Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is not a disease but a subjective feeling that signals that something is going wrong inside an individual. Every person defines it in a different way and the threshold of tolerance of pain also varies from person to person.

Perception of pain is a complex mechanism, which involves both the central and peripheral nervous system (brain and spinal cord). There are special receptors that are sensitive to harmful stimulus called ‘noci-ceptors’. These noci-ceptors are naked nerve endings found in almost every tissue of the body and they can be stimulated by thermal, mechanical, chemical and electrical energy.

The signals are then carried via peripheral nerves to the spinal cord where pain impulses can be modified. In the spinal cord chemical substances called neurotransmitters are released. Strong pain signals are transmitted to the brain but the weak impulses are blocked by the modification in the spinal cord. This explains why rubbing a sore area decreases the intensity of pain.

From the spinal cord, the signals are transmitted to the brain which is responsible for the emotional component of pain. The brain then analyzes the signals and sends signals via motor nerves to the painful area to contract the muscles in order to withdraw the part of the body away from the harmful object. Pain has a unique property of producing an unpleasant effect, unlike other senses.

Pain can be classified according to it’s duration.

Acute pain: It is the type of pain that occurs soon after an injury. It has a protective role in the sense that it makes a person aware that something is not going right, thus motivating the person to protect himself and prevent further damage. The duration of acute pain is shorter and associated with nausea, vomiting, anxiety, rapid heartbeat, increased breathing rate, elevated blood pressure, sweating and dilated pupils.

Chronic pain: Generally defined as pain lasting 3 months or longer, it may limit the normal functioning of the body or affected part. It may often not have an easily identifiable cause. Usually, it does not affect the heartbeat, breathing rate, blood pressure, or pupils, but may result in other problems such as depression, disturbed sleep, decreased energy, loss of appetite, weight loss, and loss of interest in sexual activity.

We usually try to determine whether a bodily injury or disease is causing the pain. Since there are many reasons for having pain, a detailed history is needed for the assessment of pain. Some of the following points are often useful:

• Site of pain: Patients may be asked to locate the site where pain is felt most.
  

• Duration of pain: This refers to how long you have been suffering from the pain. It can be described in hours, days, months or even years.

• Course of pain: Whether the pain is “continuous” or “intermittent” (having pain free intervals).

• Severity of pain: You may be asked to rate your pain on a scale from 1 to 10.

• Radiation: Does the pain stay in one place or does it move or spread to other parts of the body.

• Character: What does the pain feel like. Common descriptions include: stabbing, burning, pricking, gnawing, aching, dull, gripping, colicky, jolt like etc. Although it’s very difficult to describe pain in words, it does help to give a better idea of the character of the problem.

• Aggravation of pain: What brings the pain on and what makes it worse.

• Time of pain: Is there any special time when the pain occurs (e.g. after taking meals or after doing exercise etc).

• Relief: What causes the pain to improve.

• Associations: Are there any other symptoms associated with pain (e.g. vomiting, nausea, fever, headache etc).

Acute pain can generally be relieved with many options. Chronic pain is often more difficult to treat effectively. There is often a greater emphasis on non-drug treatment and enabling the patient to cope up with pain.

Drug Treatment:

The basic principal of drug treatment is to prescribe appropriate analgesics (pain killers) according to the degree of pain. The following are some common pain killers:

• Paracetamol
• Non steroidal anti-inflammatory drugs (NSAIDS)
• Opioids (Codeine)

Non-Drug Treatment:

Some common treatments that do not rely primarily on medication to achieve pain killing effects include:

• Physiotherapy
• Massage therapy
• Heat therapy
• Cold therapy
• Psychological techniques (train patient to develop techniques to counter pain)
• Surgical approaches (by cutting nerves which are carrying pain sensations)

Find out how your Pain can be more effectively treated.

For enquiries, Call 64057280