PH255 Week 11 The Nature and Symptoms of Pain

The Nature and Symptoms of Pain

Week 11

PH 255- Health and Human Behavior

What Is Pain?

• Pain = the sensory and emotional experience of discomfort, which is usually associated with actual or threatened tissue damage or irritation.
• Almost all people experience pain.
• However, those born with a condition called congenital analgesia do not feel pain.

What Is Pain?

• Pain is the most common medical complaint.
• It accounts for more than 80% of all visits to the doctor.
• Severe and prolonged pain can come to dominate the lives of those who experience it.

What Is Pain?

• Pain can impair:
• General functioning
• The ability to work
• Social relationships
• Emotional well being

What Is Pain?

• Pain also has great social and economic effects on all societies:
• In the United States, about one-third of people suffer from one or more continuous or recurrent painful conditions that require medical care.

Types

Of

Pain

Types of Pain

• 1) Organic Pain:
• Pain that is associated with tissue damage/injury (ex. burn or inflammation).
• It is observable, measurable and can be validated through medical testing.

Types of Pain

• 2) Psychogenic Pain:
• Pain that results from psychological causes.
• Sometimes referred to as non-organic or functional pain.
• Not believed to be “real” pain, but the person still experiences the feeling of pain.
• Headaches
• Stomach pain
• Back pain

Types of Pain

• Psychogenic pain is usually reported after emotional turmoil such as a divorce, trauma, rejection, etc.

 

• It can also be the result of stress.

Types of Pain

• 3) Acute Pain:
• The discomfort people experience with temporary painful conditions that last less than 6 months.
• Higher than normal levels of anxiety usually accompany acute pain.
• Distress subsides as the condition improves and pain decreases.

Types of Pain

• 4) Chronic Pain:
• Pain that lasts longer than six months.
• Causes high levels of anxiety.
• Sufferers experience feelings of hopelessness and helplessness because various medical treatments have not helped.
• It interferes with daily activities.

Describing

Pain

Describing Pain

• How a person describes pain typically indicates the kind of irritation or damage that has occurred.
• It may also indicate the location of pain:
• Sharp/stabbing/prickling feeling- may indicate damage by a brief event to the skin.
• Dull/aching/throbbing- may indicate damage that occurs deep within the body.

Describing Pain

• Other terms often used to describe pain include:
• Burning
• Cramping
• Itching
• Constant
• Shooting
• Pressure

Classifying

Pain

Classifying Pain

• Pain is classified according to its cause.
• There are two major categories of pain:
• Nociceptive pain
• Non-nociceptive pain
• There is also a third category of pain called referred pain.

Classifying Pain

• Nociceptive pain:
• Occurs when a nociceptor is stimulated.
• A nociceptor is a sensory neuron that responds to damaging or potentially damaging stimuli.
• It works by sending a “possible threat” signal to the spinal cord and the brain.

Classifying Pain

• If the brain perceives the threat as credible, it creates the sensation of pain.
• Pain is intended to call attention to that body part, so the threat can be mitigated.

Classifying Pain

Classifying Pain

• Nociceptors (pain sensors) are located throughout the body, including the skin, joints, muscles, tendons and bones.
• They detect:
• Temperature
• Vibration
• Stretch
• Chemicals released from damaged cells

Classifying Pain

• There are two types of nociceptive pain:

Somatic Pain that is felt on the skin, muscles, joints, bones and ligaments. Pain receptors will detect inflammation and sprain. They will send out a signal that is interpreted as a sharp pain (if you touch or move the area, the pain gets worse). Pain is well localized. Ex. fracture

Visceral Pain that comes from the main body cavity and internal organs. Thorax- lungs and heart Abdomen- spleen, liver, spleen, kidneys, pancreas Pelvis- ovaries, bladder, womb More difficult to localize pain. Usually described as a vague deep ache. Ex. pancreatitis

 

 

 

 

 

Classifying Pain

• Non-nociceptive pain:
• Defined as pain that comes from the nervous system.
• When a nerve is injured, it becomes unstable.
• It starts to fire off random, chaotic signals to the brain, that the brain interprets as pain.
• However, the signal may also be interpreted as numbness, a “pins and needles” feeling and/or tingling.

