what is pain? The Royal Spanish Academy defines it as
1️⃣ An annoying and afflictive sensation of a part of the body due to an internal or external cause.
2️⃣ A feeling of grief and distress.
When we think of pain, it is not only physical harm that comes to mind. It is clear that this concept also includes a psychological aspect. It hurts the body but it can also hurt the mind. This is essential to understand how pain can have a major impact on our state of mind. Improving the emotional state of patients is, in fact, one of the fundamental pillars of therapy.
Therefore, pain affects our quality of life very much. It brings us negative emotions. It can also alter our social and family relationships and cause changes in our behaviour. In the end, all our conversation revolves around the pain we suffer and we start to abandon habits such as going out with friends, going to work, exercising, etc. The pain patient thus enters a loop from which it is extremely difficult to escape.
The Gate Control Theory was published in 1965. This work provided a fundamental insight: the central nervous system plays an essential role in the perception of pain, giving rise to a mechanism by which psychological and emotional processes can modulate the sensory signal.
In other words, the experience of pain will therefore be determined by a multitude of factors such as cultural influences, past experiences or personality characteristics. People are different and considering these differences can be key to effective treatment interactions. It is obvious that human beings respond differently to the same painful stimulus. They respond similarly, predictably to some extent, but with differences. Therefore, a multidisciplinary assessment is essential.
types of pain and how can we classify them?
According to their duration
Of recent onset and limited duration, with a generally identifiable cause and temporally related to the onset of pain. Example: when we burn ourselves by touching something very hot. This unpleasant sensation can be considered an alarm mechanism to limit the damage (we move our hand away when we feel pain so as not to continue subjecting ourselves to the stimulus that causes the damage).
When it persists beyond a reasonable period, after the injury that caused it has occurred. In this case, the damage would no longer have this alarm function as it remains in the absence of an objectifiable injury.
By looking at its physiopathology. That is to say, the mechanisms that cause the pain
This is produced by painful stimuli on peripheral receptors (nociceptors). When these receptors are activated, they send this experience in the form of electrical signals to the central nervous system, which integrates this painful experience. It is considered a defensive physiological mechanism. In general, it is proportional to the intensity of the cause that provokes it and disappears when the cause ends. It has variable characteristics depending on the origin of the injury. Thus, the somatic pain (originating from structures such as skin, muscle, bone and joints) is usually described as localised and stabbing, and the visceral (from mucosal and serous structures of organs, smooth muscles and blood vessels) as dull, deep and radiating away from the site of injury. IT SUGGESTS TO RESPOND WELL TO NSAIDs and opioid analgesics
✅ neuropathic pain:
In this case we are no longer dealing with a defence mechanism. Here the problem is an imbalance of activity in the pain transmission pathways. The nervous system (either central or peripheral) is damaged. In other words, the structures necessary for the transmission and integration of the painful experience are altered. Pain is poorly transmitted. It may be associated with hyparalgesia (increased response to usually painful stimuli) and allodynia (pain provoked by stimuli that do not usually provoke pain). The pain is often perceived as burning, lancinating, strange, diffuse. In many cases, it persists after the injury has disappeared. IT DOES NOT USUALLY RESPOND TO PAINKILLERS. In this case, the treatment is more complex.
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