Pain (Chronic) Management

What is Pain?

Firstly the word “pain” describes that condition of disorder that brings about discomfort or uncomfortable sensations within the body. It flows from the activation of the nervous system usually in response to an external forces. It has a range of intensity. Generally individuals will recognise this pain on a spectrum that runs from irritating or annoying through to debilitating. There are a range of explanations for its effects but none of them will cover every type of pains manifestation. This is partly because of the variance of its intensity but also partly due to the individual organisms response to the stimulus that provokes it. This article will deal predominantly with human perception of pain however, there is no little doubt that every living creature has access to some recognition of the concept.

Pain is usually described medically as either acute or chronic. Acute describes pain that usually has a rapid onset and is constant or near constant in intensity and presence. Generally pain that has effects lasting for longer than three months is described as Chronic.

Pain is therefore, best described as unpleasant sensory feedback which is variable by its very nature and always subjective in assessment because it has both an affective and a sensory component.

Although the anatomic basis of pain reception develops before birth, individual pain responses are learned in childhood and are thus learned to some extent in social, cultural, psychological, and genetic factors, among others. Those variable factors, to some extent account for differences in pain tolerance among individuals.

Perhaps the central function of pain is to alert the person to potential tissue damage. That is accomplished through feedback, the neural processing of harmful stimuli. A hand placed near a hot candle will alert the brain to the presence of potentially damaging heat by “turning up the response to the stimulus” even though no damage has been caused yet, it will feel as though the burn has already occurred.

The pain sensation, may include an increase in blood pressure, an increase in heart rate, and a reflexive withdrawal from the stimulus.

During acute pain, an immediate intense feeling of short duration, sometimes described as a sharp pricking sensation, is followed by a dull throbbing sensation. Chronic pain, which is often associated with diseases such as cancer or arthritis, is more difficult to locate and treat. Its no surprise that chronic conditions are often those where medication errors and medication negligence occur.

Theories Of Pain

Medical attempts at describing the physiological basis of pain is a recent development. By the late 1800s the development of diagnostic testing and the identification of specific signs of pain were beginning to define neurology, leaving little room for chronic pains that could not be explained in the absence of other physiological symptoms. At the same time, practitioners of psychiatry and the emerging field of psychoanalysis found that “hysterical” pains offered potential insights into mental and emotional disease.

The contributions of individuals such as English physiologist Sir Charles Scott Sherrington supported the concept of specificity, according to which “real” pain was a direct one-to-one response to a specific noxious stimulus. Sherrington introduced the term nociception to describe the pain response to such stimuli. Specificity theory suggested that individuals who reported pain in the absence of an evident cause were delusional, neurotically obsessed, or malingering. Much of that prejudice continued to haunt modern medicine well into the initial years of the 21st century and is likely to persist for some time. Another theory, which was popular with early psychologists was “intensive pain theory”, in which pain was considered to be an emotional state, incited by unusually intense stimuli. It is worth noting that this theory was abandoned by medicine the 1970’s.

French surgeon René Leriche, who worked with injured soldiers during World War I, suggested that a nerve injury that damages the myelin sheath surrounding the sympathetic nerves (the nerves involved in the fight-or-flight response) might lead to sensations of pain in response to normal stimuli and internal physiological activity. The various theories on pain, however, were largely ignored until World War II, when organized teams of clinicians began to observe and treat large numbers of individuals with similar injuries.

In the 1950s American anesthesiologist – anesthetist, Henry K. Beecher, using his experiences of treating civilian patients and wartime casualties, found that soldiers with serious wounds frequently seemed to be in much less pain than civilian surgical patients. Beecher concluded that pain is the result of a fusion of physical sensation with a cognitive and emotional “reaction component.” Thus, the mental context of pain is important. Pain for the surgical patient meant a disruption of normal life and fears of serious illness, whereas pain for the wounded soldier meant release from the battlefield and an increased chance of survival. Therefore, the assumptions of specificity theory, which were based on laboratory experiments in which the reaction component was relatively neutral, could not be applied to the understanding of clinical pain.

In the following decades, research on the problem of pain expanded significantly. From that work, two major findings emerged. First, severe pain from an injury or other stimulus, if continued over some period, was found to alter the neurochemistry of the central nervous system, thereby sensitizing it and giving rise to neuronal changes that endure after the initial stimulus is removed.

The second finding that has emerged was that pain perception and response differ with gender and ethnicity and with learning and experience. Women appear to suffer pain more often and with greater emotional stress than do men, but some evidence shows that women may cope with severe pain more effectively than men.

Medication for Chronic Conditions

  • over-the-counter pain relievers, including acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin (Bufferin) or ibuprofen (Advil).
  • opioid pain relievers, including morphine (MS Contin), codeine, and hydrocodone (Tussigon)
  • adjuvant analgesics, such as antidepressants and anticonvulsants
  • NHS Pain Management Centers

What are the Common Causes of Chronic Conditions?

Typically chronic pain is present in the human organism as a response to the following stimuli:

The main and certainly the typical goal of most pain treatment is to reduce the effects of the pain and then return a degree of essential mobility. This helps the individual return to daily activities without discomfort or at least to live independently. The severity and frequency of chronic pain can differ among individuals. So doctors create pain management plans that are specific to each person. Your pain management plan will depend on your symptoms and any underlying health conditions. Medical treatments, lifestyle remedies, or a combination of these methods may be used to treat your chronic pain.

Medical procedures for chronic pain

  • electrical stimulation, which reduces pain by sending mild electric shocks into your muscles
  • nerve block, which is an injection that prevents nerves from sending pain signals to your brain
  • acupuncture, which involves lightly pricking your skin with needles to alleviate pain
  • surgery, which corrects injuries that may have healed improperly and that may be contributing to the pain

How is it possible to treat chronic pain without medicaiton

It is important to recognise that there is no cure for chronic pain, but the condition can be managed successfully. It’s important to stick to your pain management plan to help relieve symptoms. Eating well, getting enough sleep, and exercising regularly can keep your body healthy and reduce feelings of stress. You can boost your mood and decrease stress by participating in activities you enjoy and socialising with friends. Chronic pain may make it challenging to perform certain tasks. But isolating yourself can give you a more negative outlook on your condition and increase your sensitivity to pain. Friends, family, and support groups can lend you a helping hand and offer comfort during difficult times. Whether you’re having trouble with daily tasks or you’re simply in need of an emotional boost, a close friend or loved one can provide the support you need.

  • physical therapy
  • tai chi
  • yoga
  • art and music therapy
  • pet therapy
  • psychotherapy
  • massage

Can a Claim in Negligence be Brought for Chronic Pain Treatments?

There is no doubt that sufferers of chronic pain or chronic pain syndrome (CPS) have had their entire life disrupted by their condition. What is not often spoken about is the fact that dealing efficiently with that condition is now a medical specialty. Failures in management are sometimes the result of poor medical practice.

Our Solicitor specialist members understand that the impact of chronic pain is a treatable position and that there are treatment modalities that should be efficiently planned and managed. If you feel that you have not been treated properly and that your pain has been allowed to increase or gone without proper treatment then get in touch and we will have a medical Solicitor contact you about bringing an action

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The Law Med Medical Panel is an unincorporated association its members are clinical negligence accredited specialists.

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Published by Orange Law

A UK based Solicitor Advocate and Clinical - Dental - Surgical Specialist Outsourcing Legal Service.