Pain is so universal that it barely needs a definition to be understood.
What follows is a discussion of physical pain, not emotional pain.
The International Association for the Study of Pain (IASP) defines pain as: An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.
According to the IASP, pain is the most frequent reason for emergency department (ED) visits, accounting for over 70% of visits. In the US, more than 115 million ED visits occur each year with acute headache alone accounting for 2.1 million of these visits. Acute pain is also a common reason for visits to family practice, sports medicine, and internal medicine health care practitioners.
Recent Center for Disease Control and Prevention (CDC) and National Center for Health Statistics (NCHS) data suggest substantial rates of pain from various causes and that most people in chronic pain experience pain in multiple areas of the body. For U.S. adults reporting pain, causes include: severe headache or migraine (16.1%), low back pain (28.1%), neck pain (15.1%), knee pain (19.5%), shoulder pain (9.0%), finger pain (7.6%), and hip pain (7.1%).
The American Academy of Pain Medicine (AAPM), in its report with the Institute of Medicine of the National Academies, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research, estimates that at least 100 million adults in the US have common chronic pain conditions.
Pain helps us to remove ourselves from damaging situations, protect an injury while it heals and learn to avoid similar situations in the future. Generally, pain resolves when the painful stimulus is removed and the body has healed, but sometimes pain may persist. Pain may also arise in the absence of painful stimuli, damage or disease.
Types of Pain:
Acute Pain: Typically results from injury, disease or inflammation of the tissues. Acute pain is usually confined to a given amount of time and severity and can be diagnosed and treated. Acute pain comes on suddenly and is accompanied by anxiety and emotional distress. Rarely, it can become chronic pain.
Break-Through Pain (also known as Flare-Up Pain) is transient and excruciating pain beyond the normal pain baseline. Breakthrough pain goes above and beyond the medication taken to prevent and treat persistent pain. It may be caused by changes in treatment or in the underlying disease or physical actions - sneezing or standing up. Breakthrough pain may be caused by stress, worry or anxiety.
Chronic Pain: pain that persists over a longer period of time and is resistant to most medical treatments. Chronic pain is widely believed to represent disease itself. It can and often does cause problems for patients.
Classification for Chronic Pain:
Chronic pain is classified by the functional changes associated with the disease or injury.
- Neuropathic pain is caused by damage to the brain, spinal cord or peripheral nerves. It is typically described as burning, tingling, shooting, stabbing, stinging or "pins and needles."
- Phantom Pain - pain from a part of the body that has been lost, or from an area from which the brain no longer receives signals. This type of pain is common in amputees.
- Psychogenic Pain - (also called psychalgia or somatoform pain) is pain that is caused by, increased, or prolonged by emotional, mental or behavioral patterns.
- Nociceptive Pain - pain due to an ongoing tissue injury. Nociceptive pain is often divided into two categories:
- Somatic Pain - pain caused by activation of the pain receptors in the musculoskeletal tissues or the body's surface. It may be described as dull or aching.
- Visceral Pain - pain caused by damaged or injured internal organs. Usually described as vague, unlocalized pain that may feel like pressure, deep squeezing, dull and diffuse.
How Pain Affects Daily Life:
Pain can greatly impact quality of life and functioning for those affected by it.
People who experience both acute and chronic pain also see impairments in working memory, attention span, mental flexibility, information processing speed, and problem solving.
Pain can disrupt sleep on a nightly basis, and chronic pain sufferers have been known to make major lifestyle adjustments, including taking disability leave from work, changing jobs, getting assistance with activities of daily living, and even moving to a home that is more user-friendly in order to help cope with their pain.
Pain In The Elderly:
Chronic pain is extremely prevalent in the elderly population.
Addressing and treating pain in the elderly is a difficulty for health care professionals due to the following:
- The elderly are reluctant to report pain symptoms as they believe pain is a normal part of aging. The elderly may also be hesitant to "bother" their physician with complaints of pain.
- The elderly may be concerned by side effects of pain management as well as fear addiction to these drugs.
- Older adults have a higher likelihood of cognitive and sensory impairments.
- The elderly may be more concerned about the cost of treatment for pain management.
Common Pain-Inducing Conditions in Older Adults:
- Lower back pain
- Prior bone fractures
- Rheumatoid arthritis
- Paget's disease
- Polymyalgia rheumatica
- Coronary artery disease
- Herpes zoster
- Peripheral neuropathies
- Trigeminal neuralgia
- Central post-stroke
- Nutritional neuropathies
Pain in Children:
Chronic pain is a significant problem for the pediatric population and their caregivers. The social and emotional consequences that result from pain and disabilities may be devastating. Financial costs of childhood pain may be significant in some families, as well as losing salary for time off to care for the sick child. Also, the physical and psychological issues with chronic pediatric pain can have an impact on health as well as predisposing the child for chronic pain in adulthood.
Managing Pain with Medications:
The most common way that pain is treated is with the use of pain relievers. Pain relievers may be useful for certain patients in chronic pain; however, they are not universally effective. Pain relievers may, for certain individuals, worsen their condition or cause dangerous side effects.
