| Services and providers for Pain in the U.Pain is a feeling triggered in the nervous system.Pain may be sharp or dull.You may feel pain in one area of your body, such as your back, abdomen or chest, or you may feel pain all over, such as when your muscles ache from the flu.Pain can be helpful.Without pain, you might seriously hurt yourself without knowing it, or you might not realize you have a medical problem that needs treatment.Once you take care of the problem, pain usually goes away.However, sometimes pain goes on for weeks, months or even years.This is called chronic pain.Sometimes chronic pain is due to an ongoing cause, such as cancer or arthritis.Sometimes the cause is unknown.Fortunately, there are many ways to treat pain.Treatment varies depending on the cause of pain.Pain relievers, acupuncture and sometimes surgery are helpful.Racial Gap in ER Opioid Use in U.Integrative Pain Therapy(Continuum Center for Health and Healing, Beth Israel Medical Center, Dept.Prolotherapy: An Effective Treatment for Chronic Pain?Symptom Management: Pain(Beth Israel Medical Center, Dept.Myofascial Pain Syndrome(Beth Israel Medical Center, Dept.Pain Quiz: Are You Fooled by Familiar Pain Myths?What Does the Future Hold for Marijuana for Pain?Joseph disease: a frequent and disabling symptom.Article: Neurophysiologic study of central pain in patients with Parkinson disease.Why Do I Have Pain?For pain in the sense of "suffering", see Suffering.For other uses, see Pain (disambiguation).Pain is the conscious experience of sensorial information and a feeling of unpleasantness that can manifest as a result of nociception.Neuropathic pain differs from nociceptive pain in that it involves damage to the nerve resulting in the sensation of pain.There is also central pain in which the pain is generated in the brain from some form of lesion, and which is the most difficult for medical professionals to treat.Occasionally pain may be psychogenic, meaning caused by mental illness; however this is exceedingly rare.As a part of the body's defense system, pain triggers mental and physical behavior that seek to end the painful experience.It is also a feedback system that promotes learning, making repetition of the painful situation less likely.Insensitivity to pain
3 Management and therapy of pain
3.Sources of pain
5 Some possible causes of pain by region
5.Definitions of pain
7 Physiology of nociception
7.Intensity
Pain may range in intensity from slight through severe to agonizing and can appear as permanent or intermittent.The threshold of pain might have wide variation between individuals.Localization
Localization is not always accurate in defining the problematic area.Some pain sensations may be diffuse or referred.Referred pain, usually happening in visceral disease, occurs when sensory fibres from the viscus enter the same segment of the spinal cord as somatic nerves i.The sensory nerve from the viscus stimulates the closely associated nerve in the spinal cord and the pain perceived at the sensorial area of the brain is perceived as originating in the area supplied by the somatic nerve.An example is the left shoulder pain associated with heart damage.This subjective localisation of pain to an area of the body defines some kind of pain as neck pain, cutaneous pain, kidney pain, or the painful uterine contractions occurring during childbirth.This common usage of pain is not entirely consistent with the scientists' model of pain being a subjective experience.What seems to trigger it?Does it seem to be getting better, or getting worse, or does it remain the same?What relieves it: changing diet?The person who is suffering the pain should describe the pain, rather than saying what they think you would like to hear.Where is the pain located?Does the pain radiate (i.Does it go anywhere else?Did it start elsewhere and now localised to one spot?Does it force you to sit down, lie down, slow down?How long does an episode last?When did the pain start, at what time?How often does it occur?Is it sudden or gradual?How often do you experience it: hourly?Are you ever awakened by it?Does it lead to anything else?Does it occur seasonally?Other questions to ask when assessing a person in pain: Any medication or allergies?Any history of pain?Unverifiable material may be challenged and removed.Inability to experience pain, as in the rare condition congenital insensitivity to pain or congenital analgesia, is a cause of physical damage due to unawareness.Insensitivity to pain may also be caused by Hansen's disease or other forms of nerve damage.CIP presents in early childhood with a child frequently getting injuries, such as broken bones and bruises, because they fail to develop the normal avoidance of pain and so take risks others would not.Management and therapy of pain
Pain can be acute or chronic.The distinction between acute and chronic pain is not based on its duration of sensation, but rather the nature of the pain itself.It is usually treated simultaneously with pharmaceuticals or appropriate techniques for removing the cause and pharmaceuticals or appropriate techniques for controlling the pain sensation, commonly analgesics.Acute pain serves to alert after an injury or malfunction of the body.General physicians have only elementary training in chronic pain management and patients suffering from it are referred to specialists.Chronic pain may have no apparent cause or may be caused by a developing illness or imbalance.Sometimes chronic pain can have a psychosomatic or psychogenic cause.Chronic pain was originally defined as pain that has lasted 6 months or longer.It is now defined as "the disease of pain."The one consistent fact of chronic pain is that, as a disorder, it cannot be understood in the same terms as acute pain.The failure to treat acute pain properly may lead to chronic pain in some cases.Other therapies
Hypnosis as well as diverse perceptional techniques provoking altered states of consciousness have proven to be of important help in the management of all types of pain.Cutaneous pain is caused by injury to the skin or superficial tissues.Examples of injuries that produce cutaneous pain include paper cuts, minor cuts, minor (first degree) burns and lacerations.Somatic pain originates from ligaments, tendons, bones, blood vessels, and even nerves themselves.Myofascial pain usually is caused by trigger points in muscles, tendons and fascia, and may be local or referred.Visceral pain originates from body's viscera, or organs.The even greater scarcity of nociceptors in these areas produces pain that is usually more aching and of a longer duration than somatic pain.Visceral pain is extremely difficult to localize, and several injuries to visceral tissue exhibit "referred" pain, where the sensation is localized to an area completely unrelated to the site of injury.Myocardial ischaemia (the loss of blood flow to a part of the heart muscle tissue) is possibly the best known example of referred pain; the sensation can occur in the upper chest as a restricted feeling, or as an ache in the left shoulder, arm or even hand.The popularized term "brain freeze" is another example of referred pain, in which the vagus nerve is cooled by cold inside the throat.Referred pain can be explained by the findings that pain receptors in the viscera also excite spinal cord neurons that are excited by cutaneous tissue.Since the brain normally associates firing of these spinal cord neurons with stimulation of somatic tissues in skin or muscle, pain signals arising from the viscera are interpreted by the brain as originating from the skin.Phantom limb pain, a type of referred pain, is the sensation of pain from a limb that has been lost or from which a person no longer receives physical signals.It is an experience almost universally reported by amputees and quadriplegics.Neuropathic pain, can occur as a result of injury or disease to the nerve tissue itself.This can disrupt the ability of the sensory nerves to transmit correct information to the thalamus, and hence the brain interprets painful stimuli even though there is no obvious or known physiologic cause for the pain.Neuropathic pain is, as stated above, the disease of pain.It is not the sole definition for chronic pain, but does meet its criteria.Visceral pain sensation is often referred by the CNS to a dermatome region which may be far away from the originating organ.Examples of this include the heart which originates in the neck, thus producing the classical pain and arm pain experienced during acute cardiac pain.Definitions of pain
