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Pain and Pain Managment

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madison brittner

on 21 November 2013

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Transcript of Pain and Pain Managment

Pain and Pain Management
By: Madison Brittner

Types of pain related to injury
Analgesia: Absence of pain in response to stimulation which would normally be painful.
Anesthesia dolorosa: Pain in an area or region which is anesthetic.
Causalgia: A syndrome of sustained burning pain, allodynia, and hyperpathia after a traumatic nerve lesion, often combined with vasomotor and sudomotor dysfunction and later trophic changes.
Dysesthesia: An unpleasant abnormal sensation, whether spontaneous or evoked.
Hypoalgesia: Diminished pain in response to a normally painful stimulus.
Neuralgia: Pain in the distribution of a nerve or nerves
Neuropathic pain: Pain caused by a lesion or disease of the somatosensory nervous system.

Factors Affecting Individual Pain Tolerance
· Competing sensory input. People who suffer from arthritis or another chronic, painful disorder often report that they hurt less when watching an engrossing movie or TV program or when having a stimulating conversation. It's no coincidence that you hurt more when lying quietly in a still, dimly lit room than when you are in a bright, cheerful, and engaging environment. In the dark, quiet room, the pain messages have little competition, so the brain concentrates on them and the discomfort seems more intense. But when there is other sensory input, fewer pain messages get through to the brain, and the person hurts less, even though the underlying condition may be unchanged.
· Age. In general, tolerance for pain decreases with advancing age. Not only do older people suffer more from arthritis and other painful conditions, but they also have less competing sensory input as hearing fades, vision dims, and other senses dull.

Pain is an unpleasant feeling often caused by intense or damaging stimuli, such as stubbing a toe, burning a finger, putting alcohol on a cut

Pain Management:
Pain management (also called pain medicine) is a branch of medicine employing an interdisciplinary approach for easing the suffering and improving the quality of life of those living with pain.

According to the International Association for the study of pain, "Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage."
IASP Definition
Difference Between Pain Threshold and Tolerance
A pain threshold is defined as the point at which a person exposed to a pain-provoking substance or circumstance will feel discomfort. Until recently, we assumed that some people had a low pain threshold, while others had a higher one. Recent studies tend to debunk this assumption. In one experiment, for example, participants were asked to hold metal rods that were then heated or chilled, and to indicate when they began to experience pain. Invariably, the rods caused pain when they were heated to 105°F (43°C) or chilled to 22°F (-6°C). In other words, everyone in the experiment had pretty much the same pain threshold.


But the same did not hold for pain tolerance—the point at which the participants could no longer hold on to the rod. What's more, the ability to tolerate pain varied greatly according to the circumstances. In this regard, the power of suggestion proved powerful indeed. When participants were warned that the rods would be heated or frozen to the point where the metal could quickly cause serious burns or frozen tissue, within seconds, many started to grimace, cry out in pain, and drop the rods. The researchers had not, in fact, changed the temperatures at all—it was the anticipation of pain that produced the results.
Pain falls into two broad categories: acute and chronic. From time to time, virtually everyone experiences acute pain—for example, the sudden, sharp pain of a cut, burn, sprained ankle, or broken bone; the pounding or throbbing of a headache; the relentless pain of a toothache; the all-over achiness that heralds a bout of flu. These and other types of acute pain are warning signs of something amiss that needs our attention. In this respect, acute pain signals a need to protect the body from further harm and seek new treatment.Cancer pain is the pain related to being diagnosed with cancer and the symptoms along with that.
Acute vs. Chronic Pain vs.Cancer Pain
· Expectations: The anticipation of pain can be self-fulfilling—if you expect that an activity will be intolerably painful, chances are it will be. In contrast, if you are confident that it won't hurt, you are less likely to find the pain intolerable. (See If You Expect It to Hurt, p 16.)
· Past experience: Pain can be a learned experience. So if something hurt very badly in the past, you are likely to experience severe pain again in future encounters with a similar circumstance.
· General health, depression, and fatigue: People who are in poor health, tired, depressed, or otherwise out-of-sorts are also more likely to have a low tolerance for pain.
We have to realize, first of all, that pain is not the same as suffering. Left to itself, the body discharges pain spontaneously, letting go of it the moment that the underlying cause is healed. Suffering is pain that we hold on to. It comes from the mind's mysterious instinct to believe that pain is good, or that it cannot be escaped, or that the person deserves it. If none of these were present, suffering would not exist. It takes force of mind to create suffering, a blend of belief and perception that the one thinks one has no control over. But as inescapable as suffering may appear to be, what brings escape is not attacking the suffering itself but getting at the unreality that makes us cling to pain