Short-term use for pain medications is seldom concerning, although side effects are most problematic during the initial phase of treatment and tend to diminish after long-term use.
Long-term use - and misuse - of pain medications can lead to many adverse reactions.
Addiction should be distinguished from physical dependence. Any individual that takes sufficient doses of certain types of drugs for a significant length of time can have withdrawal symptoms if the drug is suddenly stopped or reversed by another medicine. This shows the presence of physical dependence but does not constitute addiction.
Each person should have an individualized care plan for managing chronic pain. With the help of a doctor, each medication - the pros and cons, the benefits, other medical problems and potential side effects - should be weighed before beginning any treatment plan.
Discuss all medications and treatments with your doctor before deciding on any treatment plan.
Over-The-Counter Pain Relievers:
Over-the-counter drugs are those that may be purchased without prescriptions. The two most common types of over-the-counter pain relievers are acetaminophen and non-steroidal anti-inflammatory drugs (also known as NSAIDs).
The most important thing for individuals to remember while purchasing over-the-counter drugs is to read the labels. Patients must read the labels, understand what they are taking and how much of it.
Safety And Over-The-Counter Medications:
When used sparingly, over-the-counter medications generally do not cause health problems. Occasionally, because they are drugs like any other, they are dangerous.
NSAIDs and acetaminophen are both used to prevent pain. Long-term use can lead to gastric bleeding, kidney failure, liver failure, as well as other conditions.
The most concerning over-the-counter pain medication is acetaminophen, which - even at fairly low doses - can be toxic to the liver, especially for those who have liver problems or are heavy drinkers.
Invasive Pain Interventions:
Viscosupplementation - lubricating substances are injected into the knee joint in patients suffering from osteoarthritis of the knee. These substances restore lubrication of the joint and decrease pain while increasing motility.
Intra-Articular Steroid Injections - for those suffering osteoarthritis, steroid injections may be injected into the joint for short-term relief.
Spinal Cord Stimulation - a small device is implanted under the skin - usually in the abdomen or buttocks - to deliver mild electrical signals to an area near the spine. The electrical signals can be adjusted by the patient via remote control to provide optimal pain relief.
Epidural - a steroid is injected into the epidural space in the neck or lower back, with or without a numbing agent.
Nerve Blocks - combination of local anesthetic and steroids used diagnostically to identify pain generators. These can also therapeutically blog a painful condition, although only for the short-term.
Rhiztomy - a probe is inserted to destroy the nerve that supplies the facet joint (a small joint that connects the back of the spine and cause neck or back pain).
Intrathecal Drug Delivery Systems - also known as pain pumps, these implanted devices deliver prescribed amounts of pain medication directly to the spinal cord and nerve roots.
Non-Invasive Pain Interventions:
Acupuncture - thin, metallic needles are inserted along acupuncture sites on the body to restore balance. These needles are manipulated or stimulated electrically and has gained a wide following of chronic pain sufferers.
Hyperbaric Oxygen - oxygen is administered in a pressurized chamber to increase the oxygen delivery to the tissues, but its efficacy is still largely undetermined.
Passive Therapies - passive therapies, such as massage, ultrasound, heating pads, and wax treatment or traction, can be useful for managing short-term pain but have limited benefit in chronic pain conditions.
External Stimulation Devices - a common device used to treat chronic pain is transcutaneous electrotherapy (TENS), in which electrical stimulation is applied to the surface of the skin.
Trigger Point Injections - a short-term solution for those with myofascial pain syndrome.
Monotherapies to Manage Chronic Pain:
Education - Patient and family education should be the primary focus of treatment and management of chronic pain conditions. It is crucial that the healthcare team work in conjunction with the family to develop strategies to cope with and manage chronic pain.
Exercise - The treatment for chronic pain almost universally suggests that the patient with chronic pain be kept as active as possible. The overwhelming evidence suggests that exercise programs are beneficial to those who suffer chronic pain.
Psychological Approaches - While talking to someone trained in "talk therapy" will not cure chronic pain, it can aid in the development of coping strategies to manage and fully live life.
Mind-Body Approaches - There are many mind-body approaches to living with chronic pain, including meditation, relaxation, hypnosis, biofeedback and imagery.
Chronic pain, while a difficult and frustrating condition to manage, is something unique to each individual, which means that each person will respond uniquely to differing approaches to chronic pain.
Related Resource Pages on Band Back Together
Resources for Pain:
Clinical Trials for Pain may be utilized for certain individuals who meet the standards for participation.
Guide for Safe Use of Pain Medication from the FDA.
Drug Interactions Checker - a handy way to determine the interactions between medications.
Drug Identification Checker - useful way to identify prescription medications.
FDA Website for safety information about prescription drugs.
Information about over-the-counter medications.
Physician's Desk Reference - excellent source of drug information.
RX List - comprehensive internet drug index.
International Association For The Study of Pain (IASP) is a scientific organization open to all professionals involved in the research, diagnosis or treatment of pain.
American Academy of Pain Medicine (AAPM) is a medical specialty society for physicians who practice in the field of pain medicine. The organization provides education, training, advocacy, and research in the specialty of pain medicine.