Pain

What is the real definition of pain?

And what is pain management??
How can this information help me???

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Pain
Definitions:
An unpleasant sensory and emotional experience associated with actual
or potential tissue damage.
Pain is whatever the experiencing person says it is.
May not be directly proportional to amount of tissue injury.
Highly subjective, leading to undertreatment

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Classification of Pain
1. Acute
2. Cancer
3. Chronic non-malignant

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Acute Pain
Injury, trauma, spasm or disease to skin, muscle, somatic
structures or viscera;
Perceived and communicated via peripheral mechanisms
(pathways) A delta and C fibers
Usually with autonomic response as well (tachycardia, blood
pressure, diaphoresis, pallor, mydriasis (pupil dilation);

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Acute Pain
Usually subsides quickly as pain producing stimuli
decreases
Associated with anxiety-(decreases rapidly)
Can be understood or rationalized as part of the
healing process.

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Chronic Pain

Non-malignant
Pain persists beyond the precipitating injury
Rarely accompanied by autonomic symptoms
Sufferers often fail to demonstrate objective evidence of
underlying pathology.
Characterized by location-visceral, myofacial, or neurologic
causes.

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Chronic Pain
Malignant
Has characteristics of chronic pain as well as
symptoms of acute pain (breakthrough pain).
Has a definable cause, e.g. tumor recurrence
In treatment, narcotic habituation is generally not a
concern.

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Types of Pain

Somatic
Visceral
Referred
Bone
Neuropathic
Emotional/Spiritual

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Somatic Pain
Aching, often constant
May be dull or sharp
Often worse with movement
Well localized
Skin, Muscle, Joints, superficial
or deep.
Eg:
Bone & soft tissue
chest wall

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Visceral Pain

Constant or crampy
Aching, burning
Poorly localized
Referred

Organs of Thorax & Abdominal

Cavity. Usually as a result of
stretching, infiltration and
compression

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Eg/
CA pancreas
Liver capsule distension
Bowel obstruction

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Types of Pain
Both Somatic & Visceral pain travel along the same
pathways. Pain stimuli arising from the viscera is perceived
as somatic in origin.
This can be confused by the brain and is often described as
referred pain.

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Liver
Liver
Heart
Stomach
Gallbladder
Small Intestine
Appendix
Right Ureter

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Ovary
Colon
Kidney
Bladder

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Types of Pain
Bone Pain
Poorly localised, aching, deep, burning.
Common with Breast, Lung, Prostate, Bladder, Cervical,
Renal, Colon, Stomach and Oesophagus
Can lead to pathological fractures.
Vertebral Metastases can lead to cord compression.

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Bone Pain
Osteoblasts, Osteoclasts and Osteocytes are involved in

remodelling bone.
In healthy individuals bone remodelling is carefully
regulated.
Normally Osteoblasts replace the same amount of bone
which has been resorbed by the Osteoclasts.
In malignancy process not balanced, resulting in a loss of
bone mass.
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Types of Pain
Neuropathic Pain
Caused by disturbance of function or pathological changes
in a nerve.
May arise from a lesion or trauma, infection, compression
or tumour invasion.
Described as burning, shooting, tingling.
Does not respond well to standard analgesics.
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Neuropathic Pain
Abnormal Sensations
Hyperaesthesia - an increased sensitivity to stimulation.
Hyperalgesia increased response to a stimulus that is
normally painful.
Allodynia pain caused by a stimuli that is not normally
painful

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Neuralgia
Pain in the distribution of the nerve,
lancing, shooting, jumping, electricity.
Parasthesia
An abnormal sensation, tingling, pins and
needles.
Tight Feeling
Vice like tightness, gripping, cramping.
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Major Categories of Pain

Classified by inferred pathophysiology:

1. Nociceptive pain (stimuli from somatic and visceral

structures)
2. Neuropathic pain (stimuli abnormally processed by the
nervous system)
1. CRPS 1 AND 2
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Effects of pain
Sympathetic responses
Pallor
Increased blood pressure
Increased pulse
Increased respiration
Skeletal muscle tension
Diaphoresis
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FACTORS INFLUENCING PAIN

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PHYSIOLOGICAL
SOCIAL
SPIRITUAL
PSYCHOLOGICAL
CULTURAL

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