Experts in pain have proposed a variety of definitions."Pain is whatever the experiencing person says it is; existing whenever he or she says it does.Margo McCaffrey, RN MS
"Pain is a category of complex experiences, not a single sensation produced by a single stimulus".Nociception refers to the system that carries signals of damage and pain from the tissues; it is the physiological event that accompanies pain.Nociceptors
All nociceptors are free nerve endings that have their cell bodies outside the spinal column in the dorsal root ganglion and are named based upon their appearance at their sensory ends.Deep internal surfaces are only weakly supplied with pain receptors and will propagate sensations of chronic, aching pain if tissue damage in these areas occurs.In some conditions, excitation of pain fibers becomes greater as the pain stimulus continues, leading to a condition called hyperalgesia.Transmission of nociception to the central nervous system
There are two ways for nociceptive information to reach the central nervous system, the neospinothalamic tract for 'fast spontaneous pain' and the paleospinothalamic tract for 'slow increasing pain'.The axons of these neurons travel up the spine to the brain and cross the midline through the anterior white commissure, passing upwards in the contralateral anterolateral columns.These fibres terminate on the ventrobasal complex of the thalamus and synapse with the dendrites of the somatosensory cortex.Fast pain is felt within a tenth of a second of application of the pain stimulus and is a sharp, acute, prickling pain felt in response to mechanical and thermal stimulation.Paleospinothalamic tract
Slow pain is transmitted via slower type C fibers to laminae II and III of the dorsal horns, together known as the substantia gelatinosa.Slow pain is stimulated by chemical stimulation, is poorly localized and is described as an aching, throbbing or burning pain.If the signals are sent to the reticular formation and thalamus, the sensation of pain enters consciousness in a dull poorly localised manner.From the thalamus, the signal can travel to the somatosensory cortex in the cerebrum, when the pain is experienced as localised and having more specific qualities.Analgesia
The body possesses an endogenous analgesia system, which can be supplemented with analgesic drugs to regulate nociception and pain.There is both an analgesia system in the central nervous system and peripheral receptors that decreases the grade in which pain reaches the higher brain areas.The perception of pain can be modified by the body according to gate control theory of pain.Peripheral
The peripheral regulation consists of several different types of opioid receptors that are activated in response to the binding of the body's endorphins.Thus, rubbing a bumped knee seems to relieve pain by preventing its transmission to the brain.Pain is also "gated" by signals that descend from the brain to the spinal cord to suppress (and in other cases enhance) incoming nociception (pain) information.Phenotype and pain
Pain may be experienced differently depending on phenotype.People having this disorder are completely ignorant to pain, and can perform without pain any kinds of self mutilation or damage.In the families studied, this has ranged from biting of the person's own tongue leading to damage, through to street acts with knives, to death from injuries due to a failure to have learned limits on injury through experience of pain.Pain and alternative medicine
A recent survey by NCCAM (part of the NIH) found pain was the most common reason that people use alternative medicine.CAM to treat back pain; 6.CAM to treat recurring pain.Some survey respondents may have used CAM to treat more than one of these pain conditions.Traditional Chinese treatments such as acupuncture are said to be more effective for nontraumatic pain than traumatic pain.Although these claims have not found broad scientific acceptance, research into both the mechanism and clinical efficacy of acupuncture supports that it can have a role in pain reduction for both humans and animals.The NIH's 1997 Consensus Statement on Acupunture notes that research has been mixed, partly due to difficulties with designing clinical studies with the proper controls.NIH which showed statistical evidence for the treatment's positive effect only amongst patients with moderate to severe pain, a small subsection of the study.The concept of pain has played an important part in the study of philosophy, particularly in the philosophy of mind.The question of what pain actually consists in is still open since any evaluation is dependent upon what subject one approaches the question from.Identity theorists assert that the mental state of pain is completely identical with some physical state caused by various physiological causes.Functionalists consider pain to be defined completely by its causal role (ie in the role it has in bringing about various effects) and nothing else.Some theologians and other spiritual traditions have much to say about the nature of pain and its various spiritual consequences, especially its role in growth, understanding, compassion, and in providing an aspect of life to be overcome.Survival benefit
Despite its unpleasantness, pain is an important part of the existence of humans and other animals; in fact, it is vital to survival.Pain encourages an organism to disengage from the noxious stimulus associated with the pain.Pain may also promote the healing process, since most organisms will protect an injured region in order to avoid further pain.People born with congenital insensitivity to pain usually have short life spans, and suffer numerous ailments such as broken bones, bed sores, and chronic infection.The study of pain has in recent years diverged into many different fields from pharmacology to psychology and neurobiology.Interestingly, the brain itself is devoid of nociceptive tissue, and hence cannot experience pain.Thus, a headache is not due to stimulation of pain fibers in the brain itself.Rather, the membrane surrounding the brain and spinal cord, called the dura mater, is innervated with pain receptors, and stimulation of these dural nociceptors (pain receptors) is thought to be involved to some extent in producing headache pain, been the vasoconstriction of peripheral vessels another common cause.Some evolutionary biologists have speculated that this lack of nociceptive tissue in the brain might be because any injury of sufficient magnitude to cause pain in the brain has a sufficiently high probability of being fatal that development of nociceptive tissue therein would have little to no survival benefit.Chronic pain, in which the pain becomes pathological rather than beneficial, may be an exception to the idea that pain is helpful to survival, although some specialists believe that psychogenic chronic pain exists as a protective distraction to keep dangerous repressed emotions such as anger or rage unconscious.It is not clear what the survival benefit of some extreme forms of pain (e.Pain and nociception in other species
