Boniform: What's PAIN ?

According to International Association for the Study of Pain, PAIN is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”

Pain is a feeling triggered in the nervous system. It may be sharp or dull. It may come and go, or it may be constant. You may feel pain in one area of your body, such as your back, abdomen or chest or you may feel pain all over.

Being able to feel pain is quite a good thing. Without it, you might seriously hurt yourself without knowing it, or you might not realize you have a medical problem that needs treatment. Once you take care of the problem, pain usually goes away. However, sometimes pain goes on for weeks, months or even years. Sometimes the cause is unknown. So…pain can be a friend or foe.

Pain can be due to several factors:

· Physical (insomnia, exhaustion, loss of independence, poor previous management)

· Psychological (depression, anger, anxiety)

· Social (financial, legal, interpersonal relationship)

· Spiritual (meaninglessness, guilt, regrets, unresolved, spiritual questions)

Pain Classification

Temporal : Acute, Chronic

Acute: Begins suddenly. It is usually sharp in quality. It serves as a warning of disease or a threat to the body. Acute pain might be mild and last just a moment, or it might be severe and last for weeks or months. In most cases, acute pain does not last longer than six months, and it disappears when the underlying cause of pain has been treated or has healed. If acute pain is prolonged, this leads to chronic pain.

Chronic: Chronic pain persists despite the fact that the injury has healed. Pain signals remain active in the nervous system for weeks, months, or years. Physical effects: tense muscles, limited mobility, a lack of energy, and changes in appetite. Emotional effects: depression, anger, anxiety, and fear of re-injury. Such a fear might hinder a person’s ability to return to normal work or leisure activities causes loss of function to the area.

Pathophysiological : Nociceptive, neuropathic, sympathetic, psychogenic

Nociceptive: Stimulation of sensory receptors;normal neural paths. Can be somatic or visceral

Nociceptive pain is a normal process of stimuli that damages normal tissues or has the potential to do so if prolonged. It is usually responsive to nonopioids and/or opioids.

Somatic - arises from bone, joint, muscle, skin, or connective tissue. It is usually aching or throbbing in quality. Somatic pain is well localized.

Visceral - arises from visceral organs, such as the GI tract and pancreas. This is subdivided into:

· Tumor involvement of the organ capsule that causes aching and fairly well-localized pain.

· Obstruction of hollow viscus, which causes intermittent cramping and poorly localized pain

Neuropathic: Nervous system injury (PNS-dermatomal, CNS-nondermatomal)

Neuropathic pain occurs when there is actual nerve damage. Nerves connect the spinal cord to the rest of the body and allow the brain to communicate with the skin, muscles and internal organs. Nutritional imbalance, alcoholism, toxins, infections or auto-immunity can all damage this pathway and cause pain. Neuropathic pain can also be caused by a cancer tumor pressing on a nerve or a group of nerves. People often describe this pain as a burning or heavy sensation, or numbness along the path of the affected nerve. Treatment usually includes adjuvant analgesics.

(i)Centrally generated pain :

· Deafferentation pain: Injury to either the peripheral or central nervous system.

Eg: Phantom pain may reflect injury to the peripheral nervous system; burning pain below the level of a spinal cord lesion reflects injury to the central nervous system.

· Sympathetically maintained pain: Associated with dysregulation of the autonomic nervous system.

Eg: May include some of the pain associated with reflect sympathetic dystrophy/causalgia (complex regional pain syndrome, type I, type II).

(ii) Peripherally generated pain:

· Painful polyneuropathies: Pain is felt along the distribution of many peripheral nerves. Examples: diabetic neuropathy, alcohol-nutritional neuropathy, and those associated with Guillain-Barré syndrome.

· Painful mononeuropathies: Usually associated with a known peripheral nerve injury, and pain is felt at least partly along the distribution of the damaged nerve. Examples: nerve root compression, nerve entrapment, trigeminal neuralgia.

Sympathetic: Vasomotor instability, erythema, sweating…

Sympathetic pain is a type of nerve pain (neuropathy, neuralgia, neuritis), seen in the pain clinic, that arises due to an abnormality of the function of the sympathetic nervous system.

Psychogenic: no basis of pain, evidence of psychopathology

Headaches, muscle pains, back pain, and stomach pains are some of the most common types of psychogenic pain.
The diagnosis of psychogenic pain is made when organic (related to or affecting a bodily organ) causes of pain are ruled out. A person with a pain disorder will complain of pain that does not match his or her symptoms. Medical doctors and mental health specialists working together are often most helpful to those with this disorder.

Physiological processes in pain

· Transduction

· Transmission

· Modulation

· Perception

A painful condition can affect almost every area of one's life. There are psychological reactions, social and environmental effects and physical effects. People experiencing pain often report feelings of: