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Pain

Definition

Pain is defined as a physical suffering or discomfort caused by illness or injury. A simple definition for a very complex subject. Pain is the most common reason for seeing a doctor, the major symptom in many medical conditions and can significantly interfere with quality of life.

Pain is the physical symptom that patients and their families fear most and despite its almost constant presence in any illness or disease, pain is still poorly assessed and treated. Most physicians are not knowledgeable about pain management and many patients find it difficult and tiring to constantly try to explain their pain and its effects. And currently, the fear of opioid addiction has created significant barriers to good pain management and contributes unnecessarily to the suffering of patients and their families. Removing fear of pain helps optimize pain control.

Studies show that the earlier pain is controlled the less severe it becomes. Early consultation with pain management specialists by oncologists and primary care physicians can reduce patient and family distress. Unrelieved pain can have devastating effects on patients and their families: psychological, physical, functional, social and economic. The impact is felt, as well, in business and society through lost productivity and increased health care costs.

Statistics show that pain is experienced by 70% of patients with advanced cancer and 65% of patients with non-malignant disease.

Types of Pain

Pain is complex and can be made a little less intimidating when you understand some basic medical terminology.

Acute

This is nature’s “red flag” that tells you something is wrong due to an injury or disease. It happens quickly and is short-term; easing in intensity as your body heals. It is controlled with medication (over-the-counter or prescription) and non-medical treatments such as physical therapy. Once the pain is under control and the medical condition has healed, medication and therapies are no longer needed and will be discontinued.

Chronic

This pain is persistent, constant and always there. It lasts longer than an expected, normal healing period. It can be related to an injury, disease, the procedures used to treat the injury/medical condition or it just exists because of an unknown reason. Treatment and therapies to control and relieve chronic pain are complex and ongoing. Medications (over-the-counter and prescription) and physical, along with complementary, interventional and psychological therapies can all be a part of the pain management treatment plan. Chronic pain that is not relieved can cause anxiety, trouble sleeping, depression, inability to concentrate and mood swings. The stress caused by chronic pain and its disruption of day to day living can actually expand and increase the pain experience.

Now both acute and chronic pain have subcategories: nociceptive and neuropathic pain.

Nociceptive

Think of this pain as protective (don’t touch that hot iron again!) and healing (red and swollen until the body heals itself). It, too, has sub-subcategories:

  • Somatic refers to the body and it’s muscles, tissues and bones.
  • Visceral is all about the internal organs of the body.

Neuropathic

This pain is caused by damage to or dysfunction of the nervous system. And, you guessed it, there are two sub-subcategories:

  • Central relating to the brain and spinal cord.
  • Peripheral encompasses all the nerves that spread out from the spinal column radiating through the arms, legs and torso.

Breakthrough pain and flares are also types of pain. They can occur during treatment for either acute or chronic pain.

Breakthrough

This pain is exactly what it sounds like: It breaks through the relieving effects of pain medications. It is usually associated with cancer and opioids are the most common medication prescribed for cancer pain. Relief from breakthrough pain is provided by “rescue medication“, a fast acting opioid.

Flares

This term is sometimes used interchangeably with breakthrough pain. But flares can last much longer than breakthrough pain and has been linked to strenuous exercise, hormonal changes or no apparent reason. Identifying what might have triggered the flare can help with treatment. Again, a fast acting medication may be recommended but other treatment options include ice/heat applications, massage and over-the-counter pain relievers. In addition to medication and other treatments, adjustments may have to be made to the type, length and intensity of activities that are linked to the flares; or being proactive by taking a pain reliever before engaging in possible activities that have caused flares in the past.

Pain is broken out into many categories and components which all help with its assessment and treatment. In recent years new disorders have been added to the pain category list including migraine headaches, post-traumatic stress disorder, phantom limb pain and fibromyalgia to name a few.

No matter how it is categorized or what name it is given, all pain is real. A person’s self report is the most reliable measure of pain. Each pain experience is unique to the person experiencing it.

Assessing pain

Before any physician prescribes medication for pain, a detailed assessment should be done. A physician will want to know the physical effects, functional impact and psychological factors of the patient’s pain.

An assessment begins by asking the patient some important questions about their pain.

  • Where it hurts (location) – headache, low back, pelvis
  • How long it has been hurting (duration) – a day, a week
  • What does the pain feel like (quality) – sharp, dull, burning
  • Does it come and go (intensity) – constant or variable
  • What causes the pain to increase or decrease (factors affecting) – day to day activities, exercise or time of day
  • Body system involved – myofascial (skeletal muscles), rheumatic (joints and surrounding tissue), neuropathic (damage or changes in nerves) or vascular (involving the blood vessels)

Once the physician has gathered all the information regarding the patient’s pain, he/she can then design a treatment plan that may include prescription medication and/or other forms of therapy. It is never appropriate for pain management to be withheld until a full assessment or treatment of the underlying disease or illness is complete. Pain should be treated immediately. Sometimes, two or more types of pain may be experienced by a patient at the same time and should be assessed and treated accordingly. Assessment should be ongoing to control the pain and achieve pain relief.

The most critical part of the assessment is that the patient is believed. In 1968, Margo McCaffery introduced the definition of pain used in nursing: “Pain is whatever the experiencing person says it is, existing whenever he says it does.”

MORE RESOURCES

Pain Scales

The Pain Intensity Scale rates the patient’s level of pain from 0 (no pain) to 10 (the worst pain you have ever felt in your life). It is in the form of wall charts (the little smiley to frowny faces) that you respond to verbally. Written questionnaires that are more extensive (McGill Pain Questionnaire and Multidimensional Pain Inventory or MPI) are also used in evaluating pain. Charts can be found on the internet that allow the patient to track their pain and record their medications (Pain Control Record Chart).