Pain is defined as a subjective conscious experience.The presence or absence of pain even in another human is only verifiable by their report; "Pain is whatever the experiencing person says it is, and exists whenever he says it does."Currently, it is not scientifically possible to prove whether an animal is in pain or not, however it can be inferred through physical and behavioral reactions.In veterinary science all uncertainty is overcome by assuming that if something would be painful for a human then it would be painful for an animal.Where possible, analgesics are used preemptively if there is any likelihood of pain being caused to an animal.Ann Waugh, Allison Grant (2001).Nursing management of the patient in pain.The Challenge of Pain.Feinstein B, J Langton, R Jameson, F Schiller.Experiments on pain referred from deep somatic tissues.Liem EB, Joiner TV, Tsueda K, Sessler DI.Increased sensitivity to thermal pain and reduced subcutaneous lidocaine efficacy in redheads."Scientists noted that Chinese veterinarians used acupuncture to do surgery on animals, thereby refuting the argument that the painkilling characteristics of acupuncture was one big placebo effect ascribable to cultural conditioning (no cow on earth will go along with unanaesthetized surgery just because it has a heavy investment in the cultural mores of the society in which it dwells.Acupuncture stimulates the release of large quantities of endogenous opioids, for reasons no one really understands.The best demonstration of this is what is called a subtraction experiment: block the activity of endogenous opioids by using a drug that blocks the opiate receptor..."Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial."National Institutes of Health Consensus Panel."Curcumin attenuates thermal hyperalgesia in a diabetic mouse model of neuropathic pain.""Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis."New England Journal of Medicine.Nursing management of the patient in pain.Philadelphia, Pa: JB Lippincott 1972.Look up nociception, painful, hurting, dolor in Wiktionary, the free dictionary.This page was last modified 14:49, 11 January 2008.View Related Articles
10.David Sung, Xudong Dong, Malin Ernberg, Ujendra Kumar and Brian E.View Related Articles
11.View Related Articles
12.View Related Articles
14.Charlton and Jonathan O.View Related Articles
17.View Related Articles
19.View Related Articles
20.View Related Articles
22.Nicholas, Ali Asghari and Fiona M.View Related Articles
24.Trevor Thompson, Edmund Keogh, Christopher C.View Related Articles
26.Kurt Kroenke, Jianzhao Shen, Thomas E.Taylor Muhly, William D.Swaim, Ildiko Szalayova, Jason M.Keller, Eva Mezey and Michael J.Crabb, William Kennedy, Ronald Hardrict, Norm Dahl and James W.Table of Contents (click to jump to sections)Introduction: The Universal DisorderA Brief History of PainThe Two Faces of Pain: Acute and ChronicThe A to Z of PainHow is Pain Diagnosed?How is Pain Treated?What is the Role of Age and Gender in Pain?Gender and PainPain in Aging and Pediatric Populations: Special Needs and ConcernsA Pain Primer: What Do We Know About Pain?What is the Future of Pain Research?AppendixSpine Basics: The Vertebrae, Discs, and Spinal CordThe Nervous SystemsPhantom Pain: How Does the Brain Feel?Or it's a dull ache
above your brow after a day of stress and tension.Or you may recognize it as a sharp pierce in your back after you lift something
heavy.In its most benign form, it warns us that something isn't quite right, that we should take medicine or see a doctor.Pain is a complex perception that differs enormously among individual patients, even those who appear to have
identical injuries or illnesses.In 1931, the French medical missionary Dr.Albert Schweitzer wrote, "Pain is a more terrible lord of mankind than even death
itself."Ancient civilizations recorded on stone tablets accounts of pain and the treatments used: pressure, heat, water, and sun.Early humans related pain to evil, magic, and demons.Relief of pain was the responsibility of sorcerers, shamans, priests,
and priestesses, who used herbs, rites, and ceremonies as their treatments.The Greeks and Romans were the first to advance a theory of sensation, the idea that the brain and nervous system have a role
in producing the perception of pain.Leonardo da Vinci and his contemporaries came to believe that the
brain was the central organ responsible for sensation.Descartes described what to this day is still called a "pain pathway."These drugs led to the development of aspirin,
to this day the most commonly used pain reliever."It has no future but itself," wrote the 19th century American poet Emily Dickinson, speaking about pain.The International Association for the Study of Pain defines it as: An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of
such damage.It is useful to distinguish between two basic types of pain, acute and chronic, and they differ greatly.Acute pain, for the most part, results from disease, inflammation, or injury to tissues.This type of pain generally comes on suddenly,
for example, after trauma or surgery, and may be accompanied by anxiety or emotional distress.Chronic pain is widely believed to represent disease itself.Hundreds of pain syndromes or disorders make up the spectrum of pain.There are the most benign, fleeting sensations of pain,
such as a pin prick.There is the pain of childbirth, the pain of a heart attack, and the pain that sometimes follows amputation
of a limb.There is also pain accompanying cancer and the pain that follows severe trauma, such as that associated with head
and spinal cord injuries.Arachnoiditis is a condition in which one of the three membranes covering the brain and spinal cord, called the arachnoid membrane, becomes
inflamed.These disorders are characterized by joint pain in the extremities.Many other inflammatory diseases affect the
body's soft tissues, including tendonitis and bursitis.Back pain has become the high price paid by our modern lifestyle and is a startlingly common cause of disability for many Americans,
including both active and inactive people.Back pain that spreads to the leg is called sciatica and is a very common condition
(see below).Another common type of back pain is associated with the discs of the spine, the soft, spongy padding between
the vertebrae (bones) that form the spine.Spondylolisthesis is a back condition that occurs when one vertebra extends over another, causing pressure on nerves and therefore pain.Spine Basics in the Appendix) is a serious condition, called radiculopathy, that can be extremely painful.Surgical procedures include discectomy, laminectomy, or spinal fusion (see section
