PAIN: DEFINITION,
CHARACTERISTICS, BY UJJWAL D SHIRKE
CLASSIFICATION GROUP 3E
WHAT IS ACTUALLY
SENSATION OF PAIN?
The International Association for the Study of Pain defines pain as "an
unpleasant sensory and emotional experience associated with, or
resembling that associated with, actual or potential tissue damage.
Pain motivates organisms 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 once the noxious stimulus is removed and the
body has healed, but it may persist despite removal of the stimulus and
apparent healing of the body
Pain is the most common reason for physician consultation in most
developed countries.
It is a major symptom in many medical conditions, and can interfere with a
person's quality of life and general functioning.[6] People in pain experience
impaired concentration, working memory, mental flexibility, problem solving
and information processing speed, and are more likely to experience
irritability, depression, and anxiety.
GENERAL FEATURES OF THE
PAIN
There may be many other symptoms including swelling, tightness,
tenderness, and others depending upon the location. The most
common pain disorder is myofascial pain, characterized by pain
and tender trigger points in the skeletal muscles. This is followed
by joint pain from arthritis, disk disorders, and arthralgia.
Neuropathic and neuralgic pain symptoms are common and
treatable. Receiving medical care as soon as possible typically
helps prevent or lessen problems.
There is no concrete definition of what a pain disorder is. Some
people feel they have experienced chronic pain throughout their
lives, but this isn’t necessarily a chronic pain disorder unless it has
lasted for more than 6 months and causes significant disruption in
your life.
A marked change in a person’s passivity, disability or inactivity
level.
Other individuals can notice that a person has unusual negative or
distorted cognition.
Increased levels of depression and anxiety.
Increased levels of sleeplessness and fatigue.
An overwhelming sense of helplessness or hopelessness in regard
to the person pain and its management.
Increased levels of confusion and turmoil in personal relationships
(family, friends, and/or work).
CLASSIFICATION OF PAIN
ACCORDING TO PATHOPHYSIOLOGY
1) NOCICEPTIVE PAIN
2) NEUROPATHIC
3) CENTRAL SENSITISATION
ACCORDING TO DURATION
1) ACUTE PAIN
2) CHRONIC PAIN
ACCORDING TO ANATOMICAL LOCATION
1) SOMATIC PAIN
2) VISCERAL PAIN
NOCICEPTIVE PAIN
1) Most pain comes from tissue damage – when your body's tissues are injured. The
injury can be to bone, soft tissue, or organs. It can come from a disease such as
cancer. Or it can come from a physical injury, like a cut or a broken bone.
2) The pain you feel may be an ache, a sharp stabbing, or a throbbing. It could
come and go, or it could be constant. You may feel the pain get worse when you
move or laugh. Sometimes, breathing deeply might make it feel especially strong.
3) Pain from tissue damage can be acute. For example, sports injuries like a
sprained ankle or turf toe often happen when soft tissue is damaged. Or it can be
chronic, such as arthritis or chronic headaches. And certain medical treatments,
such as radiation for cancer, can also cause tissue damage that causes pain.
NEUROPATHIC PAIN
1) Nerves work like electric cables sending signals – including pain signals – to and from the brain.
Damage to nerves can interfere with the way those signals are sent. That can cause pain signals that
don’t work the way they are supposed to. For instance, you may feel like your hand or whatever is
burning, even though there’s no heat.
2) Diseases such as diabetes can damage nerves. Or an injury can damage them. Certain chemotherapy
drugs may cause nerve damage. Nerves can also be damaged by a stroke or an HIV infection, among
other things. Pain could be from damage to the central nervous system (CNS), which is made up of the
brain and spinal cord. Or it could come from damage to peripheral nerves, those nerves in the rest of
the body that send signals to the CNS.
3) Pain caused by nerve damage, neuropathic pain, is often described as burning or prickling. Some
people describe it as an electrical shock. Others say it’s like pins and needles or a stabbing feeling.
Some people with nerve damage are often very sensitive to temperature and to touch. Just a light
touch, like brushing against a bed sheet, can set off the pain.
4) A lot of neuropathic pain is chronic.
EXAMPLES OF NEUROPATHIC
PAIN SYNDROME
Central pain syndrome. This chronic pain starts with damage to
the central nervous system. The damage can be from a stroke,
multiple sclerosis, tumors, or several other conditions. The pain –
which is usually constant and may be very bad – can affect a large
part of the body or smaller areas, such as the hands or feet.
Movement, touch, emotions, and temperature changes can often
make the pain worse.
Complex regional pain syndrome. This is a chronic pain
syndrome that can follow a serious injury. It's described as constant
burning. And you might have unusual sweating, changes in skin
color, or swelling where the pain is.
Diabetic peripheral neuropathic pain. Diabetes causes nerve
damage that affects the feet, legs, hands, or arms. It might feel like
burning, stabbing, or tingling.
Shingles and postherpetic neuralgia. The same virus that causes chickenpox
causes shingles. It’s a localized infection with a rash and pain that can be very
bad. It happens on one side of the body along the pathway of a nerve.
Postherpetic neuralgia is a common problem that comes up, in which the pain
from shingles lasts more than a month.
Trigeminal neuralgia. Inflammation of a nerve in the face causes pain described
as very serious and lightning-like. It can happen in the lips, scalp, forehead, eye,
nose, gums, cheek, and chin on one side of the face. Touching certain areas or
even slight motion can set off the pain.
ACUTE V/S CHRONIC PAIN
1) Acute pain usually comes on suddenly and lasts for a limited time. Some type of
damage to tissue – such as bone, muscle, or organs – often causes it. When it
happens, it can cause anxiety or other emotional issues.
2) Chronic pain lasts longer than acute pain. It generally can somewhat resist medical
treatment. It's usually linked to a long-term illness, such as osteoarthritis. In some
cases, such as with fibromyalgia, pain is one of the main traits of the condition.
Chronic pain can be the result of damaged tissue. But very often, nerve damage is
behind it.
3) Both acute and chronic pain can be overwhelming. 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 – can make you more likely
to get mental health issues such as depression and anxiety. At the same time, these
issues can make the pain worse.
SOMATIC AND VISCERAL
PAIN
Anatomical pain classification is used to determine what part(s) of the body
the patient experiences pain.
It is often the first step during pain assessments.
1) Somatic pain is specific to the site of injury and arises from pain receptors
activated in bones, muscles, skin, joints, ligaments, tendons and
connective tissue.
2) In contrast, visceral pain arises in internal organs, but the pain associated
with an internal injury is difficult to localise because of the low density of
nociceptors in the viscera and the fact that afferent fibres are less well
represented in cortical mapping.
3) Not considering acute pain conditions, the most common sites of chronic
pain are the back and the joints, followed closely by neck- and headache-
related pain, according to a European survey.
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