Factors That Impact The Management Of Patient Flow In Hospitals What IS Pain? You May Be Surprised – I Know I Was

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What IS Pain? You May Be Surprised – I Know I Was

When I was in science class at school, I was taught that nerves under the skin feel pain, such as touching a hot stove, and send a signal to the brain, which then sends a signal to react, such as pulling the hand away. But it doesn’t happen like that.

“We don’t have pain receptors,” explains pain neuroscientist Lorimer Moseley. Pain does not come from the region that feels it, but from the brain’s assessment of sensory danger, expectations, previous exposure, cultural/social norms/beliefs, and how we feel about it. Pain, according to the definition of the International Association for the Study of Pain, is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage”. Pain is a localized emotion.

Does that mean it’s all in our heads? Non-“danger detectors” distributed throughout the body’s tissues act as the brain’s eyes. So here’s what’s going on.

Nociceptive pain (meaning in response to stimuli) is an early warning. Nerves sense temperature, vibration, stretch, lack of oxygen or chemical changes from damaged cells and send an early warning to the brain, which in turn triggers an inflammatory response, protecting the area and sending neutrophils to fight any infection, dilating narrow blood vessels to increase flow and volume blood (causing swelling and redness).

But there are two problems. First, the inflammatory response also increases sensitivity to pain – yes, that means you feel the pain more intensely than before the injury, an overreaction. And second, mitochondria (organelles responsible for cell digestion and respiration) shed from damaged cells are attacked by neutrophils as invaders – setting up an unnecessary second round of inflammatory response (and you guessed it – greater pain sensitivity). In chronic pain, the true need for pain is distorted, and the pain is self-perpetuating.

The cause of the signal can also be confusing. In somatic pain, the pain is sharp, localized and painful to the touch. But visceral pain is a vague, deep pain that’s hard to localize—like cramping or spasms. Problems in the pelvis, abdomen or chest can manifest as pain in the lower, middle or upper back. Pain can also be referred, such as a heart attack that is felt in the shoulders, back, or neck rather than the chest.

To resolve the pain caused by an acute injury, turn off the danger detectors. This may mean medical treatment of the underlying cause, such as antibiotics for an infection. When the brain feels that it is safe, the pain will stop. Analgesics can be used to block signals and therefore pain – but now we’re back to the problems of long-term use. Codeine, for example, can even increase sensitivity to pain. And all analgesics can cause analgesic rebound, where the body’s production of natural endorphins declines in response to analgesic use, increasing sensitivity to pain again.

Non-nociceptive pain is a whole other world. There is no external stimulus here because the signal comes from the nervous system itself, either between the nerves between the tissues and the spinal cord (peripheral nervous system) or between the spinal cord and the brain (central nervous system). It can be caused by nerve degeneration (as in stroke, multiple sclerosis, or lack of oxygen), a pinched nerve (under pressure or a disc problem), a nerve infection (such as shingles), nerve injury (due to a fracture or soft tissue injury) – all signals misinterpreted as pain.

This sympathetic pain can be intense, preventing use, which in turn causes new problems, such as muscle wasting, osteoporosis, and joint stiffness (the new collagen is stiffer than the replaced collagen). It can even be pathological pain, abnormal, heightened, dysfunctional, dysfunctional pain that includes fibromyalgia, irritable bowel syndrome, and some headaches.

Neuropathic pain is also responsible for phantom pain in the limbs, from mild “pins and needles” to a constant and severe burning sensation, and for extreme pain in the limbs of complex regional pain syndrome after a seemingly minor tissue injury such as an insect bite or a minor cut. But when pain becomes chronic, in conditions such as low back pain, rheumatoid arthritis, fibromyalgia or cancer pain, treatment becomes elusive.

Pain that is not related to an acute injury can be caused by any number of factors: the immune system, the endocrine system, problems with movement, cognition, or the very mechanisms by which the brain represents the body. Sensitivity increases, the dark side of neuroplasticity. Negative emotions increase pain, such as sadness, anxiety, dwelling on pain, or simply dissatisfaction with work. Negative emotions are the result of chronic pain because depression is a common occurrence in people with chronic pain.

Muscle knots, uncomfortable posture, vitamin D deficiency, bisphosphonates (for osteoporosis or Paget’s disease), and statins (to lower high cholesterol) can cause pain. Even an easily recognized ailment, such as back pain, can be the result of poor posture, poor lifting, excess weight (heavy on the knees), curved spine, traumatic injury, high heels, bad mattress, bad shoes, aging/ spinal degeneration, diseases (rheumatoid arthritis, osteoarthritis, fibromyalgia, gall bladder, cancer, multiple sclerosis, stomach ulcer, AIDS), psychological factors after physical healing… it’s complex.

So after your doctor has dealt with the acute injury and offered analgesics if needed, imagine the overwhelming and confusing task if the pain persists. So doctors and their patients try things: massage, TENS units, anticonvulsants, antidepressants, acupuncture, meditation, chiropractic, osteopaths, biofeedback, low impact exercise, stretching, physical therapy, cognitive behavioral therapy – the fact is they are doing their best, but they guess.

“We don’t have enough evidence from studies to know which approach is right for which patient,” admits Dr. Russell Porteny, chief of pain medicine at Beth Israel Hospital and past president of the American Pain Society. “Despite decades of research,” notes WebMD, “chronic pain remains poorly understood and notoriously difficult to control. A study by the American Academy of Pain Medicine found that even comprehensive treatment … helps, on average, only about 58% of people with chronic pain.” Even that means controlling the pain, not treating it.

Pain and the response to pain vary from person to person and in the same person from moment to moment. “Any credible evidence that the body is in danger and protective behavior would be helpful will increase the likelihood and intensity of pain,” explains Dr. Moseley. “Any credible evidence that the body is safe will reduce the likelihood and intensity of pain.

“It’s just as easy and just as hard.”

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