WHAT IS PAIN?
Pain is an unpleasant experience associated with damage, or something perceived as damage, in a part of the body. The sensation of pain is subjective, which means that the same triggering cause can produce varying degrees of pain in different individuals.
Pain is described as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or similar to such experiences.
The pain you feel is real to you. No one can think otherwise, because they can't know how you feel. You are not crazy. The pain is not something you imagine. You can't forget the pain and it doesn't help much in the long run to grit your teeth, sharpen yourself or pull yourself together.
Today we say that pain is a multidimensional experience.
Pain understanding through the ages:
Over time, the perception of pain has undergone significant changes. In the period 1600-1900, pain was considered only as a nerve signal. The researchers at the time focused mostly on the physiological aspects of pain, and considered it a simple reaction of the nervous system.
In the 1960s, gate theory was introduced. This theory described how nerve cells in the spinal cord can switch pain on and off, thus modulating pain signals before they reach the brain. This was an important development in the understanding of pain, as it showed that pain could be influenced by various factors in the body.
In the 1970s came the biopsychosocial model, which saw pain and health challenges in a holistic context. This model included both biological, psychological and social factors, and recognized that pain is a complex experience that is influenced by several aspects of life.
In the 1990s and 2000s, brain-network theories were developed, which described how different parts of the brain receive and process signals from the body. This led to a deeper understanding of how the brain integrates and interprets pain signals, and emphasized that pain is an experience that involves the whole brain.
Today, pain is considered a multidimensional experience, where both physiological, psychological and social factors come into play. This modern understanding reflects a holistic approach to pain treatment and research.
Historically, the Greek philosophers believed that pain was an emotion on a par with joy and anger. In the Middle Ages, many believed that pain was a punishment from God. This shows how cultural and religious beliefs have influenced the understanding of pain throughout the ages. From the 17th to the 20th century, researchers were mostly concerned with pain as a nerve signal, an opinion that has developed significantly up to today's more holistic perspective on pain as a multidimensional experience.
Acute pain
I use to explain that acute pain is good. Pain is what has made us survive as a species here on earth. Acute pain is important to protect us from potentially harmful things in the environment and to indicate that we have an injury that needs treatment. Acute pain is an electrical nerve signal, a warning from the body that something must be protected or needs attention. Acute pain often triggers anxiety and fear, depending on the cause, such as burns, broken bones or cuts. Unlike long-term pain, acute pain often responds well to pain medications.
Chronic pain
Chronic pain, defined as pain that lasts for at least three months, can be both complex and challenging to manage. These pains are often caused by wrong signals in the nervous system.
Usually, the condition begins with an acute pain that does not go away as expected. When all examinations show that there is no clear cause for the pain, it may mean that you have developed complex pain. In such cases, the nervous system continues to send out electrical signals even after the original injury or disease has healed.
Chronic pain can have major psychological consequences. One can start to speculate about the pain, which can lead to sleep disturbances, memory problems and depressive feelings. One may experience a loss of energy, anxiety, thoughts of disaster and a feeling of helplessness. The joy of life can be significantly reduced, and everyday life becomes a struggle against the pain.
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Nociceptive pain (tissue damage): Pain that occurs due to direct damage to the body's tissues, for example from burns, cuts or broken bones. Signals from muscle, skeleton and internal organs.
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Neuropathic pain is usually caused by damage or disease in the somatosensory system. Neuropathic is defined as pain that occurs as a direct result of damage or disease in the central nervous system, i.e. in the brain or spinal cord, or in the peripheral nervous system, i.e. the nerve fibers that spread to all parts of the body from the brain and spinal cord. Neuropathic pain can occur with conditions such as diabetes, shingles, nerve damage or spinal cord injury.
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Nociplastic pain (pain arising from altered nociception despite hypersensitivity): Pain that cannot be explained by direct tissue damage or disease in the nervous system, but which is due to altered pain signaling or processing of pain signals in the brain.
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Absence of clear evidence of actual or threatened tissue damage causing activation of peripheral nociceptors: There is no obvious tissue damage that activates the pain nerves in the body.
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Absence of evidence of disease or lesion in the somatosensory system that causes the pain: There is no evidence of disease or damage in the nervous system that explains the pain.
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Chronic nociplastic pain is a new terminology in the pain field since 2017. Intended to be used clinically and research to identify individuals with pain and hypersensitivity in regions of apparently normal tissue without any signs of neuropathy.
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Mental pain (psychopathology): Pain that is strongly linked to mental disorders or conditions such as depression and anxiety.
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Existential or emotional pain: Pain that is related to emotional or emotional factors, such as grief, loss, shame, guilt, humiliation, despair, hopelessness, powerlessness.
How to Manage Pain:
Managing Mood Swings and Destructive Thoughts: Depression, anxiety and anger can worsen the pain condition. Learn techniques to manage these emotions to improve your mental health and quality of life.
Management of Physical Symptoms: Optimal use of medication, TENS (Transcutaneous Electrical Nerve Stimulation), balance between movement and rest, as well as breathing techniques and relaxation can help relieve physical pain.
Coping with Life Situations and Challenges : Understand and examine your pain, know the role of the healthcare system, learn effective pain communication and deal with social challenges. Problem solving is the key to navigating these situations.
