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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.

elderly-woman-experiencing-chronic-painPain 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.

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Medical Illustration of Invasive Procedures .  Click to Enlarge

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.

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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Medical Illustration used during trial. Click to Enlarge

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.

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.

For related information go to: Actions Against Common Carriers, Back Injuries, Chronic Pain Syndrome, Dangerous Condition of Public Property, Dog Attacks, Elder Abuse, Insurance Bad Faith, Intervertebral Disk Injuries, Medical Malpractice, Motor Vehicle Accidents, Myofascial Pain Syndrome, Negligence Law, Nerve Injuries, Nursing Home Neglect, Paraplegia, Premises Liability, Products Liability, Quadriplegia and Reflex Sympathetic Dystrophy.

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