on surgery in How is Pain Treated?Burn pain can be profound and poses an extreme challenge to the medical community.Depending on the injury, pain accompanying burns can be excruciating, and even after the wound has
healed patients may have chronic pain at the burn site.Cancer pain can accompany the growth of a tumor, the treatment of cancer, or chronic problems related to cancer's permanent effects on
the body.Fortunately, most cancer pain can be treated to help minimize discomfort and stress to the patient.Headaches affect millions of Americans.Each comes with its own telltale brand of pain.Migraines are characterized by throbbing pain and sometimes by other symptoms, such as nausea and visual disturbances.Stress can trigger a migraine headache, and migraines can also put the sufferer at risk for
stroke.Head and facial pain can be agonizing, whether it results from dental problems or from disorders such as cranial neuralgia, in which one of the
nerves in the face, head, or neck is inflamed.Another condition, trigeminal neuralgia (also called tic douloureux), affects the largest of the cranial nerves (see The Nervous Systems in the Appendix) and is characterized by a stabbing, shooting pain.Muscle pain can range from an aching muscle, spasm, or strain, to the severe spasticity that accompanies paralysis.Polymyositis, dermatomyositis, and inclusion body myositis are painful disorders characterized by muscle inflammation.Myofascial pain syndromes affect sensitive areas known as trigger points, located within the body's muscles.Myofascial pain syndromes are sometimes
misdiagnosed and can be debilitating.Fibromyalgia is a type of myofascial pain syndrome.Neuropathic pain is a type of pain that can result from injury to nerves, either in the peripheral or central nervous system (see The Nervous Systems in the Appendix).Neuropathic pain can occur in any part of the body and is frequently described as a hot, burning sensation,
which can be devastating to the affected individual.It can result from diseases that affect nerves (such as diabetes) or
from trauma, or, because chemotherapy drugs can affect nerves, it can be a consequence of cancer treatment.Phantom Pain in the Appendix), which can result from the surgical removal of a limb; postherpetic neuralgia, which can occur after an outbreak of shingles; and central pain syndrome, which can result from trauma to the brain or spinal cord.Reflex sympathetic dystrophy syndrome, or RSDS, is accompanied by burning pain and hypersensitivity to temperature.Often triggered by trauma or nerve damage,
RSDS causes the skin of the affected area to become characteristically shiny.In recent years, RSDS has come to be called
complex regional pain syndrome (CRPS); in the past it was often called causalgia.Repetitive stress injuries are muscular conditions that result from repeated motions performed in the course of normal work
or other daily activities.Sciatica is a painful condition caused by pressure on the sciatic nerve, the main nerve that branches off the spinal cord and continues
down into the thighs, legs, ankles, and feet.Sciatica is characterized by pain in the buttocks and can be caused by a number
of factors.One common cause of sciatica
is a herniated disc (see Spine Basics in the Appendix).Shingles and other painful disorders affect the skin.Pain is a common symptom of many skin disorders, even the most common rashes.One of the most vexing neurological
disorders is shingles or herpes zoster, an infection that often causes agonizing pain resistant to treatment.Sports injuries are common.In extreme cases, sports injuries can take the form of costly and painful spinal cord and head injuries, which
cause severe suffering and disability.The condition occurs naturally with aging.Surgical pain may require regional or general anesthesia during the procedure and medications to control discomfort following the operation.Control of pain associated with surgery includes presurgical preparation and careful monitoring of the patient during and
after the procedure.Trauma can occur after injuries in the home, at the workplace, during sports activities, or on the road.Any of these injuries can
result in severe disability and pain.Some patients who have had an injury to the spinal cord experience intense pain ranging
from tingling to burning and, commonly, both.It affects as many as 100,000 Americans with multiple sclerosis, Parkinson's disease, amputated limbs, spinal cord injuries,
and stroke.Their pain is severe and is extremely difficult to treat effectively.Vascular pain affects millions of Americans and occurs when communication between blood vessels and nerves
is interrupted.Ruptures, spasms, constriction, or obstruction of blood vessels, as well as a condition called ischemia in
which blood supply to organs, tissues, or limbs is cut off, can also result in pain.How is Pain Diagnosed?There is no way to tell how much pain a person has.No test can measure the intensity of pain, no imaging device can show
pain, and no instrument can locate pain precisely.Sometimes, as in the case of headaches, physicians find that the best aid
to diagnosis is the patient's own description of the type, duration, and location of pain.Defining pain as sharp or dull,
constant or intermittent, burning or aching may give the best clues to the cause of pain.These descriptions are part of what
is called the pain history, taken by the physician during the preliminary examination of a patient with pain.Physicians, however, do have a number of technologies they use to find the cause of pain.Electrodiagnostic procedures include electromyography (EMG), nerve conduction studies, and evoked potential (EP) studies.Information from EMG can help physicians tell precisely which muscles or nerves are affected by weakness or pain.Thin needles are inserted in
muscles and a physician can see or listen to electrical signals displayed on an EMG machine.With nerve conduction studies the doctor uses two sets of electrodes (similar to those used during an electrocardiogram) that are placed on the skin over
the muscles.The first set gives the patient a mild shock that stimulates the nerve that runs to that muscle.How is Pain Treated?These methods can be powerful and effective,
according to those who advocate their use.Whatever the treatment regime, it is important to remember that pain is treatable.The following treatments are among the most common.Acupuncture dates back 2,500 years and involves the application of needles to precise points on the body.Analgesic refers to the class of drugs that includes most painkillers, such as aspirin, acetaminophen, and ibuprofen.The word analgesic
is derived from ancient Greek and means to reduce or stop pain.Prescription pain relievers, sold through a pharmacy under the direction of a physician, are
used for more moderate to severe pain.Anticonvulsants are used for the treatment of seizure disorders but are also sometimes prescribed for the treatment of pain.Antidepressants are sometimes used for the treatment of pain and, along with neuroleptics and lithium, belong to a category of drugs called
psychotropic drugs.They can have serious side effects in some people and therefore, as with all prescription medicines,
should be used only under a doctor's care.Biofeedback is used for the treatment of many common pain problems, most notably headache and back pain.The individual can then learn to effect a change in his or her responses to pain,
