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What is the most common reason for visiting a physician? Pain. A key symptom in most medical conditions, it can significantly interfere with your quality of life. The Pain Consultants of West Florida believe in providing our patients with a variety of different methods for helping our patients become painless. If you have more questions, make sure to give us a call.
What is pain?
Pain is the sensation felt when you bump your funny bone, smack your finger with a hammer, or burn your arm. The body will feel better with the removal of the painful element, like when a splinter is removed from your finger. Once removed, the body will undergo the process of healing.
Why do we feel pain?
Pain is a part of our body’s defense against: ourselves. Without it, we would not avoid dangerous scenarios and stimuli. It is vital to healthy survival. People with congenital insensitivity have reduced life expectancy. By experiencing and understanding pain, we learn when it would mean certain death if ignored. The different intensities of pain we feel from lack of food, extreme temperature differential, serious injuries, and other painful scenarios is due to the natural selection of our ancestors. There are some glitches in the response, though, including supernormal stimuli.
How do we assess pain?
Pain has a lot of different assessment methods, but most utilize a scale of some sort. The scale is always explained to the patient, in order to get the most accurate score documenting their pain. Below are the common different scales used by pain management physicians around the country.
This easy scale has patients rate their pain on a scale from 0-10. 0 typically means no pain and 10 being the absolute worst pain they can think of.
This simple scale shows the patient corresponding faces depicting various levels of pain. They will then select the most correct depiction.
When patients cannot verbalize or comprehend the pain scales, they are typically given different assessments such as the FLACC table below for infants.
Primarily used for infants:
Assessment 0 1 2 Face Smiling/expressionless Frowning Clenched jaw/Anguish Legs Normal movement/Relaxed Restless/Tense Legs drawn up/Kicking Activity None/Lying quietly Squirming/Tense movements Arched back/Rigid/Jerking Cry None Occasional whimper Crying constantly/Screaming Consolability Relaxed Easily distracted or reassured Difficult to distract/reassure
The nurse then adds the different scores to get a value from 0 – 10.
What are the types of pain?
Pain is typically split into a couple of different classifications: acute, chronic, tissue damage (nociceptive), psychogenic, and nerve damage (neuropathic).
Acute pain lasts for a short period of time. It typically comes on suddenly and has a limited duration. It is usually caused by tissue damage, also known as nociceptive pain. Nociceptive is damage to tissue such as bone, muscle, or organs. It is often accompanied by anxiety or emotional distress. Acute pain will vanish if you remove your body from the stressful environment/stimuli and give it time to heal.
Pain is “chronic” when it lasts over a long period of time. This includes pain that you feel regularly, even if it comes and goes. Usually, it is due to chronic stimulus from an ongoing injury or health problem. Common causes of chronic stimulus include joint degeneration (arthritis), back injury, nervous system damage (neuropathic or peripheral neuropathy), and headaches.
Tissue damage is when the tissues of the body are physically harmed by one of three ways: thermal, mechanical, and chemical. Called nociceptive pain, the pain response is from the stimulation of peripheral nerve fibers.
It may also be divided into three different categories. The categories are called “visceral”, “deep somatic” and “superficial somatic” pain.
Visceral pain is often difficult to pinpoint and sometimes radiates to a superficial part of your body that is closest to the pain felt. Sometimes nausea and vomiting accompanies this type. The sensation is sickening, deep, squeezing, and dull.
Deep somatic pain is a dull, aching pain that will be found in ligaments, tendons, bones, blood vessels, fasciae and muscles. Sprains and broken bones are the easiest examples of this type of pain.
Lastly, we have superficial somatic pain. The body feels superficial pain through damage to the skin or other superficial tissue. Burns and cuts are the biggest examples of this type.
Nerve Damage (Neuropathic/Neuropathy)
Neuropathic pain is damage or disease affecting any part of the nervous system involved in bodily feelings. Treatment of it is challenging thanks to the multiple etiologies, symptoms and underlying causes. Neuropathic pain encompasses a variety of painful disease states that are often hard to treat with a single medication or modality. There is no “gold standard” treatment because it manifests so differently in different patients.
Our physical therapists use a variety of modalities to treat it. We employ heat, ice, TENS, iontophoresis, ultrasound and prescriptive therapeutic exercise, among others, depending on the patient’s individual needs and responses to treatment. The most common type of neuropathic pain, peripheral neuropathy, is often described as “burning”, “tingling”, “electrical”, “stabbing”, or “pins and needles” type of pain. Want to know how it feels? Bump your “funny bone”.
Psychogenic pain is caused by mental, emotional, or behavioral factors; simply put it’s pain that is in your head. Kinda of. Headache, back, and stomach pain are sometimes diagnosed as psychogenic. Specialist’s vary their approach when they are dealing with this type. This is due to a misinformed opinion that pain from a psychological source is not “real”. However, specialists believe it is no less actual or hurtful than pain from any other source.
People with long term pain from this type frequently display psychological disturbance, with elevated scores on the Minnesota Multiphasic Personality Inventory scales of hysteria, depression and hypochondriasis. This is known as the “neurotic triad” by specialists. Some investigators have argued that neuroticism causes the acute pain to turn chronic, but clinical evidence points out that chronic pain actually causes neuroticism. By reducing it, scores on the neurotic triad and anxiety fall drastically.
How do the Pain Consultants of West Florida manage pain?
When it comes to pain, we like to approach treatment a little differently. We know how to tailor your treatment to fit your unique needs. Our treatment recommendations always start with conservative interventions such as activity modification, therapeutic exercise or physical therapy. For more persistent problems, we offer non-surgical or minimally invasive procedures that can help resolve lingering painful conditions in the spine and extremities. With our multiple disciplinary approach, we help the community be painless. Call us.
All the information presented is courtesy of the following organizations:
US Dept. of Health and Human Services
National Institutes of Health
Pain Entry on Wikipedia