What is Pain?
Acute pain is the most reported presenting symptom of physician visits whereas chronic pain affects people more than diabetes, heart disease, and cancer combined. Pain also costs heavily to the public each year in health care, compensation, and litigation.
Declaration of pain as the fifth vital sign
Evidence was rising that current system to promote pain assessment across clinical settings have failed to solve the problem of undertreated pain, and may contributed its part to the opioid crisis.
One such initiative is the declaration of pain as the “fifth vital sign”. In 1995, Dr. James Campbell addressed the American Pain Society advice that health care providers treat pain as the “fifth vital sign” (P5VS) (American Pain Society, 1999), highlighting the essential need for improved pain care (American Pain Society Quality of Care Committee, 1995).
Therefore pain was officially declared "The Fifth Vital Sign." Henceforth the evaluation of pain became a requirement of proper patient care as important and basic as the assessment and management of temperature, blood pressure, respiratory rate, and heart rate.
What is Pain threshold ?
Pain threshold is the point at which a stimulus (agent that evokes pain), usually accompanying by pressure, damage or temperature, activate pain receptors and produces a sensation of pain. Or a point at which a person start feeling pain.
Pain threshold may vary from person to person and defines the intensity to the bearer
THEORIES FOR PAIN
Since humans have felt pain, they have given reasons for its existence and hunted soothing agents to decrease or stop the pain. Numerous theoretical frameworks have been proposed to describe the physiological basis of pain, although none of yet completely accounts for all aspects of pain perception. A number of theories have been postulated to describe mechanisms underlying pain perception.
Specificity Theory Of Pain:
Specificity theory of pain is the most widely accepted theory of pain transmission through the end of 19th century. The specificity theory suggests that there is a direct pathway from peripheral pain receptors to the brain. The pain receptors are located in the skin and carry pain impulses via a continuous fiber directly to the brain’s pain center. The pathway includes the peripheral nerves, the lateral STT (spino thalamic tract) in the spinal cord and the hypothalamus (the brain’s pain center).
One points of interest is that there are specialized receptors in the skin for different sensations like heat and touch. Specific stimulus has a specific receptor which goes to a location in the brain.
Von Frey (1895) argued that the body has a separate sensory system for perceiving pain—just as it does for hearing and vision. This theory considers pain as an autonomous sensation with specialized peripheral sensory receptors [nociceptors], which respond to damage and send signals through pathways (along nerve fibers) in the nervous system to target centers in the brain.
Pattern Theory Of Pain
Proposed in the early 1900s. Pattern Theory Of Pain identifies two major types of pain fibers, rapidly conducting and slowly conducting fibers (A-delta and C-fibers). The stimulation of these fibers forms a pattern. This theory does not account for individual perceptual differences and psychologic factors. These patterns occur only with intense stimulation occur. Because strong and mild stimuli of the same sense modality produce different patterns of neural activity, being hit hard feels painful, but being caressed does not.
In the effort to redefine theories of somaesthetic containing pain theories, J. P. Nafe postulated a “quantitative theory of feeling” (1929). This theory overlooked the findings of specialized nerve endings, Theory stated that any somaesthetic sensation occurred by a particular pattern of neural firing and that the spatial and temporal profile of firing of the peripheral nerves encoded the stimulus type and intensity.
Goldschneider (1920) proposed that there is no discrete system for perceiving pain, and the receptors for pain are combined with other senses, such as of touch. This theory reflects that peripheral sensory receptors, responding to touch, warmth and other non-damaging as well as to damaging stimuli, give rise to non-painful or painful experiences as a result of differences in the patterns in time of the signals sent through the nervous system and People feel pain when certain patterns of neural activity occur, for example, when suitable types of activity reach high levels in the brain, these patterns occur only with intense stimulation. As strong and mild stimuli of the same sense modality produce different patterns of neural activity, being hit hard feels painful, but being caressed does not. It suggested that all cutaneous qualities are produced by spatial and temporal patterns of nerve impulses rather than by separate, modality specific transmission routes.
Gate Control Theory Of Pain
To explain why thoughts and emotions influence pain perception, Ronald Melzack and Patrick Wall in 1965, proposed that a gating mechanism exists within the dorsal horn of the spinal cord. The interaction among these connection determines when painful stimuli go to the brain or when no input comes in. The inhibitory neuron prevents the projection neuron from sending signals to the brain (gate is closed).
Normal somato sensory input occurs when there is more large-fiber stimulation (or only large--fiber stimulation). Both the inhibitory neuron and the projection neuron are stimulated, but the inhibitory neuron prevents the projection neuron from sending signals to the brain (gate is closed). Nociception (pain reception) occurs when there is more small-fiber stimulation or only fiber stimulation. This inactivates the inhibitory neuron, and the projection neuron sends signals to the brain informing it of pain. (gate is open)
Factors which can influence level of pain
Open Gate
- Tension, stress, anxiety
- Focusing on pain
- Inactivity
- Loneliness
- Depression
Closed Gate
- Relaxation
- Distraction
- Activity
- Social Support
- Positive thinking
Intensive Theory Of Pain
The theory outlines pain as, not as a single sensory experience but, as an emotion that occurs when a stimulus is stronger than normal. This theory is based on Aristotle’s concept that pain resulted from excessive stimulation of the sense of touch. Both stimulus intensity and central summation are critical determinants of pain. It was understood that the summation occurred in the dorsal horn cells. Goldscheider further advanced the Intensity Theory, based on an experiment performed by Bernhard Naunyn in 1859. These experiments showed that repeated tactile stimulation (below the threshold for tactile perception) produced pain in patients.
TYPES OF PAIN
Pain is classified as either acute or chronic
Acute pain
Acute pain might be mild, or it might be severe and lasts just moment, or last for a weeks. Acute pain is sudden onset, serve as a warning of disease or threat to the body.
Chronic pain
Chronic pain is prolonged, persisting over 6 month or longer, ranges from mild to severe and is often result of a disease that may need ongoing treatment. This kind of pain affect the person’s life, personality, their ability to function, and there overall lifestyle.
Other Types of Pain Includes
Somatic pain
Somatic pain can be deep or superficial, originates in the skin, muscles, bones or connective tissue with sharp sensation. It can be described as aching, cramping or gnawing, or even sharp. Somatic pain usually acts in one area of the body, and movement can activate it. For Example. Sprains, headache, arthritis
Visceral pain
Visceral pain is linked to the internal organs, is often vague in nature, occurs every so often, and feels like a deep ache or pressure but less affected. Like Tumor growth, gastritis or chest pain
Neuropathic pain
Neuropathic pain is pain caused by damage or disease that affects the nervous system usually chronic. Often feels like a shooting, stabbing or burning sensation. Occasionally it can be as sharp and sudden as an electric shock. People with neuropathic pain are very sensitive to touch or cold and can experience pain as sometimes there is no obvious source of pain, still pain can occur spontaneously.
Understanding The Pain - For Nursing Students | POST RN BSN Nursing Resources
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