Pain


Pain

Description, Causes and Risk Factors:

An unpleasant sensation associated with actual or potential tissue damage and mediated by specific nerve fibers to the brain where its conscious appreciation may be modified by various factors.

Pain receptors (called nociceptors) are located throughout the human body. During times of injury, a pain receptor is stimulated and transmits a signal to nerve cells within the spinal cord, which send a pain message to the brain. When the brain processes this signal, a person becomes aware of pain. In response, the body releases natural pain killers, called endorphins.

Pain is of two types:

    Nociceptive pain: It is the pain caused by tissue damage in the skin, muscles, bone or internal organs (eg. joint pain caused by arthritis).

  • Neuropathic pain - Pain occurs because either the nerves themselves are damaged or because they are not functioning properly and are sending out persistent messages. This type of pain involves the nerve cells that transmit pain messages to the brain.

Types may include acute and chronic.

In most cases of acute pain, the initial pain results from disease, inflammation, or injury to tissues. This type of pain generally comes on suddenly after trauma. The cause of acute pain can usually be diagnosed and treated, and the pain can be confined to a given period of time and severity. In some rare instances, acute pain can become chronic. However, acute pain may be accompanied by anxiety or emotional distress.

Causes of acute pain may include:

    Burns or cuts.

  • Broken bones.

  • Soft tissue injury.

  • Dental work.

  • Labor and childbirth.

  • Surgical (postoperative) pain.

Chronic pain persists over a longer period of time than acute pain and is resistant to most medical treatments. Chronic pain can, and often does, cause severe problems for patients. Although chronic pain often begins with an injury or illness, ongoing pain can become psychological after the original injury or illness heals. Furthermore, chronic pain can be made much worse by environmental and psychological factors. But sometimes, the cause of chronic pain remains unknown (ex. chronic lower back pain).

During experiences of chronic pain, the brain continues to transmit the message of pain long after normal healing time. Doctors have found that severe and constant stimulation of pain receptors may cause changes in the spinal cord. The nerve cells in the spinal cord may actually produce their own pain transmitters completely unrelated to any actual pain signals coming from the body, interrupting the normal pain pathways.

Chronic pain can be caused by many factors, including nerve damage, injuries that fail to heal properly, and conditions that accompany normal aging. The most causes of chronic pain related to disease include:

    Arthritis.

  • Cancer.

  • Chronic pancreatitis.

  • Gallbladder disease.

  • Nerve dysfunction.

  • Soft tissue injury.

  • Spinal disorders.

  • Unresolved disease or injury (psychogenic pain).

There are certain risk factors that make it more likely that a person develops or experiences chronic pain. These include previous injury, personal medical history, and degenerative changes related to aging, although psychological and environmental factors are at work as well.

Symptoms:

Symptoms of acute pain:

    Aching.

  • Biting.

  • Burning.

  • Cramping.

  • Pressure.

  • Sharp.

  • Shooting.

  • Stabbing.

Symptoms of chronic pain can include:

    Anger.

  • Anxiety.

  • Changes in appetite.

  • Depression.

  • Fear of re-injury.

  • Lack of energy.

  • Limited mobility.

  • Tense muscles.

Diagnosis:

Often more than one specialist can help diagnose and treat chronic pain. Pain management specialists are medical doctors who specialize in the treatment of ongoing (chronic) pain, such as back pain or nerve pain from diabetes. You'll want to first work with your family doctor or general practitioner for issues involving pain. If chronic pain is moderate to severe and constant, or if treatment does not control the pain, your doctor may then recommend that you see a specialist. Medical doctors from many different specialties might further specialize in pain management such as:

    Pain management specialist.

  • Chiropractor.

  • Neurologist.

  • Orthopedic surgeon.

  • Rheumatologist.

  • Physiatrist.

  • Physical therapist.

  • Psychiatrist, psychologist, or a licensed mental health counselor.

Different types of tests needed to diagnoses the pain that may include:

    Complete medical history.

  • Physical exam - A physical examination assesses vital signs such as pulse, respiration, heart beat, blood pressure, and so on. A physical exam for pain may also include palpitation (feeling) or applied pressure to particular parts of the body.

  • Neurological exam -A neurological exam evaluates the sensory (feel) and motor (function) capabilities including reflexes, balance, ability to walk, muscle strength and muscle tone.

  • CT (computed tomography) scan.

  • X-rays.

  • Electromyography (EMG) - An electromyography uses nerve stimulation to measures muscle response and detects muscle damage and disease. An EMG can help differentiate between a muscle and nerve disorder.

  • MRI (magnetic resonance imaging) - MRIs are commonly used for musculoskeletal evaluation. An MRI provides images in great detail for bones and soft tissues.

  • Nerve conduction study (NCS) - A nerve conduction study evaluates the speed of nerve impulses as they travel along a nerve to determine if nerve damage is present, the extent of the damage, and if nerves have been destroyed.

  • Discography - During this test, doctors inject contrast dye to evaluate intervertebral discs (one or more) via x-ray or ct scans a possible pain source. The test evaluates the structural integrity of the discs and may be used to replicate back or leg pain.

  • Positron emission tomography (PET scan) - When cancer is suspected, a PET scan uses small amounts of radioactive isotopes to measure tissue changes at the cellular level.

Treatment:

Chronic pain therapy will be tailored to specific needs and circumstances. Due to rapid advances in medicine, a wide variety of medications and treatments are available for acute and chronic pain. Acute pain is usually managed with medications such as analgesics and anesthetics. However, some medicines are more effective when combined with other methods of treatment.

The goals of treating chronic pain are to:

    Reduce pain.

  • Improve function.

  • Increase quality of life.

If chronic pain persists and interferes with your daily life despite treatment, you may want to seek help at a pain management clinic. You will both receive treatment and learn to cope with chronic pain. Treatment is usually provided by a team who works together to address all the possible causes of chronic pain.

Physical Therapy: A physiatrist or physical therapist can suggest an exercise program tailored for you to increase your daily functioning and decrease pain. Other treatments may include whirlpool therapy, ultrasound and deep-muscle massage.

Psychotherapy: Many people diagnosed with chronic pain feel emotional effects of the condition. These may include feelings of anger, sadness, hopelessness or despair. In addition, pain can alter one's personality, disrupt sleep, interfere with work and relationships and often have a profound effect on family members. Support and counseling from a psychiatrist or psychologist, combined with a comprehensive pain treatment program, may be needed. Psychotherapists might also specialize in relaxation training or biofeedback to relieve pain, lessen muscle spasms and reduce stress.

Alternative medicines may include:

    Relaxation techniques.

  • Acupuncture.

  • Applying cold or warm compresses directly to the painful area.

  • Exercise.

  • Massage.

  • Diet modifications.

  • Biofeedback.

  • Chiropractor.

  • Transcutaneous electrical nerve stimulation (TENS).

  • Ultrasound deep heating therapy.

  • Water therapy.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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