Pain has many valuable functions: it is a warning signal and it produces all sort of actions to stop it. Memories of earlier pains warn us to avoid potentially dangerous situations. It also forces us to rest, in order to promote the body’s healing processes. All of these have obvious blue for survival.
Chronic pain, pain that lasts more than a month or so, is not a warning signal. There is no survival value in severe unremitting pain that persists after an injury has healed.Most chronic backaches, headaches and muscle pains have no obvious cause, are difficult to treat and diminish the lives of those suffering.
The most recent definition of pain, as defined by the International Association for the Study of Pain (IASP) is:
“An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage,” and is expanded upon by six key notes and the etymology of the word pain.
Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors.
Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory nerves. Nociception is the process by which unpleasant stimuli are transmitted through the nervous system.
Through their life experiences, individuals learn the concept of pain.
A person’s report of an experience as pain should be respected.
Although pain usually serves an adaptive role, it may have adverse effects on function and social and psychological well-being.
Verbal description is only one of several behaviors to express pain; inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain.
So is pain all in the head?
To all intents and purposes, the answer is yes because this is where all the information from the area generating the nerve signals ends up. But why is this important, you may ask? For a start not everyone’s pain is the same. What one person may feel as significant pain, another may regard as discomfort. Social environment, psychological state and even age can affect ones perception pain, as can previous experience of pain.
The theory of pain suggests that it is a unified stream of experience that is generated by the brain and is influenced by all of its cognitive functions such as memories of prior experiences and the meaning of the current situation. The theory includes the concept that there are parallel neural networks at work in the brain associated with sensory, affective and cognitive aspects of the personal, individual pain experience.
The role of stress is significant in pain. In recognising the dominant role of the brain, which coordinates our neurological and hormonal defence systems, we can now appreciate the intimate relationship between pain and stress. For a long time pain was considered a sensory thing, and the fact that injury triggers more than just pain was ignored. We now know that it significantly disrupts the brain’s regulatory systems (homeostasis) and thus produces stress. This initiates a complex set of programs governing our hormonal and immune systems to reinstate balance or homeostasis. To this extent research into the language of pain has produced many useful questionnaires that allow us to comprehend each others subjective experience of pain.
This recognition of the stress-related aspect of pain has lead to the use of psychological therapies as an integral part of pain management strategies. It recognises that pain is the result of multiple contributions and thus has given rise to the use of relaxation, hypnosis and cognitive therapies, as well as physical therapies, bringing substantial pain relief to many.
In the 3rd decade of the 21st century the management of pain by medics and other therapies needs to take into consideration this multifaceted approach. Simply to prescribe rest and pain killers is not enough, literally. The biopsychosocial model of care has developed such that those in the pain management professions need to consider a combined approach and to ignore that is to do the sufferer a significant disservice.
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