Classifying Pain

• There are two types of non-nociceptive pain:

Neuropathic Pain that is experienced as a “pinched” or “trapped” nerve. Can be caused by nerve degeneration (ex. Slipped disc). Will cause nerve inflammation which will trigger neuropathic pain.

Sympathetic Pain that occurs as a result of a fracture or soft tissue injury of the limbs. The skin and the area around the injury becomes extremely sensitive. Pain often becomes so intense that the person cannot use the affected limb.

 

 

 

 

 

Classifying Pain

• Referred pain:
• Defined as pain that is caused by damage to internal organs but is perceived as coming from another part of the body.
• Ex. :
• Damage to the heart will cause pain in the shoulders, back, or neck
• “Brain freeze” is pain felt in the head. However, the actual source of pain is the mouth and throat.

Pain Without Damage

to the Body

Pain Without Damage to the Body

• Some people experience pain without reason (there are no signs of damage).
• They are classified as syndromes.

Pain Without Damage to the Body

• Causalgia:
• Recurring episodes of severe burning pain triggered by minor stimuli such as a puff of air.
• The pain feels like it starts in a place where the person had a previous injury.
• The pain is not related to the original injury.
• These episodes also occur suddenly and unpredictably.

Pain Without Damage to the Body

• Phantom Limb Syndrome
• Usually occurs to amputees.
• Pain that is felt in a limb that is no longer there or where there are no functioning nerves.
• Can last for months or years.
• People report the pain as shooting, burning or cramping.

 

Learning and Pain

Learning and Pain

• We learn to associate pain with certain cues.
• For example, people who suffer from migraine headaches can tell when headaches are coming because they feel certain symptoms such as:
• Dizziness
• Pain on one side of the head
• Aura—seeing spots, wavy lines, or flashing lights
• These symptoms cause distress in anticipation of the pain that is to come.

Learning and Pain

• Learning also influences the way people behave when they are in pain.
• We develop pain behaviors such as:
• Moaning
• Limping
• Clutching of the head head
• Bending over

Learning and Pain

• Pain behaviors are part of the sick role.
• People in pain may exaggerate these behaviors because they think “No one believes me.”
• If pain is chronic, these behaviors become habitual and a part of the person’s lifestyle.

Social Factors, Gender

and Pain

Social Factors and Pain

• People who suffer pain generally receive attention, care and affection.
• This provides social reinforcement for pain behaviors.
• Results?
• People who receive social rewards when they exhibit pain behaviors may exhibit more of them.

Gender and Pain

• Men and women differ in the types of pain they experience.
• They also differ in their reactions to pain.
• Ex.
• Women have higher incidence rates of pain associated with arthritis, migraines, and causalgia.
• They report that pain interferes with daily activities more often than men.
• Men have greater incidence of back and cardiac pain.

Emotions and Coping with Pain

Emotions and Coping With Pain

• People in pain experience high levels of anger, fear and sadness.
• Strong emotions affect pain.
• Ex. People who have high levels of stress report more migraine headaches and tension headaches.
• People may feel that they have little control over the pain.

Emotions and Coping With Pain

• So how do people in pain cope?
• Emotion-focused strategies:
• Hoping
• Praying
• Distracting themselves
• Talking to others
• However, these are not very effective in reducing chronic pain.

Emotions and Coping With Pain

• Can people learn to cope effectively with pain?
• Yes.
• Pain acceptance- being able to engage in activities despite pain and not seeking to control or avoid it.
• Paying less attention to pain
• Using less pain medication

Assessing Pain

Assessing Pain

• Pain Rating Scales:
• People rate their pain on a scale.
• In a visual analog scale, people place a mark along a line with labels at the end.

No pain ——————————-Worst pain possible

 

• In a box scale people choose a number that represents their level of pain.

0 1 2 3 4 5 6 7 8 9 10

Assessing Pain

• Interviews:
• Conducted with patients and their families.
• Patients are asked to describe their discomfort:
• Where is the pain?
• What does it feel like?
• How strong is it?
• When does it happen?
• When did it start?
• How do you cope?

Assessing Pain

• Pain diaries:
• Detailed record of a person’s pain experiences.
• Pain questionnaires:
• Selecting words that corresponds with level of pain experienced.