Pain is an unpleasant sensation and emotional experience usually caused by tissue damage. It allows the body to react to and prevent further tissue damage. Show
People feel pain when a signal travels through nerve fibers to the brain for interpretation. The experience of pain is different for every person, and there are various ways to feel and describe pain. This variation can, in some cases, make it challenging to define and treat pain. Pain can be short- or long-term and stay in one place or spread around the body. In this article, we look at the different causes and types of pain, ways to diagnose it, and how to manage the sensation. People feel pain when specific nerves called nociceptors detect tissue damage and transmit information about the damage along the spinal cord to the brain. For example, touching a hot surface will send a message through a reflex arc in the spinal cord and cause an immediate contraction of the muscles. This contraction will pull the hand away from the hot surface, limiting further damage. This reflex occurs before the message reaches the brain. Once the pain message arrives, it causes an individual to feel an unpleasant sensation — pain. The brain’s interpretation of these signals and the efficiency of the communication channel between the nociceptors and the brain dictate how an individual experiences pain. The brain may also release feel-good chemicals, such as dopamine, to counter the unpleasant effects of pain. In 2011, researchers estimated that pain costs the United States between $560 billion and $635 billion each year in treatment costs, lost wages, and missed days of work. Pain can be either acute or chronic. Acute painThis type of pain is generally intense and short-lived. It is how the body alerts a person to an injury or localized tissue damage. Treating the underlying injury usually resolves acute pain. Acute pain triggers the body’s fight-or-flight response, often resulting in faster heartbeats and breathing rates. There are different types of acute pain:
Chronic painThis type of pain lasts far longer than acute pain, and there is often no cure. Chronic pain can be mild or severe. It can also be continuous, such as in arthritis, or intermittent, as with a migraine episode. Intermittent pain occurs on repeated occasions but stops between flares. The fight-or-flight reactions eventually stop in people with chronic pain, as the sympathetic nervous system that triggers these reactions adapts to the pain stimulus. If enough cases of acute pain occur, they can create a buildup of electrical signals in the central nervous system (CNS) that overstimulate the nerve fibers. This effect is known as “windup,” which compares the buildup of electrical signals to a wind-up toy. Winding a toy with more intensity leads to the toy running faster for longer. Chronic pain works in the same way, which is why a person may feel pain long after the event that first caused it. Describing painThere are other, more specialized ways of describing pain. These include:
Knowing how to describe pain can help a doctor provide a more specific diagnosis. An individual’s subjective description of the pain will help the doctor make a diagnosis. There is no objective scale for identifying the type of pain, so the doctor will take a pain history. They will ask the individual to describe:
Several systems can identify and grade pain. However, the most important factor in getting an accurate diagnosis is clear communication between the individual and their doctor. Measuring painSome of the pain measures that doctors use are:
Other indicators of painWhen people with cognitive impairments cannot accurately describe their pain, there can still be clear indicators. These include:
The doctor will either treat the underlying problem, if it is treatable, or prescribe pain-relieving treatment to manage the pain. There is a prevalent myth that Black people feel pain differently from white people. Due to this, Black Americans often receive insufficient treatment for pain compared with their white counterparts. Racial bias in pain assessment and management is well-documented. For instance, a 2016 study revealed that half of white medical students and residents believed that Black people have thicker skin or less sensitive nerve endings than white people. The research also showed that these misconceptions affected the medical personnel’s pain assessments and treatment recommendations. This indicates that healthcare professionals with these beliefs may not treat Black people’s pain appropriately. Eradicating racist stereotypes and biases are crucial steps toward addressing systemic inequities in healthcare. Read more about systemic racism in healthcare and health inequities here. Doctors will treat different types of pain in different ways. A treatment that is effective against one type of pain may not relieve another. Acute pain treatmentTreating acute pain often involves taking medication. Often, this type of pain results from an underlying health issue, and treating it may relieve the pain without the need for pain management. For example, if a bacterial infection is causing a sore throat, antibiotics can treat the infection, easing the soreness as a result. AcetaminophenAcetaminophen is a type of analgesic, or pain reliever. It is an active ingredient in hundreds of medications, including over-the-counter and prescription drugs. Often known by the brand name Tylenol, acetaminophen can relieve pain and fever. Combined with other ingredients, it can help treat allergy symptoms, coughs, flu symptoms, and colds. Doctors often prescribe drugs that contain acetaminophen and other ingredients to treat moderate to severe pain. However, when taken in higher doses, acetaminophen can cause serious liver damage. People should never exceed the recommended dosage. Nonsteroidal anti-inflammatory drugs (NSAIDs)NSAIDs are another type of analgesic. They can reduce pain and help a person regain daily function. They are available over the counter or by prescription at a range of strengths. NSAIDs are suitable for minor acute pains, such as headaches, light sprains, and backaches. NSAIDs can relieve localized inflammation and pain that is due to swelling. These drugs may have side effects relating to the digestive system, including bleeding. Therefore, a doctor will monitor a person taking a high dosage. It is always important to read the packaging to check the maximum dosage and find out what is in an analgesic before taking it. People should never exceed the recommended dosage. OpioidsDoctors prescribe these drugs for the most extreme acute pains, such as those that result from surgery, burns, cancer, and bone fractures. Opioids are highly addictive, cause withdrawal symptoms, and lose effectiveness over time. They require a prescription. In situations involving severe trauma and pain, a doctor will carefully manage and administer the opioid dosage, gradually reducing the amount to minimize withdrawal symptoms. People should discuss all medication options carefully with a doctor and disclose any health conditions and current medications. Opioids may significantly affect the progression of several chronic diseases, including:
Opioids can cause dangerous side effects in people with certain chronic diseases. For instance, they can cause respiratory depression, which can exacerbate the symptoms of COPD. Chronic pain treatmentA range of nondrug therapies can help relieve pain. These alternatives to medication may be more suitable for people experiencing chronic pain. These therapies include:
With adequate pain management, it is possible to maintain daily activities, social engagement, and an active quality of life. Discover how yoga can help people who have fibromyalgia. What term describes the primary medical problem as defined by the patient?Chief Complaint. Primary medical problem as defined by the patient; important because it focuses the clinical history towards the single most important issue. Chronology.
Which of the following are part of the sacred seven elements of the patient clinical history?Information available regarding a patient's condition; traditionally comprises data on (the sacred seven) localization, quality, quantity, chronology, setting, aggravating or alleviating factors, and associated manifestations.
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