for example, by using relaxation techniques.Chili Peppers, Capsaicin, and Pain in the Appendix).Chemonucleolysis is a treatment in which an enzyme, chymopapain, is injected directly into a herniated lumbar disc (see Spine Basics in the Appendix) in an effort to dissolve material around the disc, thus reducing pressure and pain.Chiropractic refers to hand manipulation of the spine, usually for relief of back pain, and is a treatment option that continues to grow
in popularity among many people who simply seek relief from back disorders.Chiropractic's usefulness as a treatment for back pain is, for the most part, restricted to a select group of individuals
with uncomplicated acute low back pain who may derive relief from the massage component of the therapy.It is used for postoperative
pain, cancer pain, and the pain of childbirth.Counseling can give a patient suffering from pain much needed support, whether it is derived from family, group, or individual counseling.Support groups can provide an important adjunct to drug or surgical treatment.Psychological treatment can also help patients
learn about the physiological changes produced by pain.This in turn produces temporary pain relief.Peripheral nerve stimulation uses electrodes placed surgically on a carefully selected area of the body.Spinal cord stimulation uses electrodes surgically inserted within the epidural space of the spinal cord.Exercise has come to be a prescribed part of some doctors' treatment regimes for patients with pain.Just as we know that stress contributes
to pain, we also know that exercise, sleep, and relaxation can all help reduce stress, thereby helping to alleviate pain.Exercise has been proven to help many people with low back pain.It is important, however, that patients carefully follow
the routine laid out by their physicians.Hypnosis, first approved for medical use by the American Medical Association in 1958, continues to grow in popularity, especially
as an adjunct to pain medication.In general, hypnosis is used to control physical function or response, that is, the amount
of pain an individual can withstand.How hypnosis works is not fully understood.Hypnosis may result in relief of pain by acting on chemicals in the nervous system, slowing impulses.While it is often dismissed as quackery and pseudoscience by skeptics, proponents offer the theory that magnets
may effect changes in cells or body chemistry, thus producing pain relief.Nerve blocks employ the use of drugs, chemical agents, or surgical techniques to interrupt the relay of pain messages between specific
areas of the body and the brain.Nerve Blocks in the Appendix).Opioids have a narcotic
effect, that is, they induce sedation as well as pain relief, and some patients may become physically dependent upon them.Physical therapy and rehabilitation date back to the ancient practice of using physical techniques and methods, such as heat, cold, exercise, massage, and manipulation,
in the treatment of certain conditions.These may be applied to increase function, control pain, and speed the patient toward
full recovery.Placebos offer some individuals pain relief although whether and how they have an effect is mysterious and somewhat controversial.Placebos are inactive substances, such as sugar pills, or harmless procedures, such as saline injections or sham surgeries,
generally used in clinical studies as control factors to help determine the efficacy of active treatments.This positive response is known as the placebo effect, which is defined as the observable or measurable change that
can occur in patients after administration of a placebo.Surgery, although not always an option, may be required to relieve pain, especially pain caused by back problems or serious musculoskeletal
injuries.Surgery may take the form of a nerve block (see Nerve Blocks in the Appendix) or it may involve an operation to relieve pain from a ruptured disc.Other operations for pain include rhizotomy, in which a nerve close to the spinal cord is cut, and cordotomy, where bundles of nerves within the spinal cord are severed.Cordotomy is generally used only for the pain of terminal cancer
that does not respond to other therapies.Another operation for pain is the dorsal root entry zone operation, or DREZ, in which spinal neurons corresponding to the patient's pain are destroyed surgically.Occasionally, surgery is carried out with electrodes that selectively damage neurons in a targeted area of the brain.In some cases, the results of an operation are remarkable.What is the Role of Age and Gender in Pain?It is now widely believed that pain affects men and women differently.For example, young children may learn to respond to pain based on how they are treated when they experience
pain.Some children may be cuddled and comforted, while others may be encouraged to tough it out and to dismiss their pain.Many investigators are turning their attention to the study of gender differences and pain.Similarly, the presence of testosterone, a male hormone, appears to elevate tolerance for pain in female mice: the animals
are simply able to withstand pain better.Estrogen, therefore, may act as a sort of pain switch, turning on the ability to recognize pain.Or is there another explanation, such as differences
between men and women in their perception of pain?Continued research may result in a better understanding of how pain affects
women differently from men, enabling new and better pain medications to be designed with gender in mind.Pain is the number one complaint of older Americans, and one in five older Americans takes a painkiller regularly.American Geriatrics Society (AGS) issued guidelines* for the management of pain in older people.Pain in younger patients also requires special attention, particularly because young children are not always able to describe
the degree of pain they are experiencing.Although treating pain in pediatric patients poses a special challenge to physicians
and parents alike, pediatric patients should never be undertreated.Recently, special tools for measuring pain in children
have been developed that, when combined with cues used by parents, help physicians select the most effective treatments.Nonsteroidal agents, and especially acetaminophen, are most often prescribed for control of pain in children.In the case
of severe pain or pain following surgery, acetaminophen may be combined with codeine.Pain Primer: What Do We Know About Pain?We may experience pain as a prick, tingle, sting, burn, or ache.The spinal cord acts as a sort of relay center where
the pain signal can be blocked, enhanced, or otherwise modified before it is relayed to the brain.One area of the spinal
cord in particular, called the dorsal horn (see section on Spine Basics in the Appendix), is important in the reception of pain signals.The most common destination in the brain for pain signals is the thalamus and from there to the cortex, the headquarters for
complex thoughts.In people who undergo an amputation, the representation of the amputated
limb is stored in the thalamus.For a discussion of the thalamus and its role in this phenomenon, called phantom pain, see
section on Phantom Pain in the Appendix.Pain is a complicated process that involves an intricate interplay between a number of important chemicals found naturally
in the brain and spinal cord.The body's chemicals act in the transmission of pain messages by stimulating neurotransmitter receptors found on the surface of cells; each receptor has a corresponding neurotransmitter.Receptors function much like gates or
