PAIN, TYPES, CAUSES AND MANAGEMNET

PAIN

  • Pain is defined as an unpleasant and emotional experience associated with or without actual tissue damage. 
  • Pain sensation can be sharp, pricking, electrical, dull ache, shooting, cutting, stabbing, etc. Often it induces crying and fainting. 
  • Pain is produced by real or potential injury to the body. Often it is expressed in terms of injury.

For example,

  • pain produced by fire is expressed as a burning sensation;
  • pain produced by severe sustained contraction of
  • skeletal muscles are expressed as cramps.

BENEFITS OF PAIN SENSATION

Pain is an important sensory symptom. Though it is an unpleasant sensation, it has protective or survival benefits such as:

  1. Pain gives a warning signal about the existence of a problem or threat. It also creates awareness of injury.
  2. Pain prevents further damage by causing the reflex withdrawal of the body from the source of injury
  3. Pain forces the person to rest or to minimize the activities thus enabling rapid healing of the injured part
  4. Pain urges the person to take the required treatment to prevent major damage.

ACUTE PAIN

  • ACUTE PAIN is a sharp pain of short duration with an easily identified cause. Often it is localized in a small area before spreading to neighboring areas. Usually, it is treated by medications. 
  • The pain of fewer than 6 months duration is considered “acute “pain. 
  • It is better defined as an unpleasant sensory, perceptual, emotional, and mental experience provoked by acute disease or injury with autonomic, psychological, and behavioral responses.

SUBACUTE PAIN

  • Does not have a structured definition but exists to explain the spectrum of pain experience between the acute and chronic.
  • This category is useful for patients who have pain somewhat longer than the healing period but not so long-standing that it has caused significant behavioral or physiological alteration.

CHRONIC PAIN

  • It is the intermittent or constant pain with different intensities. 
  • Mostly pain lasting longer than 6 months is considered “chronic” pain. 
  • It is somewhat difficult to treat chronic pain and it needs professional expert care.


VISCERAL PAIN

Pain from the viscera is unpleasant. It is poorly localized.

CAUSES OF VISCERAL PAIN

Ischemia

Substances released during ischemic reactions such as bradykinin and proteolytic enzymes stimulate the pain receptors of the viscera.

Chemical Stimuli

Chemical substances like acidic gastric juice, leak from ruptured ulcers into the peritoneal cavity and produce pain.

Spasm and Overdistention of Hollow Organs

Spastic contraction of smooth muscles in the gastrointestinal tract and other hollow organs of the viscera cause pain by stimulating the free nerve endings. Overdistention of hollow organs also causes pain

 REFERRED PAIN

DEFINITION

Referred pain is the pain that is perceived at a site adjacent to or away from the site of origin. Deep pain and some visceral pain are referred to other areas. But, superficial pain is not referred to the other areas.

EXAMPLES OF REFERRED PAIN

  1. Cardiac pain is felt at the inner part of the left arm and left shoulder
  2. Pain in the ovary is referred to the umbilicus
  3. Pain from the testis is felt in the abdomen
  4. Pain in the diaphragm is referred to the shoulder
  5. Pain in gallbladder is referred to epigastric region
  6. Renal pain is referred to loin.

MECHANISM OF REFERRED PAIN

Dermatomal Rule

  • According to the dermatomal rule, pain is referred to a structure, which is developed from the same dermatome from which the pain-producing structure is developed. 
  • A dermatome includes all the structures or parts of the body, which are innervated by afferent nerve fibers of one dorsal root. 
  • For example, the heart and inner aspect of the left arm originate from the same dermatome. So, the pain in the heart is referred to the left arm.

NEUROTRANSMITTERS INVOLVED IN PAIN SENSATION

  • Glutamate and substance P are the neurotransmitters secreted by pain nerve endings. Aδ afferent fibers, which transmit impulses of fast pain secrete glutamate. 
  • The C type fibers, which transmit impulses of slow pain secrete substance P.

PAIN PATHWAY

  • Analgesic pathway
  • Pain gate theory

Therapeutic pain management

  • Because impairments and functional limitations can arise from pain and can affect the musculoskeletal, neuromuscular, cardiopulmonary, or integumentary systems, therapists can employ a wide variety of treatment techniques. 
  • These techniques run the gamut from modalities to patient education, mobilization and massage, therapeutic exercise, and gait training and conditioning. 
  • Interventions that are not diagnosis and impairment specific include pain control modalities, therapeutic exercise, and patient education.

Modalities are only used as a bridge until the patient can actively participate in the prescribed exercise. Hence at the period of pain relief therapeutic exercise and patient education are must

 

 

 

 

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