On Pain

Overview

The assessment and management of pain is core to all disciplines of healthcare providers - and for those of us who work in palliative care, it is perhaps the most common symptom we are asked to address.
While we mostly speak of pain as a physical experience, "total" pain is recognized as something that is influenced and modulated by emotions, stress, spiritual distress or hope, as well as by the physical condition of our bodies and the direct issue that is triggering the pain.

Types of pain

  • Nociceptive: is due to tissue irritation from noxious stimuli and inflammation.  Nerve conduction is generally normal.  Nociceptive pain can be acute or chronic.  Bone pain from cancer metastases may be an example of chronic nociceptive pain.  Description: dull or sharp, aching.
  • Neuropathic: is due to nerve damage, either acute or chronic, leading to misfiring of the afferent nervous system.  Description: burning, stinging, tingling, electric shock.  
    • Allodynia - pain to non-painful stimuli (i.e. light touch, sheets).
    • Anesthesia - loss of normal sensation (i.e. numbness)
    • Dysesthesia - unpleasant abnormal sensation
    • Hyperalgesia - exaggerated sensation of pain to stimulus
    • Hypoesthesia - decreased sensation
    • Paresthesia - strange, abnormal sensations without stimulus
    • Phantom pain -  pain at or distal to location of amputation
    • Referred pain - pain at a location that is different from the cause of the pain
  • Mixed Pain:  Combination of nociceptive and neuropathic pain
  • Chronic Pain: Pain that persists more than 3 months.  It is often associated with nerve damage.  Often patients who have chronic pain appear comfortable to the observer.
  • Acute Pain: Acute pain can last up to 3 months, but usually resolves sooner than that.  It is usually the result of direct tissue damage causing stimulation of the nociceptors (unmyelinated and thinly myelinated fibers) and inflammation.  This type of pain can trigger autonomic nervous system response.  Under-treated acute pain can lead to chronic pain.

Articles

Principles of Pain Management:
Total Pain:
Basic Science:
Spirituality and Pain:
  1. Spirituality, Religiosity, and Spiritual Pain in Advanced Cancer Patients. Delgado-Guay MO, Hui D, Parsons HA, Govan K, de la Cruz M, Thorney S, Bruera E.  Journal of Pain and Symptom Management. 2011; 41(6): 986-994, DOI: 10.1016/j.jpainsymman.2010.09.017)*** (Open Access)