An Introduction to Pain

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by Steven M. Benecke, MD

Pain is a major reason why people
seek healthcare. This may be the pain of a broken bone, the pain of a heart
attack, the joy-filled pain of labor, or even the pain of appendicitis. Pain
from events such as these and numerous others force people into the health care
system asking for assistance according to Disaboom, the leading online
community for people with disabilities. Back pain is the number two reason to
miss work in the US, second only to a “cold.”

The International Association for
the Study of Pain has defined “pain” as “an unpleasant sensory and emotional experience associated
with actual or potential tissue damage.”  This definition reflects that
pain is a result of tissue damage as when the skin is lacerated or a bone is
broken. The definition also indicates that pain may be the result of an
unpleasant emotional experience in the absence of tissue damage. We all know
this to be true as we find ourselves tolerating injury differently depending on
our emotional well- being. If we are feeling well, the pain of a sprained ankle
is far more tolerable, less painful, than a sprained ankle occurring at the
funeral of one’s parent.

The key concept to understand when
discussing or considering the topic of pain is imprecision. There is no
objective way anyone can assess the magnitude of someone else’s suffering.
Different cultures, different genders tolerate and accept pain differently and
will manifest pain differently. There is no device that allows a third party to
assess the magnitude of pain of an individual. This is readily apparent to
parents who try to guess whether their infant is crying because of pain,
hunger, or a wet diaper. The manifestation of all three is the same. Some
manifest pain as facial grimacing, descriptive words; while others withdraw,
say nothing, or isolate themselves. No one can say the pain of one is greater
than the suffering of the other.

Pain as a term—as a concept—is imprecise
and methods of assessing pain are imprecise as well. Presently, health care
workers gauge pain by a verbal pain score, ranging from zero (no pain) to 10
(worst possible pain imaginable). However, this numeric scale is not exact
enough to enable relating a similar type of pain in different individuals. Pain
as a term and the tools to assess its magnitude are imprecise.

Pain may be acute or chronic. Acute pain
is that which occurs and lasts less than three months. Examples include the
pain of a broken bone, the pain of a heart attack, or the pain of a disc
herniation. Chronic
Pain is pain which lasts more than three months. Examples
include disc herniation, angina associated with heart disease, and neuropathy
of the feet as a result of long-standing diabetes. The definition is arbitrary
and based upon time and has no relationship to tissue damage or ongoing injury.
Also, acute pain versus chronic pain implies nothing with respect to intensity
of suffering.

Pain is also broken down based upon types of nerve
receptors being stimulated. Consequently, we refer to somatic pain
and neuropathic
pain. Thinking simplistically, somatic pain is pain of
musculoskeletal origin. This is the chronic or acute pain of a pulled muscle
that we describe as achy, sharp, or stabbing. It may radiate in a predictable
fashion. Very often, in the acute phase it is associated with swelling,
redness, warmth at the site of injury, and it hurts to use the affected body
part. Contrast this with neuropathic pain that is described as burning, tingling,
or an electric shock. Neuropathic pain can occur in many different conditions
and the signs and symptoms will also vary. For example, individuals with a
spinal cord injury, stroke, multiple sclerosis, or brain injury may have a
completely normal appearing arm or leg, but they may describe a constant
ongoing burning.

Managing one’s pain is a key step to living a
fulfilled life.  Learn more about the
types of pain, treatment and treatment concerns by visiting the health section
at Disaboom, scroll
through the conditions, and click on pain.