spinal cord called
neurotransmitters, transmit nerve impulses from one cell to another.
Pain is classified as acute and chronic. The
distinction between acute and
chronic pain is usually based on the duration
of a particular pain problem. Pain that persists beyond six months is
generally regarded as chronic. No one can directly see or measure another
person’s pain. One may experience pain without any observable indications
of injury or disease. Some doctors erroneously assume that there must be a
correlation between the greater the pain and the greater degree of injury.
Although this may be true for acute pain, it is often not the case with
chronic pain.
Acute pain is a warning signaling
physical injury or disease. Acute pain sensations are considered to be
biologically appropriate, necessary and usually accurate warning signals
that directly indicate tissue damage or physiological dysfunction. Such
pain is referred to as nociception. Nociception refers to sensory input associated with
the stimulation of specific nerve endings that are triggered by tissue
damaging stimuli. The perception and interpretation of nociception input in
the brain is what we ordinarily experience as pain. It is assumed that once
natural healing takes place or appropriate medical treatment is completed,
nociceptive input and pain should cease.
| There has been much discussion in the
medical community as to what is chronic pain. Some believe that chronic
pain is centrally generated pain produced by abnormalities within the
mind/brain system. In many cases, the pain may have begun as a result of
some peripheral injury; however, the persistence of pain after the injury
has healed is likely the result of psychological factors. Chronic pain, in
the sense of persistent or recurring pain, can also involve peripheral
factors. For some these may play a significant role, whereas for others
peripheral nociception may be entirely absent.
Medical treatment approaches to chronic pain
can be divided into two broad categories depending on the goal of
treatment. These can be referred to as curative and symptom-focused
approaches. The first category includes repetitive efforts to resolve,
repair, or eliminate the underlying physical mechanism presumed to be
responsible for the pain. The second category consists of treatment
approaches aimed at alleviating the pain symptom. Some of these approaches,
such as medication, are aimed at temporarily alleviating the pain itself or
other associated symptomatic consequences of chronic pain such as
depression, anxiety, sleep disturbances, and muscle spasm. Others,
primarily neurosurgical procedures attempt to eradicate the pain primarily
by destroying nerve mechanisms presumed to transmit pain impulses.
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Medication is a widely used measure to
temporarily relieve pain. The use of narcotics can be very useful in the
treatment of acute-pain conditions and chronic cancer pain. In almost all
pain clinics the goal is to have the patient withdraw from pain medications,
especially narcotics.
Non-narcotic pain agents are also used in
the treatment of many chronic pain conditions. The types of medication
include anti-inflammatory, anti-coagulant, and fever-reducing drugs. These
medications operate at the site of the injury rather than in the central
nervous system where narcotics offer relief. Non-narcotics do not produce
tolerance or dependence as narcotic medications do. Unfortunately the
non-narcotic pain medications generally are only useful at eliminating mild
to moderate pain conditions. One drawback with the non-narcotic pain
medications is that they often have adverse gastrointestinal and renal
system side effects.
Non-analgesics medications also help with
pain. Anti-anxiety agents may reduce muscle tension, muscle spasm and
anxiety associated with chronic pain. These medications, however, can
produce tolerance, dependency and adverse effects on mental processes.
Since sleep disturbance often accompanies chronic-pain, sleep medications
are sometimes used. Unfortunately these too can result in dependency.
Anti-depressant medications are also useful in managing chronic pain
conditions. It has been known for some time that depression can exacerbate
the symptoms of pain.
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Other than medication, some patients with
chronic pain utilize nerve blocks to alleviate the suffering. Injections of
various chemicals have been used. Injections of anesthetics or steroids
have been used for pain caused by inflammation. Myofascial Pain Syndromes
can be treated by
trigger-point injections of a local anesthetic agent.
Injections into the epidural space surrounding the spinal cord have been
used for chronic neck and back conditions. Sympathetic blocks have been
used to treat Reflex Sympathetic Dystrophy. The use of these injections is
to block the ability of particular nerves to transmit pain impulses. Other techniques have been used to try to
treat pain. These techniques involve various forms of massage, stretching,
spinal manipulation, heat, ultrasound, cold, transcutaneous electrical
nerve stimulation (TENS) and acupuncture.
There have been a number of neurosurgical
procedures that have been used to destroy nerves or parts of the nervous
system with the goal of preventing the transmission or perception of pain.
These techniques called neurolysis can cause unwanted side effects such as
loss of sensations other than pain and paralysis of various muscles.
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Psychological approaches have also been used
to treat chronic pain. Biofeedback is aimed at directly altering
physiological factors presumed to generate pain. With biofeedback training
one can learn more about one’s own physiological responses and use this
knowledge to gain greater control over stress and tension. Psychological
counseling is utilized to help a chronic pain patient to cope with his or
her pain.
When one experiences chronic pain, it has a
direct relationship on one’s emotional reactions. Chronic pain often
causes anxiety, fear, depression, frustration, irritability, impatience and
anger. Unfortunately the emotional responses triggered by chronic pain acts
as a Catch 22 that only exacerbates the sensation of pain. Chronic
pain also interferes with one’s cognitive activities including memory, judgment
and problem solving capabilities. These cognitive problems only become
worse with increased medication use.
When one suffers from chronic pain the
person often becomes deconditioned. When one experiences chronic pain, one
generally stops engaging in the activities that increase the sensation of
pain. By ceasing physical activity, one’s body becomes deconditioned.
There is decreased muscle tone and increased joint stiffening and bone
demineralization. There is also a loss aerobic fitness and many people
experience unwanted weight gain. Deconditioning, just like adverse
emotional responses, plays a role in the vicious cycle of people with
chronic pain.
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