Difference between Pain and Suffering
Possible Harmful Effects of Unrelieved Pain
Somatic Pain:
Neurology Pain arising in nerve endings of muscles, skin, bones; it is highly localizable.Pain emanating from muscles, skeleton, skin; pain in the parts of the body other than the viscera.
Origin of Stimuli Neuropathic vs. Nociceptive
Visceral Pain:
Visceral pain is the pain we feel when our internal organs are damaged or injured and it is, by far, the most common form of pain.Visceral pain shows peculiarities that make it very different from pain affecting the somatic organs (the skin, muscles, joints and bones). For instance, not all internal organs are sensitive to pain and some can be damaged quite extensively without the person feeling a thing.
Centrally Generated Pain:
"initiated or caused by a primary lesion or dysfunction in the central nervous system" and the equivalent in the peripheral nervous system is called. Central sensitization with N-methyl-D-aspartate receptors result in neuronal “wind-up”Progressive increase in the discharge of dorsal horn neurons (hyperexcitability) from prolonged noxious stimuli.Innocuous stimuli produce pain.
Expectation of Duration:
Nociceptive pain is usually time limited, meaning when the tissue damage heals, the pain typically resolves. (Arthritis is a notable exception in that it is not time limited.) Another characteristic of nociceptive pain is that it tends to respond well to treatment with opioids.Neuropathic pain is frequently chronic, and tends to have a less robust response to treatment with opioids, but may respond well to other drugs such as anti-seizure and antidepressant medications. Usually, neuropathic problems are not fully reversible, but partial improvement is often possible with proper treatment.
Peripherally Generated Pain:
After a peripheral nerve lesion, aberrant regeneration may occur. Neurons become unusually sensitive and develop spontaneous pathological activity, abnormal excitability, and heightened sensitivity to chemical, thermal and mechanical stimuli. This phenomenon is called "peripheral sensitization".
Neuropathic Pain:
Neuropathic pain is pain caused by damage or disease that affects the somatosensory system.It may be associated with abnormal sensations called dysesthesia, and pain produced by normally non-painful stimuli (allodynia). Neuropathic pain may have continuous and/or episodic (paroxysmal) components
Nociceptive Pain:
Nociceptive pain is usually time limited, meaning when the tissue damage heals, the pain typically resolves. Examples include sprains, bone fractures, burns, bumps, bruises, inflammation (from an infection or arthritic disorder), obstructions, and myofascial pain
anatomy and physiology of somatic and viseral senations of pain
Somatic and Visceral Sensations of Pain
Visceral pain should be suspected when vague midline sensations of malaise are reported by a patient. True visceral pain is characterized as a vague, diffuse, and poorly defined sensation.Regardless of specific organ of origin, the pain is usually perceived in the midline spanning anywhere from the lower abdomen up to the chest. In the early phases the pain is perceived in the same general area and it has a temporal evolution, making the onset sensation insidious and difficult to identify.
Sensory neurons of the dorsal root ganglia allow us to detect stimuli to the body surface that lead directly to the sensations such as touch and pain. In my group we are interested in the genes that allow these neurons to transduce different types of stimuli. Sensory neurons can, for example, detect changes in temperature of the skin in non-noxious (not painful) as well as the noxious range (painful heat or cold). They can also detect gentle movement of the skin as well as intense mechanical stimulation of the skin that is normally harmful.

Referred pain, also called reflective pain, is pain perceived at a location other than the site of the painful stimulus. An example is the case of ischemia brought on by a myocardial infarction (heart attack), where pain is often felt in the neck, shoulders, and back rather than in the chest, the site of the injury. The International Association for the Study of Pain, as of 2001, has not officially defined the term. Radiation is different from referred pain. The pain related to a myocardial infarction could either be referred pain or pain radiating from the chest. Classically the pain associated with a myocardial infarction is located in the mid or left side of the chest where the heart is actually located. The pain can radiate to the left side of the jaw and into the left arm. Referred pain is when the pain is located away from or adjacent to the organ involved. Referred pain would be when a person has pain only in their jaw or left arm, but not in the chest.
Referred Pain:
Pain that Signals Immediate Medical Attention
Chest Pain:
Chest pain comes in many varieties, ranging from a sharp stab to a dull ache. Some types of chest pain can be described as crushing or burning. In certain cases, the pain travels up the neck, pierces through to the back or radiates down one or both arms. Many different types of problems can cause chest pain. The most life-threatening ones involve the heart or lungs. Because it can be difficult to determine what exactly is causing chest pain, it's best to seek immediate medical help.

