Pain - What Is It?

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-11-27 18:19

Pain: what is it?

According to the World Pain Organization IASP (= International Association for the Study of Pain), pain is an unpleasant sensory and emotional experience that is linked to actual or threatened tissue damage or is described in terms of such damage. The term “sensory experience” refers to the quality of the pain, for example burning, stabbing, piercing or tearing, and its strength. The term “emotional experience” relates to the emotional parts of the pain, eg tormenting, murderous or exhausting.

According to the current state of knowledge of pain research, it is important for a promising treatment to evaluate pain not only - as has been the case for a long time - according to its severity and duration, but also according to its type.

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• Continue reading
• more on the subject
• Advice, downloads & tools
• Measure subjective pain
• Acute and chronic pain
• What types of pain are there?
• How is pain diagnosed?
• Whom can I ask?

Measure subjective pain

Pain is perceived very differently from person to person. This does not only depend on the pure nerve signal. Biological (ie hereditary), psychological and social factors such as family and cultural traditions in dealing with pain also play a role. A measurement of the subjectively perceived pain is especially important for the following reasons:

• to be able to decide whether treatment is necessary,
• to be able to check the effectiveness of a pain therapy.

Various pain scales are available for this purpose, e.g.

• Numerical rating scale (NRS): The perceived pain intensity is indicated with a numerical value from “0” (= no pain) to “10” (strongest imaginable pain).
• Visual analog scale (VAS): The pain levels (no pain and unbearable pain) are shown with a line on which the personal sensation can be indicated.
• Verbal Rating Scale (VRS): Assessment of whether there is no pain or a slight, moderate, severe or extreme pain.

Acute and chronic pain

Acute pain, while uncomfortable, is useful (a vital sensory perception): it alerts us to potential or actual harm. Chronic pain, on the other hand, does not have this vital warning function, but represents a largely “senseless” burden for us. In Austria, depending on the study, every fifth to fifteenth person is affected by chronic pain.

Acute pain

Acute pain occurs suddenly and usually subsides on its own as soon as the trigger is healed or eliminated. They have a necessary warning function in order to avoid tissue damage and inform us about where irritations, wounds or inflammations have occurred. Acute pain occurs, for example, with dental problems, injuries, muscle tension, sunburn, biliary colic or heart attacks.

Chronic pain

Pain that persists beyond an expected normal healing time, lasts longer than three months, or recurs is considered chronic. They no longer have to do with the actual injury and can therefore occur in completely different parts of the body. A chronic pain disease develops when the pain has lost its function as a warning signal and develops into an independent clinical picture.

Strong and long-lasting pain stimuli - for example due to a lack of or inadequate pain treatment - can make the transmitting nerve cells in the spinal cord and brain more sensitive to subsequent pain stimuli. Even light touch, moderate heat or pressure are perceived as painful. In addition, the spinal cord and brain can harden and become more sensitive to pain. This learning process is also known as “pain memory” or “pain engram”.

Chronic pain can occur at any age. However, the age group between 40 and 70 is particularly affected. The most common are pain in the musculoskeletal system, headache and nerve pain, and pain associated with cancer.

What types of pain are there?

A distinction is made between three different types of pain, depending on the underlying mechanisms of development: receptor pain, nerve pain and mixed forms.

Receptor pain

Receptor pain (nociceptive pain) is the classic pain that occurs after tissue damage. They express themselves dull, oppressive, convulsive or colicky. The pain indicators, so-called pain receptors (= nociceptors), are stimulated in the tissue, in the joint or in the bones and pass this information on as a pain signal. The irritation of the pain receptors can be triggered by direct mechanical action (e.g. knife cut), by chemical (e.g. acid), thermal (e.g. heat) or endogenous substances (e.g. inflammatory messengers).

Examples of receptor pain are:

• acute injuries,
• post-operative pain,
• Broken bones, osteoporosis,
• Sports injuries,
• Skin and mucous membrane injuries,
• Joint diseases (osteoarthritis or rheumatism),
• Back pain,
• Tumor pain,
• Intestinal pain,
• A headache,
• Inflammation.

Nerve pain

Nerve pain (neuropathic pain) can be traced back to direct damage to or malfunction of a pain-conducting nerve fiber, e.g. through injuries, changes in the spinal cord, amputations or diseases such as shingles or diabetes mellitus. The nerve itself - and not the pain receptor - triggers the pain. The damage to the nervous system ultimately leads to excessive excitability of the nerve cells - they continuously transmit pain impulses to the brain and lead to chronic pain.

In the case of nerve damage, the pain cannot be felt at the site of the injury, but in a completely different part of the body. For example, an injured nerve in the back can cause pain radiating to the leg.

Examples of nerve pain:

• Phantom pain,
• Back pain with nerve injuries,
• Post-zoster neuralgia (chronic pain after shingles),
• HIV,
• diabetic polyneuropathy.

Mixed forms

Much chronic pain doesn't have just one underlying type of pain. One speaks of mixed pain when both receptor pain and nerve pain are underlying. Both types of pain must be treated accordingly in order to achieve therapeutic success.

Examples of mixed forms are:

• chronic back pain disorders,
• Tumor pain with nerve infiltration,
• Osteoarthritis pain.

How is pain diagnosed?

A diagnosis that is as precise as possible is necessary in order to find the optimal therapy for the person affected. To do this, the doctor needs precise information, including the duration, severity and type of pain. Information provided by the patient on the following questions can provide important information:

• Where is the pain?
• How does the pain feel
• When did the pain start?
• How long does the pain last?
• When does the pain occur?
• How is the pain positively or negatively influenced?

Whom can I ask?

For both acute and chronic pain, it is important to initiate appropriate pain therapy as early as possible. If you are in pain, you can contact the following offices:

• General Practitioner,
• Pain therapist: These are doctors from a wide variety of disciplines, such as anesthesia, neurology, orthopedics or psychiatry who specialize in pain therapy or have additional training. Your specialist knowledge is particularly in demand in the treatment of chronic pain.