Register for a free account Sign up for a free Medical News Today account to customize your medical and health news experiences. Register take the tour. Table of contents Causes Types Diagnosis Treatment and management. Fast facts on pain: Here are some key points about pain. More detail is in the main article. Pain results from tissue damage. It is a part of the body's defense mechanism. It warns us to take action to prevent further tissue damage. People experience and describe pain differently, and this makes it hard to diagnose.
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We strive to make the EWN community a safe and welcoming space for all. EWN reserves the right to: If the pain is continuous for a long period, parts of the intact body may become sensitized, so that touching them evokes pain in the phantom limb. Phantom limb pain may accompany urination or defecation. Local anesthetic injections into the nerves or sensitive areas of the stump may relieve pain for days, weeks, or sometimes permanently, despite the drug wearing off in a matter of hours; and small injections of hypertonic saline into the soft tissue between vertebrae produces local pain that radiates into the phantom limb for ten minutes or so and may be followed by hours, weeks or even longer of partial or total relief from phantom pain.
Vigorous vibration or electrical stimulation of the stump, or current from electrodes surgically implanted onto the spinal cord, all produce relief in some patients. Mirror box therapy produces the illusion of movement and touch in a phantom limb which in turn may cause a reduction in pain. Paraplegia , the loss of sensation and voluntary motor control after serious spinal cord damage, may be accompanied by girdle pain at the level of the spinal cord damage, visceral pain evoked by a filling bladder or bowel, or, in five to ten per cent of paraplegics, phantom body pain in areas of complete sensory loss.
This phantom body pain is initially described as burning or tingling, but may evolve into severe crushing or pinching pain, or the sensation of fire running down the legs or of a knife twisting in the flesh. Onset may be immediate or may not occur until years after the disabling injury. Surgical treatment rarely provides lasting relief.
Psychogenic pain, also called psychalgia or somatoform pain , is pain caused, increased, or prolonged by mental, emotional, or behavioral factors. However, specialists consider that it is no less actual or hurtful than pain from any other source. People with long-term pain frequently display psychological disturbance, with elevated scores on the Minnesota Multiphasic Personality Inventory scales of hysteria , depression and hypochondriasis the " neurotic triad ". Some investigators have argued that it is this neuroticism that causes acute pain to turn chronic, but clinical evidence points the other direction, to chronic pain causing neuroticism.
When long-term pain is relieved by therapeutic intervention, scores on the neurotic triad and anxiety fall, often to normal levels. Self-esteem , often low in chronic pain patients, also shows improvement once pain has resolved. Breakthrough pain is transitory pain that comes on suddenly and is not alleviated by the patient's regular pain management. It is common in cancer patients who often have background pain that is generally well-controlled by medications, but who also sometimes experience bouts of severe pain that from time to time "breaks through" the medication. The characteristics of breakthrough cancer pain vary from person to person and according to the cause.
Management of breakthrough pain can entail intensive use of opioids , including fentanyl.
What is pain and how do you treat it?
The ability to experience pain is essential for protection from injury, and recognition of the presence of injury. Episodic analgesia may occur under special circumstances, such as in the excitement of sport or war: Although unpleasantness is an essential part of the IASP definition of pain,  it is possible to induce a state described as intense pain devoid of unpleasantness in some patients, with morphine injection or psychosurgery.
Insensitivity to pain may also result from abnormalities in the nervous system. This is usually the result of acquired damage to the nerves, such as spinal cord injury , diabetes mellitus diabetic neuropathy , or leprosy in countries where that disease is prevalent. People with diabetes-related nerve damage, for instance, sustain poorly-healing foot ulcers as a result of decreased sensation.
A much smaller number of people are insensitive to pain due to an inborn abnormality of the nervous system, known as " congenital insensitivity to pain ". Some die before adulthood, and others have a reduced life expectancy. Experimental subjects challenged by acute pain and patients in chronic pain experience impairments in attention control, working memory , mental flexibility , problem solving, and information processing speed.
If I have matters right, the consequences of pain will include direct physical distress, unemployment, financial difficulties, marital disharmony, and difficulties in concentration and attention…. Although pain is considered to be aversive and unpleasant and is therefore usually avoided, a meta-analysis which summarized and evaluated numerous studies from various psychological disciplines, found a reduction in negative affect. Across studies, participants that were subjected to acute physical pain in the laboratory subsequently reported feeling better than those in non-painful control conditions, a finding which was also reflected in physiological parameters.
Before the relatively recent discovery of neurons and their role in pain, various different body functions were proposed to account for pain. There were several competing early theories of pain among the ancient Greeks: Hippocrates believed that it was due to an imbalance in vital fluids. Specificity theory saw pain as "a specific sensation, with its own sensory apparatus independent of touch and other senses". However, after a series of clinical observations by Henry Head and experiments by Max von Frey , the psychologists migrated to specificity almost en masse, and by century's end, most textbooks on physiology and psychology were presenting pain specificity as fact.
They proposed that all skin fiber endings with the exception of those innervating hair cells are identical, and that pain is produced by intense stimulation of these fibers. In Ronald Melzack and Kenneth Casey described chronic pain in terms of its three dimensions:. They theorized that pain intensity the sensory discriminative dimension and unpleasantness the affective-motivational dimension are not simply determined by the magnitude of the painful stimulus, but "higher" cognitive activities can influence perceived intensity and unpleasantness. Cognitive activities "may affect both sensory and affective experience or they may modify primarily the affective-motivational dimension.
