What is Pain?

A universal and complex experience

Pain is an experience that is unique for each of us. It can be sudden and relatively short lived. We burn our hand on a hot plate or scrape a knee. Most of us have also experienced aches and hurt that last a longer time. We are all familiar with shoulder or neck tension, back ache, or recurrent headaches. Pain is a natural part of the human experience. It is the most common reason for people to seek medical care.

Pain results from a communication between the brain and the nerves. The nerves send a signal to the brain. We are protected by aches, hurt and tension. They serves as an alarm or a warning. Therefore, pain is one of the human body’s defense mechanisms. It indicates that the body is experiencing a problem.

Multidimensional and subjective

It is difficult to define pain because it is multidimensional and subjective. As a result, there are various definitions of hurt and ache depending on if it is viewed through a physical, biomedical, or a more holistic perspective. Pain viewed through a biopsychosocial perspective can be defined as a complex experience including sensory, emotional, cognitive and behavioral components.

The perception and experience

The perception of pain refers to how we understand and interpret the sensations. Our understanding and interpretation is guided by unconscious associations, such as images and beliefs. Also, our memories from earlier experiences influence our understanding of pain. The experience of pain is connected to our personal involvement with the pain sensation. Our emotions, the type of stress, and the context in which we experience of discomfort can have a powerful effect on how we feel the ailment. For example, the fact that childbirth is a natural and important part of life makes the considerable stress of contractions easier to bear.

Physical aches are often a symptom of or accompanies mental health struggles as well. Anxiety, depression and chronic pain feed on each other in a negative cycle. Anxiety and depression make pain worse, pain causes anxiety and depression.

Two types

When a patient first seeks medical care for their aches, it is essential to define the type of pain they are dealing with. This is the most important factor that guides the assessment and the type of treatment. First, however, thorough examinations and tests to eliminate the possibility of any serious illness or injury that might be causing the aches are needed.

The common types of pain include nociceptive and neuropathic pain. Nociceptive pain represents the normal response to a noxious insult or injury of tissues such as skin, muscles, visceral organs, joints, tendons or bones. Neuropathic pain results from an injury to the nervous system. The injury can be to the peripheral nervous system, nerves outside the brain and spinal cord, or to the central nervous system, the brain and spinal cord.

Acute and chronic

Pain during normal tissue healing is acute. If soreness after an injury persists beyond expected healing time it becomes chronic. The specific timeframe for an expected healing period is variable and often difficult to ascertain. For ease of classification, pain lasting beyond 3-6 months is considered chronic pain.

Because of the multidimensional nature of chronic pain, it can be best understood from a biopsychosocial perspective. The holistic perspective focuses on viewing chronic pain as an illness rather than disease. Thus, recognizing it as a subjective experience and giving importance to the management of the condition, rather than the cure.

For acute pain the major goals are pain control and relief. It is also important to identify and treat the underlying physical cause as well as help healing and recovery. Acute pain is treated with analgesics. Non-drug methods such as massage, heat/cold treatment, patient education, distraction and relaxation are important, too.

In chronic conditions, pain relief is the primary approach as well. In addition, the aim is to improve in function and quality of life. A multidisciplinary approach has shown to be most appropriate and efficient for assessment and treatment in chronic cases. The multidisciplinary team may consist of an anesthesiologist, neurologist, primary care physician, psychologist, physiotherapist, occupational therapist and a nurse. This approach is the best for chronic conditions because the causes of aches and discomfort may be difficult to identify. Also, in chronic cases pain cannot be eliminated completely. In addition, multiple physiological, psychological, social and cultural mechanisms are at play.

The author, clinical psychologist Vappu Eerola Labacci works at OCP Medical Clinic, a pain management clinic in Dubai.