What is pain?

Pain is described as a usually localized physical suffering associated with bodily disorder (as a disease or an injury) <the pain of a twisted ankle>; also :  a basic bodily sensation induced by a noxious stimulus, received by naked nerve endings, characterized by physical discomfort (as pricking, throbbing, or aching), and typically leading to evasive action <the pain of bee stings>

The International Association for the Study of Pain describes pain as  “an unpleasant sensory and emotional experience associated with actual or potential tissue damage.” Pain is very personal and subjective. Unlike a fever, where a thermometer can show if you have a high temperature, there is no objective way to measure how much pain you are feeling.

How do we feel pain?

Your out walking and step on a rock, how does that transmit to you brain?  How does your sensory nerve in the peripheral nervous system know this is not branch or twig? Different sensory nerve fibers respond to different things, and produce different chemical responses which determine how sensations are interpreted. Some nerves send signals associated with light touch, while others respond to deep pressure.

Special pain receptors called nociceptors activate whenever there has been an injury, or even a potential injury, such as breaking of the skin or causing a large indentation into your skin.

 Even if the rock does not break your skin, the tissues in your foot become compressed enough to cause the nociceptors to fire off notification to your brain. Now, an impulse is heading through the nerve into the spinal cord, and eventually reaches its target your brain. This happens within fractions of a second.

Different Feelings of Pain

While it may seem simple, the process of detecting pain is complicated by the fact that it is not a one-way system. It isn’t even a two-way system. Pain is more than just cause and effect: it is affected by everything else that is going on in the nervous system. Your mood, your past experiences and your expectations can all change the way pain is interpreted at any given time. How is that for confusing?

If you step on that rock after you have a fight with your wife, your response may be very different than it would if you had just won the lottery. Your feelings about the experience may be tainted if the last time you stepped on a rock, your foot became infected. If you stepped on a rock once before and nothing terrible happened to you, you may recover more quickly. You can see how different emotions and histories can determine your response to pain. In fact, there is a strong link between depression and chronic pain.

What are the different types of pain?

In general, following SCI, there are three types of pain, based on where in the body the pain is felt: somatic, visceral, and neuropathic. Pain of all three types can be either acute or chronic. Acute pain is short lasting and usually manifests in ways that can be easily described and observed. Chronic pain is defined as pain lasting more than three months. It is much more subjective and not easily described as acute pain. The three pain types can be felt at the same time or singly and at different times. The different types of pain respond differently to the various pain medications. Somatic and visceral pain are easier to treat than neuropathic pain.

Somatic pain is caused by the activation of pain receptors in either the body surface or musculoskeletal tissues. A common cause of somatic pain in SCI persons is postsurgical pain from the surgical incision. It is usually described as dull or aching.

Visceral pain is the pain we feel when our internal organs are damaged or injured and is by far the most common form of pain. Viscera refers to the internal areas of the body that are enclosed in a cavity. Visceral pain is caused by the activation of pain receptors in the chest, abdomen or pelvic areas. Visceral pain is vague and not well localized and is usually described as pressure-like, deep squeezing, dull or diffuse.

Neuropathic pain is caused by injury or malfunction to the spinal cord and peripheral nerves. Neuropathic pain is typically a burning, tingling, shooting, stinging, or “pins and needles” sensation. Some people also complain of a stabbing, piercing, cutting, and drilling pain. This type of pain usually occurs within days, weeks, or months of the injury and tends to occur in waves of frequency and intensity.

Chronic pain

Chronic pain can be defined as pain that lasts longer than six months. Chronic pain can be mild or excruciating, episodic or continuous, merely inconvenient or totally incapacitating.

With chronic pain, signals of pain remain active in the nervous system for months or even years. This can take both a physical and emotional toll on a person.

The most common sources of pain stem from headaches, joint pain, pain from injury, and backaches. Other kinds of chronic pain include tendinitis, sinus pain, carpal tunnel syndrome, and pain affecting specific parts of the body, such as the shoulders, pelvis, and neck. Generalized muscle or nerve pain can also develop into a chronic condition.

Your pain can be Managed

Pain ManagementLiving with persistent pain can be discouraging. It’s easy to feel defeated. There is hope. Research shows that getting involved in managing your pain can have a big impact on your quality of life. Self management refers to the skills and behaviours that can help you live well with your chronic condition. Self management doesn’t replace physical therapies, medication and psychological support, but it’s a big part of feeling better.

The most important consideration in looking for a pain management specialist is to find someone who has the training and experience to help you with your particular pain problem and with whom you feel a comfortable rapport. Since many types of chronic pain may require a complex treatment plan as well as specialized interventional techniques, pain specialists today must have more training than in the past, and you should learn about how your pain physician was trained and whether he or she has board certification in pain management.

On your first visit to a pain management specialist, he or she will get to know you and begin to evaluate your particular pain problem. This will usually involve a detailed history, a physical exam and review of tests that you have had performed. The questions you are asked and the physical examination will focus on your particular problem, but your pain physician will want to know about past and current medical history as well.

Your pain can be changed

Pain can be changed by stopping pain signals from reaching your brain. These pain signals can be reduced or blocked anywhere along the pain pathway. It may not be possible to eliminate all pain due to your chronic pain condition. However, there are things you can do to reduce your pain.

Pain can be changed using:

  • Pharmacological strategies or pain medications
  • Physical methods such as heat, cold, massage, and exercise
  • Psychological strategies such as relaxation, distraction (engaging in pleasurable activities) and changing the way you think

Goals of Pain Management


Goals of Pain Management

The goal of pain medicine is to manage acute or chronic pain by reducing pain frequency and intensity. Besides addressing pain issues, a multidisciplinary pain management program may address your functional goals for activities of daily living. Overall, a pain medicine program aims to give you a feeling of well-being, increase your level of activity (including return to work), and reduce or eliminate your reliance on medication.