Thus, excitement in games or war appears to block both dimensions of pain, while suggestion and placebos may modulate the affective-motivational dimension and leave the sensory-discriminative dimension relatively undisturbed. Wilhelm Erb's "intensive" theory, that a pain signal can be generated by intense enough stimulation of any sensory receptor, has been soundly disproved. Some sensory fibers do not differentiate between noxious and non-noxious stimuli, while others, nociceptors , respond only to noxious, high intensity stimuli. At the peripheral end of the nociceptor, noxious stimuli generate currents that, above a given threshold, send signals along the nerve fiber to the spinal cord.
The "specificity" whether it responds to thermal, chemical or mechanical features of its environment of a nociceptor is determined by which ion channels it expresses at its peripheral end. Dozens of different types of nociceptor ion channels have so far been identified, and their exact functions are still being determined. The pain signal travels from the periphery to the spinal cord along an A-delta or C fiber. This is followed by a duller pain, often described as burning, carried by the C fibers.
These A-delta and C fibers connect with "second order" nerve fibers in the central gelatinous substance of the spinal cord laminae II and III of the dorsal horns. The second order fibers then cross the cord via the anterior white commissure and ascend in the spinothalamic tract. Before reaching the brain, the spinothalamic tract splits into the lateral , neospinothalamic tract and the medial , paleospinothalamic tract.
Second order, spinal cord fibers dedicated to carrying A-delta fiber pain signals, and others that carry both A-delta and C fiber pain signals to the thalamus have been identified. Other spinal cord fibers, known as wide dynamic range neurons , respond to A-delta and C fibers, but also to the large A-beta fibers that carry touch, pressure and vibration signals. Pain is part of the body's defense system, producing a reflexive retraction from the painful stimulus, and tendencies to protect the affected body part while it heals, and avoid that harmful situation in the future.
People with congenital insensitivity to pain have reduced life expectancy. In The Greatest Show on Earth: The Evidence for Evolution , biologist Richard Dawkins addresses the question of why pain should have the quality of being painful. He describes the alternative as a mental raising of a "red flag". To argue why that red flag might be insufficient, Dawkins argues that drives must compete with one other within living beings.
The most "fit" creature would be the one whose pains are well balanced. Those pains which mean certain death when ignored will become the most powerfully felt. The relative intensities of pain, then, may resemble the relative importance of that risk to our ancestors. This may have maladaptive results such as supernormal stimuli. Idiopathic pain pain that persists after the trauma or pathology has healed, or that arises without any apparent cause may be an exception to the idea that pain is helpful to survival, although some psychodynamic psychologists argue that such pain is psychogenic, enlisted as a protective distraction to keep dangerous emotions unconscious.
In pain science, thresholds are measured by gradually increasing the intensity of a stimulus such as electric current or heat applied to the body. The pain perception threshold is the point at which the stimulus begins to hurt, and the pain tolerance threshold is reached when the subject acts to stop the pain.
Differences in pain perception and tolerance thresholds are associated with, among other factors, ethnicity, genetics, and gender. People of Mediterranean origin report as painful some radiant heat intensities that northern Europeans describe as nonpainful. And Italian women tolerate a lesser level of intense electric shock than Jewish or Native American women. Some individuals in all cultures have significantly higher than normal pain perception and tolerance thresholds.
For instance, patients who experience painless heart attacks have higher pain thresholds for electric shock, muscle cramp and heat.
pain - Wiktionary
A person's self-report is the most reliable measure of pain. Quality can be established by having the patient complete the McGill Pain Questionnaire indicating which words best describe their pain. The visual analogue scale is a common, reproducible tool in the assessment of pain and pain relief.
When applied as a pain descriptor, these anchors are often 'no pain' and 'worst imaginable pain". Cut-offs for pain classification have been recommended as no pain mm , mild pain mm , moderate pain mm and severe pain mm. The Multidimensional Pain Inventory MPI is a questionnaire designed to assess the psychosocial state of a person with chronic pain. When a person is non-verbal and cannot self-report pain, observation becomes critical, and specific behaviors can be monitored as pain indicators. Behaviors such as facial grimacing and guarding indicate pain, as well as an increase or decrease in vocalizations, changes in routine behavior patterns and mental status changes.
Patients experiencing pain may exhibit withdrawn social behavior and possibly experience a decreased appetite and decreased nutritional intake. A change in condition that deviates from baseline such as moaning with movement or when manipulating a body part, and limited range of motion are also potential pain indicators. In patients who possess language but are incapable of expressing themselves effectively, such as those with dementia, an increase in confusion or display of aggressive behaviors or agitation may signal that discomfort exists, and further assessment is necessary.
Infants do feel pain , but lack the language needed to report it, and so communicate distress by crying. A non-verbal pain assessment should be conducted involving the parents, who will notice changes in the infant which may not be obvious to the health care provider. Pre-term babies are more sensitive to painful stimuli than those carried to full term. The way in which one experiences and responds to pain is related to sociocultural characteristics, such as gender, ethnicity, and age. Their ability to recognize pain may be blunted by illness or the use of medication.
Depression may also keep older adult from reporting they are in pain.
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Decline in self-care may also indicate the older adult is experiencing pain. They may be reluctant to report pain because they do not want to be perceived as weak, or may feel it is impolite or shameful to complain, or they may feel the pain is a form of deserved punishment. Cultural barriers may also affect the likelihood of reporting pain. Sufferers may feel that certain treatments go against their religious beliefs.