What is pain?
The definition of pain, as given by the International Association for the Study of Pain, underscores the following:
"An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described by the patient in terms of such damage."
However, pain is not always a signal of tissue damage or injury. Pain can also arise from a functional disturbance in the nervous system.
What are the different types of pain?
Two primary types of pain include the following:
- chronic pain - pain that persists for weeks, months, or even years.
What is chronic pain?
Chronic pain is defined as pain that overwhelms all other symptoms and may become the problem. It may affect people so that often they cannot work, lose their appetites, and physical activity of any kind is exhausting and aggravates the pain.
Chronic pain is considered a major medical condition that can and should be treated accordingly.
What causes chronic pain?
Chronic pain may have started from an initial illness or accident, from which a person has long since recovered, or there may be an ongoing cause of pain, such as arthritis or cancer.
Many people suffer from chronic pain in the absence of any past injury or evidence of illness. The most common type of chronic pain is from an abnormal function in the nervous system. Neuropathic pain refers to pain that can arise when there is abnormal function in the peripheral nervous system.
What is the "terrible triad?"
When an individual becomes preoccupied with pain, he/she may become depressed, and irritable. This depression and irritability often leads to insomnia and weariness, which compounds the problem by causing more irritability, depression, and pain. This vicious cycle is called the "terrible triad" of suffering, sleeplessness, and sadness.
The urge to stop the pain can make some people drug dependent, and may drive others to have repeated surgeries, or resort to questionable treatments.
Treatment for chronic pain:
Specific treatment for chronic pain will be determined by your physician based on:
- your age, overall health, and medical history
- extent of the condition
- your tolerance for specific medications, procedures, or therapies
- expectations for the course of the condition
- your opinion or preference
Chronic pain involves all aspects of a person's life, therefore, the most effective treatment includes not only relief of symptoms, but other types of support. Management of pain may include the involvement of several different specialists, including the following:
- neurologists
- neurosurgeons
- physical therapists
- occupational therapists
- anesthesiologists
- psychologists
- psychiatrists
- other healthcare providers
Special pain programs are located in many hospitals, rehabilitation facilities, and pain clinics.
Treatment may include:
- over-the-counter (OTC) medications
Over-the-counter medications may include the following:
- aspirin
- nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, naproxen, and ketoprofen
- acetaminophen
- heat and cold treatments
Heat and cold treatments can reduce the stiffness and pain, particularly of arthritis.
- Cold packs numb the sore area and are especially effective for severe joint pain and swelling.
- Heat treatments relax muscles, particularly dry heat methods, such as a heating pad or heat lamp, or moist heat methods, such as a bath or hydrocollator pack.
- prescription pain medications
Prescription pain medications usually can provide stronger pain relief than aspirin, including the opiate-related compounds. When used wisely, they are important recruits in the chemical fight against pain. However, all of these drugs have some potential for abuse, and may have unpleasant and even harmful side effects. In combination with other medications or alcohol, some can be dangerous.
- prescription antidepressants
Prescription antidepressants can benefit some patients who report that pain relief happens before any uplift in mood, a result that specialists think happens because the antidepressant increases the supply of a naturally produced neurotransmitter, serotonin. Now scientists have evidence that cells using serotonin are also an integral part of a pain-controlling pathway in the brain.
- local electrical stimulation
Local electrical stimulation, the application of brief pulses of electricity to nerve endings under the skin, can provide pain relief in some chronic pain patients. This procedure, called transcutaneous electrical nerve stimulation (TENS), blocks pain messages to the brain and modifies pain perception.
- brain stimulation
Brain stimulation is another type of electrical stimulation that is mainly used for controlling pain that is widespread and severe. After the electrodes are surgically implanted in the brain, the patient controls the delivery of electrical stimulations by operating an external transmitter.
- psychological treatment
Psychological treatment for pain may include the following:
- psychoanalysis and other forms of psychotherapy
- relaxation training
- meditation
- hypnosis
- biofeedback
- behavior modification
The philosophy common to all of these varied psychological approaches is the belief that patients can do something on their own to control their pain. That something may mean changing attitudes, feelings, or behaviors associated with pain, or understanding how unconscious forces and past events have contributed to the present painful predicament.
- surgery
Surgery may be considered for chronic pain. Surgery can bring release from pain, but may also destroy other sensations as well, or become the source of new pain. Relief is not necessarily permanent, and pain may return. There are a variety of operations to relieve pain.
- acupuncture
Acupuncture is the practice of puncturing the skin with needles at certain anatomical points in the body to relieve specific symptoms associated with many diseases. The anatomical points (acupuncture points) are thought to have certain electrical properties, which affect chemical neurotransmitters in the body.
Acupuncture is one of the oldest, most commonly used medical practices in the world. Originating in China more than 2,500 years ago, acupuncture gained attention in this country in the 1970s, when China and the US opened relations. The practice has been growing in popularity since.
According to theories of traditional Chinese medicine, the human body has more than 2,000 acupuncture points connected via pathways, or meridians. These pathways create an energy flow (Qi, pronounced "chee") through the body that is responsible for overall health. Disruption of the energy flow can cause disease. Acupuncture may correct these imbalances when applied at acupuncture points and improve the flow of Qi.
Many studies have documented acupuncture's effects on the body, but none has fully explained how acupuncture works within the framework of Western medicine. Researchers have proposed several processes to explain acupuncture's effects, primarily on pain.
In general, acupuncture points are believed to stimulate the central nervous system, which, in turn, releases chemicals into the muscles, spinal cord, and brain. These chemicals either alter the experience of pain or release other chemicals that influence the body's self-regulating systems. These biochemical changes may stimulate the body's natural healing abilities and promote physical and emotional well-being.
Research is continually being conducted on the brain and nervous system in order to increase the understanding, diagnosis, and treatment of chronic pain.
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