ports and enable pain messages to pass through and on to neighboring cells.During experiments, mice with blocked glutamate receptors show a reduction in their responses to pain.Another type of receptor that responds to painful stimuli is called a nociceptor.Nociceptors are thin nerve fibers in the skin, muscle, and other body tissues, that, when stimulated, carry pain signals
to the spinal cord and brain.The body's natural painkillers may yet prove to be the most promising pain relievers, pointing to one of the most important
new avenues in drug development.Endorphins and enkephalins are other natural painkillers.Endorphins may be responsible for the "feel good" effects experienced by many people after
rigorous exercise; they are also implicated in the pleasurable effects of smoking.Similarly, peptides, compounds that make up proteins in the body, play a role in pain responses.When exposed to mild pain, these mice react in the same way as
mice that carry the missing gene.But when exposed to more severe pain, the mice exhibit a reduced pain response.NINDS, may pave the way for drugs tailored to treat different severities of
pain.For example, a type of frog native to Ecuador has been found to have a chemical in its skin called epibatidine, derived
from the frog's scientific name, Epipedobates tricolor.The idea of using receptors as gateways for pain drugs is a novel idea, supported by experiments involving substance P.Importantly, the animals still responded to acute, that is, normal, pain.The protective, early warning signal
that pain provides is essential for normal functioning.If this work can be translated clinically, humans might be able to
benefit from similar compounds introduced, for example, through lumbar (spinal) puncture.Within a week or so, rats receiving
these transplants cease to exhibit telltale signs of pain.Extensive animal studies will be required to learn if this technique
might be of value to humans with severe pain.One way to control pain outside of the brain, that is, peripherally, is by inhibiting hormones called prostaglandins.Prostaglandins stimulate nerves at the site of injury and cause inflammation and fever.Certain drugs, including NSAIDs,
act against such hormones by blocking the enzyme that is required for their synthesis.Blood vessel walls stretch or dilate during a migraine attack and it is thought that serotonin plays a complicated role in
this process.They are called serotonin agonists because they mimic the action of endogenous (natural) serotonin and bind to specific subtypes of serotonin receptors.Ongoing pain research, much of it supported by the NINDS, continues to reveal at an unprecedented pace fascinating insights
into how genetics, the immune system, and the skin contribute to pain responses.CYP2D6 also helps break down certain other drugs.CYP2D6 is currently under investigation for its role
in pain.Liebeskind, a renowned pain expert and a professor of psychology at UCLA, found that pain
can kill by delaying healing and causing cancer to spread.In his pioneering research on the immune system and pain, Dr.These cells are thought to help protect the body against tumors.Cytokines can trigger pain by promoting
inflammation, even in the absence of injury or damage.Certain types of cytokines have been linked to nervous system injury.After trauma, cytokine levels rise in the brain and spinal cord and at the site in the peripheral nervous system where the
injury occurred.Improvements in our understanding of the precise role of cytokines in producing pain, especially pain resulting
from injury, may lead to new classes of drugs that can block the action of these substances.What is the Future of Pain Research?In the forefront of pain research are scientists supported by the National Institutes of Health (NIH), including the NINDS.Developing better pain treatments is the primary goal of all pain research being conducted by
these institutes.Some pain medications dull the patient's perception of pain.Morphine is one such drug.Patients receiving morphine also face the problem of morphine tolerance,
meaning that over time they require higher doses of the drug to achieve the same pain relief.One objective of investigators working to develop the future generation of pain medications is to take full advantage of the
body's pain "switching center" by formulating compounds that will prevent pain signals from being amplified or stop them altogether.Blocking or interrupting pain signals, especially when there is no injury or trauma to tissue, is an important goal in the
development of pain medications.An increased understanding of the basic mechanisms of pain will have profound implications
for the development of future medicines.The following areas of research are bringing us closer to an ideal pain drug.Positron emission tomography (PET), functional magnetic resonance imaging (fMRI), and other
imaging technologies offer a vivid picture of what is happening in the brain as it processes pain.Interestingly, when patients undergo hypnosis so that the unpleasantness of a painful stimulus is not experienced,
activity in some, but not all, brain areas is reduced.This emphasizes that the experience of pain involves a strong emotional
component as well as the sensory experience, namely the intensity of the stimulus.The possibility now exists for developing new classes
of drugs, including pain cocktails that would act at the site of channel activity.Trophic Factors: A class of "rescuer" or "restorer" drugs may emerge from our growing knowledge of trophic factors, natural chemical substances
found in the human body that affect the survival and function of cells.These receptors may provide targets for new pain therapies.Molecular Genetics: Certain genetic mutations can change pain sensitivity and behavioral responses to pain.These genetic mutations cause
a disruption or alteration in the processing of pain information as it leaves the spinal cord and travels to the brain.Plasticity: Following injury, the nervous system undergoes a tremendous reorganization.This in turn disrupts the cells' supply of trophic factors.Scientists can now identify and study the changes that occur during
the processing of pain.For example, using a technique called polymerase chain reaction, abbreviated PCR, scientists can study
the genes that are induced by injury and persistent pain.There is evidence that the proteins that are ultimately synthesized
by these genes may be targets for new therapies.The dramatic changes that occur with injury and persistent pain underscore
that chronic pain should be considered a disease of the nervous system, not just prolonged acute pain or a symptom of an injury.Neurotransmitters: Just as mutations in genes may affect behavior, they may also affect a number of neurotransmitters involved in the control
of pain.Using sophisticated imaging technologies, investigators can now visualize what is happening chemically in the spinal
cord.From this work, new therapies may emerge, therapies that can help reduce or obliterate severe or chronic pain.Hope for the Future
Thousands of years ago, ancient peoples attributed pain to spirits and treated it with mysticism and incantations.Today, scientists understand a great deal about the causes and mechanisms of pain, and research has produced
dramatic improvements in the diagnosis and treatment of a number of painful disorders.Their research offers a powerful weapon in the battle to prolong and improve the lives of people
