Home About Me disabled former page Arthur Articles

The Pain Process, Page 2/3

The following represents Arthur's opinions only and not necessarily those of Christie.

Computer Help
Pain Page 1/3
Pain Page 2/3
Pain Page 3/3
Theory of Personality

The degree of pain sensed is proportional to the number and strength of the signals sent, which in turn is an indicator of the intensity of the originating noxious stimulus.  The specific detection mechanisms upon which certain proteins consider any type of stimuli to be “noxious,” remain a mystery to science (Caterina & Julius, 2001).   While this process of pain sensation is well researched and widely held as true, it is not to be equivocated as the exclusive mechanism upon which pain is felt.   In the issue of chronic, psychogenic, and phantom pain, no specific nociceptive mechanism may be present, since the localized region may be completely free from tissue damage.  Yet even so, the patient may still report intense pain from the region, leading some to theorize that ultimately the brain itself may be responsible for the generation of pain (Bloom, Nelson, & Lazerson, 2001).   The true answer is most likely to be somewhere in between, namely that some pain has a physical, electrical origin via nociceptors that traverse a specified pain pathway throughout the central nervous system, and other types of pain may have both origin and destination completely within the brain itself. 

Nociceptive Pain

This is the protective type of pain that most people are accustomed.  The level of pain usually correlates well to the level of noxious stimuli.  Nociceptive pain is the normative expectant result from tissue damage or harm, such as sprains, inflammation, sickness, and injury.   The key factor to defining nociceptive pain is that it dissipates upon the restoration of the affected area.  Namely, when healing occurs, the pain goes away. 

Neuropathic Pain

Neuropathic pain is a sensation of pain that originates from within the nervous system, rather than an external source.  It can be either chronic or acute, and frequently does not respond well to opioids (Wentz, 2003).  It is the most difficult type of pain to treat, as it is not fully understood.  This type of pain is generally described as a tingling, stinging, or burning sensation and can have all degrees of severity.  In general, it is thought that neuropathic pain serves no defensive purpose, often following a trauma, infection, or illness.  The pain may persist in various forms throughout life, never fully going away.  Peripheral neuropathic pain begins in the extremities and often migrates up the limbs.  Because the unique mechanism in each patient diagnosed with neuropathic pain is difficult to identify, dealing with it often is a process of trial and error. 

Increased pain from stimuli that ordinarily produces lower levels of pain, known as hyperalgesia is considered a symptom of neuropathic pain.  A similar condition, allodynia, is undergoing a severe pain response from nonpainful stimuli.  Phantom pain normally referred to as the discomfort of one who has undergone an amputation with the feeling of pain in the missing limb, is another type of neuropathic pain.   Some types of cancer pain, peripheral neuropathy and causalgia, among others, all contribute to the spectrum of neuropathic pain.  While the precise mechanisms of these kinds of pain are uncertain, they are clinically recognized as real pain with a medical basis, rather than psychosomatic or imagined.

Idiopathic Pain

            Idiopathic pain is generally referred to as real pain with a foundational basis in psychogenic factors.  The underlying cause may be completely unknown, but is usually assumed to have a basis in the functioning of the brain itself.   In some patients, there is no evidence of an associated organic cause, whereas in others, pain and associated symptoms are out of proportion to identifiable organic pathology (Lehmann, 1998). This type of pain may both originate and terminate strictly within the brain, though its true cause is still in dispute.  Examples include myofacial pain syndrome and somatoform disorder. 

Chronic and Acute Pain

Chronic pain is defined as prolonged pain lasting at least six months.  It can be neuropathic, idiopathic, or nociceptive, or a combination of all three.  It is a “multidimensional experience with sensory, affective, cognitive evaluative components, each of which interacts and contributes to the final pain response” (Galises & Melzack, 1997).   Chronic pain is currently becoming recognized as a primary issue unto itself, rather than a symptom of an underlying problem.  Chronic pain sufferers are more dependent upon processes of pain management, rather than constantly seeking for a ‘cure’.  Learning to manage the pain over the course of the lifespan represents the greatest chance one with chronic pain has to enjoy a fulfilling life, as complete healing may never come.

Where chronic pain is often difficult to fully understand, and can have unknown or various causes, acute pain is usually nociceptive and correlates to identifiable noxious stimuli.  This type of pain is considered temporary and treatable and results from physical damage to the body.  Unlike chronic pain, treatment for acute pain deals with the direct underlying cause.  In some cases, acute pain can lead to chronic pain.  Ekman and Koman (2004) warn that inadequate treatment of acute pain can eventually result in chronic pain due to the desensitization of the peripheral and central nervous system.

Psychology and the Pain Pathway

The psychology of the patient plays a crucial role in the individual experience of pain.  The intensity, duration, and degree of disruption of pain bind fundamentally to the emotional and psychological state of the individual experiencing it.   In addition, these beliefs also influence the process of pain management.   In recent studies with cancer patients (Dawson, et. al., 2005), individuals were asked, over a period of time, to rate their pain experiences using subjective scales of one to ten to correlate with the intensity of suffering.   Later, these patients were asked evaluative questions pertaining to their personal beliefs about pain and treatments for pain.  Conclusions indicated a relationship with the effectiveness of the pain management process to the beliefs and concerns of the patients governing pain.    For example, those who lacked high school education were more likely to interpret pain as having direct correlation to the severity of the physical condition; hence, to experience a bout of sudden severe pain could cause a lot of fear since that meant the physical condition was drastically worsening.  This fear, in turn, can exacerbate the original pain, making it more intense, hence causing the patient to rate the overall experience higher on the one to ten scale than it would have been otherwise.