PAIN
What is pain?
The International
Association for the Study of Pain defines it as: An unpleasant sensory
and emotional experience associated with actual or potential tissue damage
or described in terms of such damage.
It is useful to distinguish between two basic types of pain, acute and chronic, and they differ greatly.
• Acute pain, for the most part, results from disease, inflammation,
or injury to tissues. This type of pain generally comes on suddenly, for
example, after trauma or surgery, and may be accompanied by anxiety or
emotional distress. The cause of acute pain can usually be diagnosed and
treated, and the pain is self-limiting, that is, it is confined to a given
period of time and severity. In some rare instances, it can become chronic.
• Chronic pain is widely believed to represent disease itself. It can
be made much worse by environmental and psychological factors. Chronic
pain persists over a longer period of time than acute pain and is resistant
to most medical treatments. It can—and often does—cause severe problems
for patients.
How is pain diagnosed?
There is no way to tell how much pain a person has. No test can measure
the intensity of pain, no imaging device can show pain, and no instrument
can locate pain precisely. Sometimes, as in the case of headaches, physicians
find that the best aid to diagnosis is the patient's own description of
the type, duration, and location of pain. Defining pain as sharp or dull,
constant or intermittent, burning or aching may give the best clues to
the cause of pain. These descriptions are part of what is called the pain
history, taken by the physician during the preliminary examination of
a patient with pain.
Physicians, however, do have a number of technologies they use to find the cause of pain. Primarily these include:
• Electrodiagnostic procedures include electromyography (EMG), nerve
conduction studies, and evoked potential (EP) studies. Information from
EMG can help physicians tell precisely which muscles or nerves are affected
by weakness or pain. Thin needles are inserted in muscles and a physician
can see or listen to electrical signals displayed on an EMG machine. With
nerve conduction studies the doctor uses two sets of electrodes (similar
to those used during an electrocardiogram) that are placed on the skin
over the muscles. The first set gives the patient a mild shock that stimulates
the nerve that runs to that muscle. The second set of electrodes is used
to make a recording of the nerve's electrical signals, and from this information
the doctor can determine if there is nerve damage. EP tests also involve
two sets of electrodes-one set for stimulating a nerve (these electrodes
are attached to a limb) and another set on the scalp for recording the
speed of nerve signal transmission to the brain.
• Imaging, especially magnetic resonance imaging or MRI, provides physicians
with pictures of the body's structures and tissues. MRI uses magnetic
fields and radio waves to differentiate between healthy and diseased tissue.
• A neurological examination in which the physician tests movement, reflexes,
sensation, balance, and coordination.
• X-rays produce pictures of the body's structures, such as bones and
joints.
How is pain treated?
The goal of pain management is to improve function, enabling individuals
to work, attend school, or participate in other day-to-day activities.
Patients and their physicians have a number of options for the treatment
of pain; some are more effective than others. Sometimes, relaxation and
the use of imagery as a distraction provide relief. These methods can
be powerful and effective, according to those who advocate their use.
Whatever the treatment regime, it is important to remember that pain is
treatable.
Pain in aging and pediatric populations: special
needs and concerns
Pain is the number one complaint of older Americans, and one in five older
Americans takes a painkiller regularly. In 1998, the American Geriatrics
Society (AGS) issued guidelines* for the management of pain in older people.
The AGS panel addressed the incorporation of several non-drug approaches
in patients' treatment plans, including exercise. AGS panel members recommend
that, whenever possible, patients use alternatives to aspirin, ibuprofen,
and other NSAIDs because of the drugs' side effects, including stomach
irritation and gastrointestinal bleeding. For older adults, acetaminophen
is the first-line treatment for mild-to-moderate pain, according to the
guidelines. More serious chronic pain conditions may require opioid drugs
(narcotics), including codeine or morphine, for relief of pain.
Pain in younger patients also requires special attention, particularly because young children are not always able to describe the degree of pain they are experiencing. Although treating pain in pediatric patients poses a special challenge to physicians and parents alike, pediatric patients should never be undertreated. Recently, special tools for measuring pain in children have been developed that, when combined with cues used by parents, help physicians select the most effective treatments.