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Pain Management; Overview.

Pain is one of the most common human experiences. Yet pain has never been fully accepted as a medical problem. One reason may be because pain is a subjective and highly individualized experience. You can measure pain even though you can't touch it, feel it (unless it's your own), image it or prove its existence. Even a pinprick creates differing sensations of pain for different people.

Nevertheless, pain is the reason for at least 70 million visits to health care professionals' offices every year.

Pain is the body's way of sending a warning to the brain that something is wrong. Aches are felt when pain messages, carried by chemicals called neurotransmitters, travel from the nerves, along the spinal cord to the brain. In the brain, pain messages are meshed with thoughts, emotions and expectations that shape our interpretation and response to the pain.

Both emotions and drugs can change the perception of pain because both affect neurotransmitter levels. Both emotions and chemicals also alter the amount of endorphins, the body's natural pain relievers, which block the relay of pain messages to the brain. Depending on your mood and mental state, pain messages can be slowed, strengthened or stopped entirely. For example, fear, anger and worry can mask or heighten pain, while calming, positive thoughts can ease it.

There are two types of pain. "Nociceptive" pain is pain caused by tissue damage in the skin, muscles, bone or internal organs. Joint pain caused by arthritis, for instance, is an example of nociceptive pain. "Neuropathic" involves the nerve cells that transmit any pain messages to the brain because either the nerves themselves are damaged or because they are not functioning properly and sending out persistent messages.

You may hear nociceptive and neuropathic pain referred to as "acute" and "chronic" pain. Pain specialists prefer the terms nociceptive and neuropathic because they better define the parameters of the pain experience and the more scientific terms enable clinicians to zero in on where and how to begin diagnosis and treatment

These newer classifications are important because they are based on current understanding of pain pathophysiology of the nervous system. The terms, "acute pain" and "chronic pain" are less scientific. And, they're not accurate because there is no time relationship between when pain changes from being acute to being chronic. An arbitrary time frame-typically three months-was identified as the point at which the pain experience changed from acute to chronic.

But time has no relationship to changes in the nervous system. For example, phantom pain, which is an excellent example of neuropathic pain, can occur within 24 hours of an amputation and be permanent. The newer classification helps us better understand complex pain problems.

Understanding Nociceptive and Neuropathic Pain

Nociceptive pain basically represents pain associated with a pain receptor. This kind of pain is a signal to the body that it's being damaged in some way that needs immediate attention. Trauma, infection or illness can cause nociceptive pain. Toothaches, sprains, backaches or a broken bone are other common causes. Although unpleasant, most injuries resulting in nociceptive pain are short-lived and are easily treated with rest or medications.

Neuropathic pain refers to pain that is not associated with specific pain receptors, and probably represents sensitization of the nervous system (this is when pain becomes the disease process itself, rather than representing a "warning" of underlying pathology). It is constant, often lasting for months after an initial injury or trauma and can be disabling.

Neuropathic pain can cause fatigue, concentration problems and appetite changes and lead to suppression of the immune system, depression, anxiety and even suicide. Conditions that cause such pain include osteoarthritis and fibromyalgia, and are more common in women than in men. This form of pain is also associated with progressive illnesses such as arthritis and cancer. Cancer pain is, more often than not, nociceptive and neuropathic recurring pain associated with the worsening of the cancer.

While under-treated nociceptive pain can lead to neuropathic pain, not all neuropathic pain needs to have been preceded by nociceptive pain, nor is there any timeframe for when it can occur. Perhaps the worst aspect of either persistent nociceptive or neuropathic pain is not knowing how long it will last or what can relieve it, which makes coping with it difficult.

"COX-2 Selective and Non-Selective Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)." U.S. Food and Drug Administration Center for Drug Evaluation and Research. Updated April 15, 2005. Accessed June 3, 2005.

"FDA Issues Public Health Advisory on Vioxx as its Manufacturer Voluntarily Withdraws Its Product." U.S. Food and Drug Administration. Accessed October 1, 2004. "OxyContin Abuse and Diversion and Efforts to Address the Problem." U.S. General Accounting Office: Report to Congressional Requestors. December 2003., a multimedia educational program for people living with pain. c 1998 D. J. Wilkie. A new product under development by eNURSING LLC, Seattle, WA, Accessed June 6, 2004. "Lumbar Spine Pathology and Atherosclerotic Risk Factors: A 52-Year Prospective Study of 1337 Patients." American Academy of Orthopaedic Surgeons 2001 Annual Meeting. Feb 28-Mar. 4, 2001. Poster Session. Accessed February 2002. Woodside JR. "Female smokers have increased postoperative narcotic requirements." J Addict Dis 2000; 19(4):1-10. Department of Family Medicine, East Tennessee State University, Johnson City, TN.MEDLINEplus Health Information: a service of the National Library of Medicine and the U.S. National Institutes of Health. Accessed June 6, 2004. http://www.nlm.nih.govInternational Center for the Control of Pain in Childen and Adults. The University of Iowa College of Nursing. Accessed June 6, 2004."FDA Strengthens Warnings for OxyContin." U.S. Food and Drug Administration FDA Talk Paper. July 25, 2001.http://www.fda.go. Accessed June 6, 2004.Pain Management Standards for 2001. The Joint Commission on Accreditation of Health care Organizations (JCAHO). Accessed June 6, 2004. "Rheumatoid Arthritis." National Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health. Accessed June 6, 2004."Acupunture Information and Resources." National Center for Complimentary and Alternative Medicine, National Institutes of Health. Updated March 2002. Accessed June 6, 2004."Managing Cancer Pain." Reviewed April 2002. American Pain Foundation. Accessed June 6, 2004."Osteoarthritis." The Arthritis Foundation. Accessed June 6, 2004.Lippe, PM. An apologia in defense of pain medicine. Clin J Pain 1998; 14: 189-190.Ray, A. Pain Perception. Clin Geriatrics March 2001; 10:3, 38-43. Ray, A and Zbik, A. Cognitive Therapies and Beyond, in Tollison, CD, ed, Practical Pain Management 3rd ed, Lippincott, Williams & Wilkins, 2002; 189-208.Sifton, David, ed. The PDR Family Guide to Natural Medicines and Healing Therapies (PDR Family Guides). Medical Economics, 1999.Watkins, CE. "Medical Hypnosis--Uses, Techniques and Contraindications of Hypnotherapy." Northern County Psychiatric Associates. Accessed June 6, 2004."Lifecycle and Headache." American Council for Headache Education. Accessed June 6, 2004.

Editorial Staff of the National Women's Health Resource Center 2002/07/31 2005/06/15 Pain is one of the oldest and most common human experiences. And yet pain has never been fully accepted as a medical problem. One reason may be because pain is subjective and a highly individualized experience. Acetaminophen,Acute pain,Chronic pain,Electrical Stimulation,Endorphins,Neurotransmitters,Pain clinics,Pain management
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Publication:NWHRC Health Center - Pain Management
Geographic Code:1USA
Date:Jun 15, 2005
Next Article:Pain Management; Treatment.

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