with pain: hope.Where can I get more information?American Chronic Pain Association (ACPA)P.National Headache Foundation820 N.Promotes research into headache causes and treatments and educates the public.National Foundation for the Treatment of PainP.The Mayday Pain Project works to increase awareness and to provide objective information concerning the treatment of pain.Offers free brochures on various types of arthritis, treatment options, and management of daily activities
when affected.Stacked on top of one another in the spine are more than 30 bones, the vertebrae, which together form the spine.The vertebrae are linked by ligaments, tendons, and muscles.Back pain can occur when, for example, someone lifts something
too heavy, causing a sprain, pull, strain, or spasm in one of these muscles or ligaments in the back.In many cases, degeneration or pressure from overexertion can cause a disc to shift or
protrude and bulge, causing pressure on a nerve and resultant pain.When this happens, the condition is called a slipped,
bulging, herniated, or ruptured disc, and it sometimes results in permanent nerve damage.Along the dorsal root are the cells
of the dorsal root ganglia, which are critical in the transmission of "pain" messages from the cord to the brain.It is here
where injury, damage, and trauma become pain.The autonomic nervous system controls involuntary functions in the body, like perspiration,
blood pressure, heart rate, or heart beat.It is divided into the sympathetic and parasympathetic nervous systems.Neuralgia, as in trigeminal neuralgia, is a term that refers to pain that arises from abnormal activity of a nerve trunk or
its branches.The type and severity of pain associated with neuralgia vary widely.Phantom Pain: How Does the Brain Feel?Sometimes, when a limb is removed during an amputation, an individual will continue to have an internal sense of the lost
limb.Similarly, many amputees
are frequently aware of severe pain in the absent limb.Their pain is real and is often accompanied by other health problems,
such as depression.What causes this phenomenon?Scientists believe that following amputation, nerve cells "rewire" themselves and continue to
receive messages, resulting in a remapping of the brain's circuitry.The brain's ability to restructure itself, to change
and adapt following injury, is called plasticity (see section on Plasticity).Our understanding of phantom pain has improved tremendously in recent years.Investigators previously believed that brain
cells affected by amputation simply died off.They attributed sensations of pain at the site of the amputation to irritation
of nerves located near the limb stump.MRI), scientists can actually visualize increased activity in the brain's cortex when an individual feels
phantom pain.Surprisingly, the brain's cells can be stimulated by other body parts, often those located closest to the missing limb.The hot feeling, red face, and watery eyes you experience when you bite into a red chili pepper may make you reach for a cold
drink, but that reaction has also given scientists important information about pain.In 1997, scientists at the University of California at San Francisco discovered a gene for a capsaicin receptor, called the
vanilloid receptor.Once in contact with capsaicin, vanilloid receptors open and pain signals are sent from the peripheral
nociceptor and through central nervous system circuits to the brain.It works by reducing the amount of substance P found in nerve endings and interferes with the transmission
of pain signals to the brain.Some individuals find the burning sensation they experience when using capsaicin cream to be intolerable,
especially when they are already suffering from a painful condition, such as postherpetic neuralgia.Soon, however, better
treatments that relieve pain by blocking vanilloid receptors may arrive in drugstores.As a painkiller, marijuana or, by its Latin name, cannabis, continues to remain highly controversial.In the eyes of many individuals campaigning on its behalf, marijuana rightfully
belongs with other pain remedies.In 1997, the National Institutes of Health held a workshop to discuss research on the possible therapeutic uses for smoked
marijuana.Panel members from a number of fields reviewed published research and heard presentations from pain experts.There is evidence, however, that receptors to which marijuana binds are found in
many brain regions that process information that can produce pain.Nerve blocks can also be used to prevent or even diagnose pain.Regional blocks affect a larger area of the body.Morphine and methadone are opioid narcotics (such
drugs end in ine or one) that are sometimes used for regional analgesia and are administered as an injection.Neurolytic blocks employ injection of chemical agents such as alcohol, phenol, or glycerol to block pain messages and are
most often used to treat cancer pain or to block pain in the cranial nerves (see The Nervous Systems).Surgical blocks are performed on cranial, peripheral, or sympathetic nerves.They are most often done to relieve the pain
of cancer and extreme facial pain, such as that experienced with trigeminal neuralgia.There are several different types of
surgical nerve blocks and they are not without problems and complications.For that reason, the procedure should be reserved for a select group of patients
and should only be performed by skilled surgeons.Spinal dorsal rhizotomy in which the surgeon cuts the root or rootlets of one or more of the nerves radiating from the spine.Other rhizotomy procedures
include cranial rhizotomy and trigeminal rhizotomy, performed as a treatment for extreme facial pain or for the pain of cancer.Sympathectomy, also called sympathetic blockade, in which a drug or an agent such as guanethidine is used to eliminate pain in a specific area (a limb, for example).The term takes its name from the sympathetic nervous system (see The Nervous Systems) and may involve, for example, cutting a nerve that controls contraction of one or more arteries."Pain: Hope Through Research," NINDS.National Institute of Neurological Disorders and Stroke or any other Federal agency.Credit to the NINDS or the NIH is appreciated.What are your treatment options?Heartburn Health Check
Assess your pain.Is pain limiting your life?Sunlight: Good for Bad for Cancer Risk?How Safe Are Your Arthritis Painkillers?Is Your Back Pain a Warning Sign?Box_links_fmt li, * html .Academic Research: These are the current technical articles your doctor is reading.Clinical Guidelines: Expert panels set these standards for diagnosis and treatment."The email address you have entered is invalid.When MS Attacks, Are You Ready?Travel Without InjuryHolidays are hard on the nerves but can be harder on the back.Avoid spending your holiday in pain.Avoiding Yoga InjuriesYoga is making a comeback as one of the hottest fitness crazes.Acupuncture for Menopause The ancient Chinese therapy offers some menopausal women another option for their hot flashes.Burn VacuumThe first priority in treating burns is to stop infection.But little can be done to stop the burn itself from going deeper into the flesh.Now doctors are testing suction from a vacuum to stop a burn in its tracks.The Gender SolutionsTM Knee.The knee women are talking about.Take your next steps in pain relief.The 300 Workout: Can You Handle It?Met a lot of people, drank alot of drinks..We were also one of the first non Russian bands to do a real Russian