Sudden Severe Headache:
Although migraines and headaches are rarely the symptoms of a serious illness, occasionally they may indicate a serious medical condition such as a tumor or aneurysm (blood vessel rupture). It is important for you to become familiar with your personal headache symptoms, and those that require immediate medical attention.
Severe Abdominal Pain:
Abdominal pain, or stomachache, affects many children. There are many possible causes of abdominal pain. It can be a sign of infection, constipation, or a serious medical condition. The pain may also be unrelated to a medical problem, and simply be your child’s way of expressing feelings of stress or anxiety (which does not mean that it doesn’t truly hurt!). Abdominal pain results in many doctor and ER visits, as well as many missed days of school.
Pelvic Pain in Women:
Acute pelvic pain is much more common in women than in men. Most women experience mild pelvic pain at some time due to periods, ovulation or sexual intercourse. In its severest form, it is the most common reason for urgent arthroscopic examination in the UK. Chronic pelvic pain is much more common in women than in men. It may occur in as many as 1 in 6 adult women.
Joint Swelling or Pain following Injury:
Joint swelling should be checked out by a doctor if:
it occurred after an injury
your joints are swollen and you are not sure what could be causing the problem
your body temperature is elevated
Sudden Severe Back Pain:
Back pain after a severe blow or fall
Burning with urination or blood in your urine
History of cancer
Loss of control over urine or stool (incontinence)
Pain traveling down your legs below the knee
Pain that is worse when you lie down or that wakes you up at night
Redness or swelling on the back or spine
Severe pain that does not allow you to get comfortable
Unexplained fever with back pain
Weakness or numbness in your buttocks, thigh, leg, or pelvis

Action Of Endorphins
Endorphins ("endogenous morphine") are endogenous opioid peptides that function as neurotransmitters.[1] They are produced by the pituitary gland and the hypothalamus in vertebrates during exercise,[2] excitement, pain, spicy food consumption, love, and orgasm,[3][4] and they resemble the opiates in their abilities to produce analgesia and a feeling of well-being.
Possible Harmful Effects of Unrelieved Pain on the Function of the Body's Systems
Social, Physical and Emotional Growth on development of Children:
Unrelieved pain can lead to social neglect and stunts in physical growth. The emotions of the child would be effected heavily and could cause them to be very sad. If you hurt a growth plate as a child it could stunt your growth and you will be a midget
Behavior and Relationships:
The behavior of the child due to unrelieved pain could cause anger and aggression towards others because of the constant burden being placed on them. The relationships would be effected heavily because of the negative atmosphere it creates. If someone breaks their leg and can no longer walk they will have less friends
Quality of Life:
the quality of a persons life due to a chronic illness would be brought down a significant amount due to the fact that they would be used to living a care free life before the illness but now may feel to be a burden to people around them and a burden to themselves. They may become suicidal because of this and may feel that they are no longer needed.
Work and Daily Activities:
the work and daily living would be effected greatly because they could lose their job and would not be able to earn a living anymore which would effect the activities that they do day to day. If you hurt your back you could possibly lose your job and not be able to work
How Pain Feels:
Pins and needles,tingling, knives stabbing you, ache, burn, cramp,soreness,misery, stress,discomfort, cramp, fever
Words to Describe Pain:
How Pain Acts:
Violently, sad,suddenly,torture, intense, soreness, stiffness, affliction,
Emotional and Physical Responses:
Crying, sweating, bruising, redness, heat, tenderness, ange
Non-Verbal Behaviors That Indicate the Presence of Pain
-Vocalizations such as grunting, moaning, crying and screaming
-Facial Expressions such as clenching the jaw, frowning, grimacing and mouthing without noise
-Bracing such as tightening muscles, holding an area of the body and squeezing something in the individuals hands
-Restlessness after awaking from sleep
-Protecting the area
-Self soothing movements such as slow breathing patterns
Strategies For The Effective Control And Relief Of Pain
Use Of Heat:
Decrease sensitivity to pain and can relieve muscle spasms, joint stiffness, low back pain and muscle aches. Heat helps blood flow, muscles relax and soothes throbbing pain and stiffness
Use of Cold:
Decreases sensitivity to pain and can relieve muscle spasms, joint stiffness, low back pain, help muscles relax and numb the painful area
Use of Vibration and Superficial Massage:
These methods are used as successful pain relief without the use of drugs. The massage/vibrations help circulate blood to help pain perceived by the brain
Humor as a Pain Management Strategy:
Humor can be used to ease pain because it takes the mind off the pain. Humor therapy is generally used to improve quality of life, provide pain relief, encourage relaxation, and reduce stress. Researchers have described different types of humor. Passive humor results from seeing prepared material, such as watching a funny movie or stand-up comedy or reading an amusing book. Spontaneous or unplanned humor involves finding humor in everyday situations. Being able to find humor in life can be helpful when dealing with cancer.
Role of Sleep in Pain Management:

