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Analgesia (Pain Relief) | | Description |
Pain, or "analgesia", is an unpleasant sensory and emotional
experience associated with actual or potential tissue damage or described
in terms of such damage (International Association for the Study of Pain,
1979). Pain is perceived in the cerebral cortex of the brain and is always
subjective. Stimuli which cause pain usually damage tissues. Pain is
always unpleasant, and sometimes sensations that would usually be benign
can be perceived as painful (e.g. allodynia (extreme tenderness of the
skin) or dysaesthesia (unpleasant skin sensations resulting from partial
damage to sensory nerve fibres)). Pain may be broadly defined as being
acute or chronic.
Acute pain is caused by internal or
external injury or disease. It warns the individual that harm or damage is
occurring and stimulates them to take avoiding or protective action. With
either effective treatment of disease or injury and/or the natural healing
process the pain resolves, though some acute pain syndromes may develop
into chronic pain. Stimuli which are sufficiently intense potentially to
damage tissue will cause the stimulation of specific receptors known as
nociceptors. Damage to tissues releases substances which stimulate
the nociceptors. On the surface of the body there is a high density of
nociceptors and each area of the body is supplied by nerves from a
specific spinal segment or level. This allows the brain to localize the
source of the pain accurately. Pain from internal structures and organs is
more difficult to localize and is often felt in some more superficial
structure. For example, irritation of the diaphragm is often felt as pain
in the shoulder as the nerves from both structures enter the spinal cord
at the same level (often the structures have developed from the same parts
of the embryo). This is known as referred pain.
The impulses from
nociceptors travel along nerves to the spinal cord. Within the
spinal cord there is modulation of the pain 'messages' by other
incoming sensory modalities and descending input from the brain (Melzack
and Walls' gate-control theory). This modulation involves endogenous
morphine-like molecules (the endorphins and encephalins)
amongst many other pain-transmitting and -modulating substances. The
modified input then passes up the spinal cord through the thalamus to the
cerebral cortex. Thus the amount of pain 'felt' may be altered by the
emotional state of the individual and by other incoming sensations. Once
pain is perceived then 'action' is taken. This involves withdrawal of the
area being damaged, vocalization, and autonomic nervous system
response and examination of the painful area. Analysis of the event using
memory will occur and appropriate action taken to reduce pain and treat
the damage.
Chronic pain may be defined in several ways. It
is often defined as pain resistant to one month's treatment or pain
persisting one month beyond the usual course of an acute illness or
injury. Some doctors may also arbitrarily choose the figure of six months.
Chronic pain differs from acute pain. The physiological response is
different and pain may be either caused by stimuli which do not usually
cause the perception of pain or pain may arise within nerves or the
central nervous system with no apparent external stimulation. It seldom
has a physiological protective function in the way acute pain has. Also,
chronic pain may be self perpetuating. First, if individuals gain a
psychological advantage from having pain, they may continue to do so (e.g.
gaining attention from family or health professionals, etc.). The nervous
system itself alters when pain is longstanding so that it becomes more
sensitive to painful inputs and tends to perpetuate the pain. This is
because the pathways within the central nervous system are not constant.
They are thought to have some plasticity and may be altered by, for
example, chronic painful stimuli.
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A Selection of Products that may be useful for Analgesia (Pain Relief).
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