Nursing On Pain

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Chronic pain

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General physicians have only elemental training in chronic pain management and patients suffering from it are referred to specialists.

Chronic pain may have no apparent cause or may be caused by a developing illness or imbalance. This disorder can trigger multiple psychological problems that confound both patient and health care provider, leading to various differential diagnoses and to patient's feelings of helplessness and hopelessness. Sometimes chronic pain can have a psychosomatic or psychogenic cause.[4]

Chronic pain was originally defined as pain that has lasted 6 months or longer. It is now defined as "the disease of pain." Its origin, duration, intensity, and specific symptoms vary. The one consistent fact of chronic pain is that, as a disorder, it cannot be understood in the same terms as acute pain.

The failure to treat acute pain properly may lead to chronic pain in some cases

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Acute pain

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In general, physicians are more comfortable treating acute pain, which usually is caused by soft tissue damage, infection and/or inflammation among other causes. It is usually treated simulateneously with pharmaceuticals or appropiate techniques for removing the cause and pharmaceuticals or appropiate techniques for controlling the pain sensation, commonly analgesics. Acute pain serves to alert after an injury or malfunction of the body

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Pain

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is sensation transmitted from sensory nerves through the spinal cord and to the sensory area of the cerebrum where the sensations are perceived. It is defined by the International Association for the Study of Pain (IASP) as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”.

Pain can be adjunct and simultaneous to nociception [1] (sometimes also called nociperception[2]), the system which carries information about inflammation, damage or near-damage in tissue, to the spinal cord and brain, however, it is independently perceived. Nociception conveys somatic information without conscious awareness while pain is a perception of sensorial information.

As a part of the body's defense system, pain triggers mental and physical behavior that seek to end the painful experience. It is also a feedback system that promotes learning, making repetition of the painful situation less likely. The nociceptive system may transmit signals that trigger the sensation of pain, it is a critical component of the body's ability to react to damaging stimuli and it is part of a rapid-warning relay instructing diverse organs and principally the central nervous system to initiate reactions for minimizing injury

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Cutaneous pain

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is caused by injury to the skin or superficial tissues. Cutaneous nociceptors terminate just below the skin, and due to the high concentration of nerve endings, produce a well-defined, localized pain of short duration. Examples of injuries that produce cutaneous pain include paper cuts, minor cuts, minor (first degree) burns and lacerations

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Somatic pain

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originates from ligaments, tendons, bones, blood vessels, and even nerves themselves. It is detected with somatic nociceptors. The scarcity of pain receptors in these areas produces a dull, poorly-localized pain of longer duration than cutaneous pain; examples include sprains and broken bones. Myofascial pain usually is caused by trigger points in muscles, tendons and fascia, and may be local or referred

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Visceral pain

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originates from body's viscera, or organs. Visceral nociceptors are located within body organs and internal cavities. The even greater scarcity of nociceptors in these areas produces pain that is usually more aching and of a longer duration than somatic pain. Visceral pain is extremely difficult to localize, and several injuries to visceral tissue exhibit "referred" pain, where the sensation is localized to an area completely unrelated to the site of injury. Myocardial ischaemia (the loss of blood flow to a part of the heart muscle tissue) is possibly the best known example of referred pain; the sensation can occur in the upper chest as a restricted feeling, or as an ache in the left shoulder, arm or even hand. The popularized term "brain freeze" is another example of referred pain, in which the vagus nerve is cooled by cold inside the throat. Referred pain can be explained by the findings that pain receptors in the viscera also excite spinal cord neurons that are excited by cutaneous tissue. Since the brain normally associates firing of these spinal cord neurons with stimulation of somatic tissues in skin or muscle, pain signals arising from the viscera are interpreted by the brain as originating from the skin. The theory that visceral and somatic pain receptors converge and form synapses on the same spinal cord pain-transmitting neurons is called "Ruch's Hypothesis

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Phantom limb pain

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a type of referred pain, is the sensation of pain from a limb that has been lost or from which a person no longer receives physical signals. It is an experience almost universally reported by amputees and quadriplegics.