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What is Pain?

Pain is an unpleasant feeling often caused by intense or damaging stimuli, such as stubbing a toe, burning a finger, putting alcohol on a cut, and bumping the "funny bone". The International Association for the Study of Pain's widely used definition states: "Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage".

Pain motivates the individual to withdraw from damaging situations, to protect a damaged body part while it heals, and to avoid similar experiences in the future. Most pain resolves promptly once the painful stimulus is removed and the body has healed, but sometimes pain persists despite removal of the stimulus and apparent healing of the body; and sometimes pain arises in the absence of any detectable stimulus, damage or disease.

Pain is the most common reason for physician consultation in the United States. It is a major symptom in many medical conditions, and can significantly interfere with a person's quality of life and general functioning. Psychological factors such as social support, hypnotic suggestion, excitement, or distraction can significantly modulate pain's intensity or unpleasantness.

Physiological Types of Pain

It is easier to understand pain, locate its cause, and treat it by using physiological explanations of it. Pain can be divided into two types of physiological explanations: Nociceptive and Neuropathic.

Nociceptive pain
The body's nervous system is working properly. There is a source of pain, such as a cut, a broken bone or a problem with the spine. The body's system of telling the brain that there is an injury starts working. This information is passed on to the brain and one becomes aware that they are hurting.

Neuropathic pain
The body's nervous system is not working properly. There is no obvious source of pain, but the body nonetheless tells the brain that injury is present.

What are types of nociceptive pain?
Most back, leg, and arm pain is nociceptive pain. Nociceptive pain can be divided into two parts, radicular or somatic.

Radicular pain: Radicular pain is pain that stems from irritation of the nerve roots, for example, from a disc herniation. It goes down the leg in the distribution of the nerve that exits from the nerve root at the spinal cord. Associated with radicular pain is radiculopathy, which is weakness, numbness, tingling or loss of reflexes in the distribution of the nerve.

Somatic pain: Somatic pain is pain limited to the back or thighs. The problem that doctors and patients face with back pain, is that after a patient goes to the doctor and has an appropriate history taken, a physical exam performed, and appropriate imaging studies (for example, X-rays, MRIs or CT scans), the doctor can only make an exact diagnosis a minority of the time. Research has shown that most back pain that does not go away after conservative treatment usually comes from one of three structures in the back: the facet joints, the discs, or the sacroiliac joint. The facet joints are small joints in the back of the spine that provide stability and limit how far you can bend back or twist. The discs are the "shock absorbers" that are located between each of the bony building blocks (vertebrae) of the spine. The sacroiliac joint is a joint at the buttock area that serves in normal walking and helps to transfer weight from the upper body onto the legs.
Fluoroscopically (x-ray) guided injections can help to determine where pain is coming from. Once the pain has been accurately diagnosed, it can be optimally treated.

What are types of neuropathic pain?
  • Complex regional pain syndrome(CRPS), also called reflex sympathetic dystrophy
  • Sympathetically maintained pain
  • Fibromyalgia
  • Interstitial cystitis
  • Irritable bowel syndrome

Treatment of neuropathic pain

The various neuropathic pains can be difficult to treat. However, with careful diagnosis and often a combination of methods of treatments, there is an excellent chance of improving the pain and return of function.

Medications are a mainstay of treatment of neuropathic pain. In general, they work by influencing how pain information is handled by the body. Much pain information is filtered out by the central nervous system, usually at the level of the spinal cord, so that you never need to deal with that information. For example, if you are sitting in a chair, your peripheral nerves would correctly send the response to the pressure between your body and the chair to your nervous system. But, because that information serves no usual purpose, it is filtered out in the spinal cord. Many medications to treat neuropathic pain operate on this filtering process. Amongst the types of medications are antidepressants, influencing the amount of serotonin or norepinephrine and antiseizure medications, influencing the amount of various neurotransmitters, such as GABA and glycine.
One of the most powerful tools in treating neuropathic pain is the spinal cord stimulator, which delivers tiny amounts of electrical energy directly onto the spine. The effect of this stimulation of the spinal cord is to allow the spinal cord to function normally even during a painful condition. It works by interrupting inappropriate pain information being sent up to the brain.

Types of Pain

There are several ways to categorize pain. One is to separate it into acute pain and chronic pain. Acute pain typically comes on suddenly and has a limited duration. It's frequently caused by damage to tissue such as bone, muscle, or organs, and the onset is often accompanied by anxiety or emotional distress.

Acute Pain
Also known as “warning pain”, this type of pain comes on suddenly and signals that something is wrong inside the body. A classic example of this type of pain is an injury that results in a broken bone. The pain is sudden and warns the person that something has gone wrong. Infections, tumors, and internal bleeding are other examples. Acute pain can sometimes be eliminated by treating the underlying cause. A person may respond to chronic pain with fear, anxiety, and restlessness. If the underlying cause in untreatable, the pain may develop into chronic pain.

Chronic pain lasts longer than acute pain and is generally somewhat resistant to medical treatment. It's usually associated with a long-term illness, such as osteoarthritis. In some cases, such as with fibromyalgia, it's one of the defining characteristic of the disease. Chronic pain can be the result of damaged tissue, but very often is attributable to nerve damage.

Both acute and chronic pain can be debilitating, and both can affect and be affected by a person's state of mind. But the nature of chronic pain -- the fact that it's ongoing and in some cases seems almost constant -- makes the person who has it more susceptible to psychological consequences such as depression and anxiety. At the same time, psychological distress can amplify the pain.

About 70% of people with chronic pain treated with pain medication experience episodes of what's called breakthrough pain. Breakthrough pain refers to flares of pain that occur even when pain medication is being used regularly. Sometimes it can be spontaneous or set off by a seemingly insignificant event such as rolling over in bed. And sometimes it may be the result of pain medication wearing off before it's time for the next dose.


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