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Pain Management
Basic Information

Pain Management

Table of Contents

Introduction: The Universal Disorder

You know it at once. It may be the fiery sensation of a burn moments after your finger touches the stove. Or it's a dull ache above your brow after a day of stress and tension. Or you may recognize it as a sharp pierce in your back after you lift something heavy.

It is pain. In its most benign form, it warns us that something isn't quite right, that we should take medicine or see a doctor. At its worst, however, pain robs us of our productivity, our well-being, and, for many of us suffering from extended illness, our very lives. Pain is a complex perception that differs enormously among individ...

 
Fast Facts: Learn! Fast!

What are acute and chronic 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 or described in terms of such damage.
  • It is useful to distinguish between two basic types of pain, acute and chronic, and they differ greatly.
  • Acute pain, for the most part, results from disease, inflammation, or injury to tissues. This type of pain generally comes on suddenly, for example, after trauma or surgery, and may be accompanied by anxiety or emotional distress. The cause of acute pain can usually be diagnosed and treated, and the pain is self-limiting, that is, it is confined to a given period of time and severity. In some rare instances, it can become chronic.
  • Chronic pain is widely believed to represent disease itself. It can be made much worse by environmental and psychological factors. Chronic pain persists over a longer period of time than acute pain and is resistant to most medical treatments. It can, and often does, cause severe problems for patients.
  • Hundreds of pain syndromes or disorders make up the spectrum of pain.

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What causes pain?

  • We may experience pain as a prick, tingle, sting, burn, or ache.
  • Receptors on the skin trigger a series of events, beginning with an electrical impulse that travels from the skin to the spinal cord.
  • The 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.
  • The most common destination in the brain for pain signals is the thalamus and from there to the cortex, the headquarters for complex thoughts.
  • Pain is a complicated process that involves an intricate interplay between a number of important chemicals found naturally in the brain and spinal cord. In general, these chemicals, called neurotransmitters, transmit nerve impulses from one cell to another.
  • The body's chemicals act in the transmission of pain messages by stimulating neurotransmitter receptors found on the surface of cells; each receptor has a corresponding neurotransmitter.
  • Another type of receptor that responds to painful stimuli is called a nociceptor. Nociceptors are thin nerve fibers in the skin, muscle, and other body tissues, that, when stimulated, carry pain signals to the spinal cord and brain.
  • The body's natural painkillers may yet prove to be the most promising pain relievers, pointing to one of the most important new avenues in drug development.

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How is pain diagnosed?

  • There is no way to tell how much pain a person has.
  • No test can measure the intensity of pain, no imaging device can show pain, and no instrument can locate pain precisely.
  • Sometimes, as in the case of headaches, physicians find that the best aid to diagnosis is the patient's own description of the type, duration, and location of pain.
  • Defining pain as sharp or dull, constant or intermittent, burning or aching may give the best clues to the cause of pain.
  • These descriptions are part of what is called the pain history, taken by the physician during the preliminary examination of a patient with pain.
  • Physicians, however, do have a number of technologies they use to find the cause of pain. Primarily these include:
    • Electrodiagnostic procedures include electromyography (EMG), nerve conduction studies, and evoked potential (EP) studies.
    • Imaging, especially magnetic resonance imaging or MRI, provides physicians with pictures of the body's structures and tissues.
    • X-rays produce pictures of the body's structures, such as bones and joints.
    • A neurological examination in which the physician tests movement, reflexes, sensation, balance, and coordination.

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How is pain treated?

  • The goal of pain management is to improve function, enabling individuals to work, attend school, or participate in other day-to-day activities.
  • Patients and their physicians have a number of options for the treatment of pain; some are more effective than others.
  • Sometimes, relaxation and the use of imagery as a distraction provide relief. These methods can be powerful and effective, according to those who advocate their use.
  • Whatever the treatment regime, it is important to remember that pain is treatable.
  • Click here for a list of common treatment methods.

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