When you sleep you allow your body to rejuvenate its cells. A study found that those with arthritis and depression or anxiety were at the highest risk for disturbed sleep. As might be expected, joint pain and limitations due to pain mediated the relationship between arthritis and sleep.1 Conversely, sleep disruption can reduce pain threshold and contribute to other symptoms like fatigue, cognitive fogginess, and irritability, as well as diminished functioning and overall decreased quality of life.2
Difference Between Primary and Secondary Headaches
The three types of primary headache are:

Sinus headache. By definition, this type of headache should resolve when the course of antibiotics is completed.
Medication overuse headache. By definition, this type of headache should resolve when the medication being overused is discontinued,
Headaches from illness such as meningitis.
Post-traumatic headache from the trauma event such as a snow-boarding accident.
Spinal headache. This type of headache is common after an epidural is given such as during labor.
Brain tumor or aneurysm headache.
Cervicogenic headache. This type of headache is related to the underlying neck condition such as degenerative disc disease of the cervical vertebrae.
Common Causes Of:
Neck Pain
:Bending over a desk for hours
Poor posture while watching TV or reading
Having your computer monitor positioned too high or too low
Sleeping in an uncomfortable position
Twisting and turning the neck in a jarring manner while exercising
Low Back Pain:
the most common cause of low back pain is muscle or ligament strains. If back pain comes on suddenly, it's usually a sign of a muscle tear, sprained ligament, or disc problem. A slipped disc occurs when pressure on a disc causes it to bulge or rupture, pushing cartilage sideways. The cartilage presses on the spinal cord nerves, causing intense pain.
Other Back Pain:
bending awkwardly or for long periods
lifting, carrying, pushing or pulling incorrectly
slouching in chairs
driving in a hunched position or driving for long periods without taking a break
overuse of the muscles, usually due to sport or repetitive movements (repetitive strain injury)
Three Common Types Of Headaches
Tension Headaches:
A tension headache is generally a diffuse, mild to moderate pain in your head that's often described as feeling like a tight band around your head. A tension headache (tension-type headache) is the most common type of headache, and yet its causes aren't well understood.
Treatments for tension headaches are available. Managing a tension headache is often a balance between fostering healthy habits, finding effective nondrug treatments and using medications appropriately.
A migraine headache can cause intense throbbing or a pulsing sensation in one area of the head and is commonly accompanied by nausea, vomiting, and extreme sensitivity to light and sound.
Migraine attacks can cause significant pain for hours to days and be so severe that all you can think about is finding a dark, quiet place to lie down.
Cluster Headaches:
Cluster headaches occur in cyclical patterns or clusters, which gives the condition its name. Cluster headache is one of the most painful types of headache.
Cluster headache commonly awakens you in the middle of the night with intense pain in or around one eye on one side of your head.
Sinus Headaches:
Sinus headaches are headaches that may accompany sinusitis, a condition in which the membranes lining your sinuses become swollen and inflamed. You may feel pressure around your eyes, cheeks and forehead. Perhaps your head throbs.
Many people who assume they have sinus headaches, including many who have received a diagnosis of sinus headaches, actually have migraines or tension headaches
begins with free nerve endings of C fibres and delta-A fibres that respond to physically harmful stimuli
Stimuli comes from the site of injury along the nociceptor fibers to the dorsal horn in the spinal cord, then up to the brain
the point in which the pain is interpreted and becomes a conscious experience. the pain triggers the activation responses
involves changing or inhibiting the transmission of pain impulses in the spinal cord. the descending modulatory pain pathways can decrease the amount of pain impulses the person is receiving
Eye Injury or acute changes in vision
:In most cases, if a person has continuing symptoms of pain, visual disturbance, abnormal appearance of the eye or bleeding, they should go to an emergency medicine physician at an emergency department or see an ophthalmologist.Chemical exposures: If the substance was known to be caustic, immediate medical evaluation by either an ophthalmologist or in the emergency department is needed, regardless of symptoms. Acids and alkalis are the worst and require immediate attention. Lacerations: Cuts that affect the eyelid margins (where the eyelashes are) or the eyeball itself need immediate medical attention.
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