tour, which was one of the highlights in my music career with PAIN.So much crazyness in a possitive way and i hope it wasnt the last time..Now its time to write new songs..Finding out how your brain processes pain signals can help.Your experience of pain is part biology, but it's also influenced by psychological and cultural factors.Sensations of severe pain are transmitted almost instantaneously.There, they release chemicals (neurotransmitters) that activate other nerve cells in the spinal cord, which process the information and then transmit it up to the brain.Your brain responds to pain by sending messages that moderate the pain in the spinal cord.The location of your pain can affect how you perceive it.World War II veterans and their reactions to different types of injuries.Pain messages don't travel directly from your pain receptors to your brain.When pain messages reach your spinal cord, they meet up with specialized nerve cells that act as gatekeepers, which filter the pain messages on their way to your brain.For severe pain that's linked to bodily harm, such as when you touch a hot stove, the "gate" is wide open, and the messages take an express route to your brain.Weak pain messages, however, may be filtered or blocked out by the gate.Nerve fibers that transmit touch also affect gatekeeper cells.The signals of touch from the rubbing actually decrease the transmission of pain signals.Nerve cells in your spinal cord may release chemicals that intensify the pain, increasing the strength of the pain signal that reaches your brain.At the same time, inflammation at the site of injury may add to your pain.Messages from your brain also affect the gate.Rather than just reacting to pain, your brain actually sends messages that influence your perception of pain.For example, a minor sensation that would barely register as pain, such as a dentist's probe, can actually produce exaggerated pain for a child who's never been to the dentist and who's heard horror stories about what it's like.Athletes can condition themselves to endure pain that would incapacitate others.And, if you were raised in a home or culture that taught you to "Grin and bear it" or to "Bite the bullet," you may experience less discomfort than do people who focus on their pain or who are more prone to complain.Pain is generally described as chronic when it lasts six months or longer.As with acute pain, chronic pain can feel tingling, jolting, burning, dull, aching or sharp.It may remain constant, or it can come and go, like the pain of migraines.Sometimes, chronic pain is due to a chronic condition, such as arthritis, which produces painful inflammation in your joints.Occasionally, chronic pain may stem from an accident, infection or surgery that damages a peripheral or spinal nerve.Occasionally, the cause of chronic pain isn't well understood.There may be no evidence of disease or damage to tissues that doctors can directly link to pain.Or pain may remain after the original injury shows every indication of being healed.Doctors and researchers think chronic pain may be partly caused by a process called sensitization.In this process, your nervous system amplifies and distorts pain, much the way your stereo speakers change the character of recorded music when you crank up the volume.The result is a painful condition that is severe and out of proportion to the disease or original injury.In the peripheral nervous system, sensitization can result from inflammation, which causes your nociceptors to fire with greater intensity, for a longer time and at a lower threshold than usual.In the spinal cord, sensitization is the result of chemical reactions that increase pain messages being sent to your brain.When this occurs, chronic pain may be associated with emotional and psychological suffering.Pain researchers are focused on identifying the biology that underlies sensitization.They're also investigating other genetic and psychological factors behind how you feel pain, with the goal of developing new and better pain treatments.Mayo Foundation for Medical Education and Research (MFMER).LEGAL CONDITIONS AND TERMS OF USE APPLICABLE TO ALL USERS OF THIS SITE.ANY USE OF THIS SITE CONSTITUTES YOUR AGREEMENT TO THESE TERMS AND CONDITIONS OF USE.Mayo Foundation for Medical Education and Research.Buy 2 books and get 1 free!Get your free trial issue of Health Letter now!Pain: Hope Through ResearchChronic pain information page compiled by the National Institute of Neurological Disorders and Stroke (NINDS).Low Back Pain Fact SheetBack Pain information sheet compiled by the National Institute of Neurological Disorders and Stroke (NINDS).NINDS Trigeminal Neuralgia Information PageTrigeminal Neuralgia (tic doloreaux) information compiled by NINDS, the National Institute of Neurological Disorders and Stroke.NINDS Central Pain Syndrome Information PageCentral Pain Syndrome information sheet compiled by the National Institute of Neurological Disorders and Stroke (NINDS).NINDS Complex Regional Pain Syndrome Information PageComplex Regional Pain Syndrome (also called Causalgia and Reflex Sympathetic Dystrophy Syndrome) information page compiled
by the National Institute of Neurological Disorders and Stroke (NINDS).Complex Regional Pain Syndrome Fact SheetComplex Regional Pain Syndrome (also called Causalgia and Reflex Sympathetic Dystrophy Syndrome) information page compiled
by the National Institute of Neurological Disorders and Stroke (NINDS).Amid Ongoing Controversy, Researchers Find Opiates Relieve Chronic Pain From Nervous System DamageMay 2003 news summary on recent findings that opioid drugs can be effective in treating chronic pain.Study Links Chronic Pain to Signals in the BrainJanuary 2003 news summary on proteins that play a role in chronic pain.Pain: Hope Through ResearchTable of Contents (click to jump to sections)What is Chronic Pain?What is Chronic Pain?While acute pain is a normal sensation triggered in the nervous system to alert you to possible injury and the need to take
care of yourself, chronic pain is different.Pain signals keep firing in the nervous system for weeks,
months, even years.Many chronic pain conditions affect older adults.Medications, acupuncture, local electrical stimulation, and brain stimulation, as well as surgery, are some treatments for
chronic pain.Some physicians use placebos, which in some cases has resulted in a lessening or elimination of pain.Many people with chronic pain can be helped if they understand all the causes of pain and the many and varied steps that can
be taken to undo what chronic pain has done.Scientists believe that advances in neuroscience will lead to more and better
treatments for chronic pain in the years to come.What research is being done?Investigations of acupuncture include wiring the needles to stimulate nerve endings electrically (electroacupuncture),
which some researchers believe activates endorphin systems.Other experiments with acupuncture have shown that there are higher
levels of endorphins in cerebrospinal fluid following acupuncture.Investigators are studying the effect of stress on the
experience of chronic pain.Chemists are synthesizing new analgesics and discovering painkilling virtues in drugs not normally
prescribed for pain.American Chronic Pain Association (ACPA)P.National Foundation for the Treatment of PainP.Credit to the NINDS or the NIH is appreciated. |
![Gescom : That [single]](/covers/17/17833/alb_72245_th.jpg "Gescom : That [single]")