Changing Destructive Thought Patterns: Adjust your activity level, set realistic goals, improve your physical fitness and gradually increase your activity level. Remember to reward yourself for the progress you make.
Maintaining Progress and Dealing with Setbacks: Accept the situation, look ahead and learn to deal with challenges in working life. Be prepared for setbacks and have strategies in place to deal with them so you can continue to make progress.
Other measures for long-term pain
One in three adult Norwegians report experiencing chronic pain. What we clearly know today is that medications have little effect on chronic pain conditions. There are effective medications for acute pain, but most of these provide reduced relief over time, do not address the root cause, and in some cases, prolonged use may even lead to increased pain. However, the most important thing is to be conscious of whether what you put into your body is having the desired effect.
When it comes to over-the-counter painkillers, there are two main categories: Paracetamol and NSAIDs (Non-Steroidal Anti-Inflammatory Drugs).
Paracetamol
- First Choice: Paracetamol is often the first choice for pain relief due to its effectiveness and safety profile.
- Few Side Effects: This medication has few side effects, making it safe for most people.
- Not for Liver Disease: It’s important to note that paracetamol should not be used by individuals with liver disease, as it can worsen the condition.
NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
- Side Effects: NSAIDs can be effective against pain and inflammation but come with several potential side effects and contraindications:
- Not for Pregnant Women: Pregnant women should avoid NSAIDs as they can negatively affect the fetus.
- Asthma and Allergies: People with asthma or allergies should be cautious, as NSAIDs can worsen these conditions.
- Stomach Ulcers: These medications can increase the risk of stomach ulcers and should be used with caution by those with a history of ulcers.
- Heart Disease: NSAIDs can negatively affect the heart and blood vessels, and should be avoided by individuals with cardiovascular conditions.
- Diabetes: Diabetics should be careful with NSAIDs, as they can affect blood sugar levels.
- Kidney Disease: NSAIDs can harm the kidneys, especially in those with existing kidney disease.
- Severe Liver Disease: People with severe liver disease should avoid NSAIDs, as they can worsen liver function.
By understanding these differences and risks, you can choose the most appropriate pain relief for your needs. Always consult a doctor or pharmacist before starting new medications, especially if you have existing health conditions or take other medications.
Managing Chronic Pain: For managing chronic pain, there are several alternative measures that can help alleviate symptoms and improve quality of life. Here are some of the most effective methods:
Non-Pharmacological and Physical Treatments:
- Versatis and Qutenza Patches: These patches are used for superficial neuropathic pain, such as after shingles, to provide local pain relief. They contain active ingredients that block pain transmission from the skin to the nerves.
- Injection Therapy: Injecting pain-relieving agents like xylocaine (a local anesthetic) and botulinum toxin (often used for muscle spasms) can target pain in specific areas of the body. This is still considered an experimental pain treatment.
- TENS (Transcutaneous Electrical Nerve Stimulation): This is a good and cost-effective option for side effect-free pain relief. A small handheld device sends low-voltage electrical impulses to alleviate and distract from pain. Electrodes are placed on the skin near the pain area, over pain points, or along a superficial nerve, sending impulses that can block pain signals to the brain and stimulate the production of endorphins and enkephalins.
- TENS Vagus Nerve Stimulation: This is a specialized form of TENS aimed at the vagus nerve. The vagus nerve is the 10th cranial nerve and part of the parasympathetic nervous system, which puts the body in a state of rest, relaxation, and digestion. Chronic pain is often accompanied by symptoms of a nervous system in constant alert mode, known as sympathetic activation. The vagus nerve is crucial in treating chronic pain conditions. Vagus nerve stimulation typically uses an ear clip.
- Spinal Cord Stimulation and Sacral Nerve Stimulation (SNS): These are valuable treatment methods for selected patients with chronic neuropathic pain and can provide symptom relief, improved function, and enhanced quality of life for some other pain conditions. In spinal cord stimulation, an epidurally placed electrode connected to a pulse generator is used. The spinal cord stimulator resembles a pacemaker and is programmed to send currents to the spinal cord for pain relief.
Knowledge-Based and Physical Measures:
- Patient Education: Gaining a better understanding of pain and pain mechanisms can be a powerful tool for patients. This can help them develop better strategies to manage pain and reduce its impact on daily life.
- Breathing and Relaxation: Techniques such as mindful breathing, body scanning, and progressive muscle relaxation can help reduce stress and promote relaxation. These methods can positively impact pain relief by shifting the autonomic nervous system from sympathetic to parasympathetic mode, which promotes rest, relaxation, and digestion, helping the body relax and reduce tension.
- Pain Management Courses: These courses provide insights into various aspects of pain, including the autonomic nervous system, techniques for managing breath, thoughts, and emotions, and raise awareness of automatic behaviors. The goal is to equip participants with tools to better cope with pain and live a more fulfilling life.
- Movement Groups: Regular movement can be very beneficial in reducing pain and improving overall health. Movement helps keep the body strong and flexible, which can relieve pain and improve quality of life.
By combining medical treatments with knowledge-based and physical methods, patients can achieve better control over their pain and improve their quality of life. Each person is unique, so it’s important to find the right combination of measures that work best for the individual.