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Pain Definition
Pain, while complex, seems too obvious a human experience to attempt a verbal definition but the International Association for the Study of Pain (IASP) has nevertheless, after much debate, research and deliberation reduced pain to the following definition:
Pain:
"An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage"
This accepted definition suggests a bridge between physical and psychological generators of the pain experience. The work of Crue and associates (1979, 1980, 2004) and others conceptualize pain as an interpretation of the meaning of signals coming from the body's periphery. In their view pain is not a primary sensation. It is an interpretation of activity coming from the sensory receptors (vision, hearing, taste, smell, touch, pressure, temperature, proprioception).
Early life experiences of a subjective nature provide the learning basis of pain which can shape and form our later reactions to pain.
Melzack and Wall (1965) found that pain perception involves three different systems:
- Sensory-discriminative
- Motivational-affective
- Cognitive-evaluative
Known as the "Gate-Control Theory", it integrates peripheral stimuli with brain/spinal cord mechanisms. Thus, incoming stimulation from sensations (ie., temperature, pressure, etc. receptors) in the body are processed in the brain and spinal cord which determines whether the sensation is determined to be "painful" or not. Important to the theory is the idea that the brain and all it's functions including confidence, memory, anxiety, depression to name a few, exerts a downward influence on incoming sensations. It can "dampen" or even entirely stop the upward flow of strong sensations. It can also reinterpret the arriving sensations in ways that changes the experience. From "excruciating" to "annoying" or from "agonizing" to "irritating" or the reverse!
The work of Crue, Melzack and others forms a neurophysiologic basis for explaining the development of some persistent chronic pain syndromes. Also, known as "central pain disorders", they have been shown to be improved with treatment methods used in chronic pain management programs. These treatments are designed to strengthen the functioning of the brain and spinal cord. This includes chemical, mental, emotional and physical functions.
At Pacifica Pain Management Services we have adapted existing definitions with our clinical experience to formulate the following definition of a chronic pain syndrome:
Chronic Pain Syndrome:
An unpleasant sensory or emotional experience associated with actual or potential tissue damage which has lasted for at least 6 months and has not responded to aggressive medical pain management efforts. It has resulted in a cluster of problems (syndrome) such as weight gain, narcotic dependency/abuse/addiction, depression, muscle wasting, sexual dysfunction, secondary physical problems (ie., gastric distress, bowel dysfunction), insomnia, social withdrawal, etc. The syndrome interacts with pain to create a complex that is difficult to treat. It is frequently confused with a primary psychological disorder which it is not.
Selected Definitions:
Pain: "An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage" - International Association for the Study of Pain (1994)
Acute pain is the normal, predicted physiological response to an adverse chemical, thermal, or mechanical stimulus associated with surgery, trauma, and acute illness. It is usually of recent onset and generally time-limited
Hyperesthesia: reduced reaction to a noxious or aversive stimulus.
Hyperalgesia: excessive pain response.
Paresthesia: an abnormal sensation which is not perceived as painful but perhaps as tingling or pins and needles.
Dysesthesia is a strong sensation which is perceived as unpleasant or painful.
Allodynia is pain produced by a stimulus which would not normally cause pain.
Tolerance (drug) is a physiologic state resulting from regular use of a drug in which an increased dosage is needed over time to produce the same effect, or a reduced effect is observed with a constant dose.
Physical dependence (drug): a physiologic state marked by the emergence of a withdrawal syndrome if drug use is stopped/decreased abruptly, or if an antagonist is administered. Physical dependence usually occurs with use of narcotics. By itself, it does not necessarily equate with addiction.
Addiction is a neurobehavioral syndrome with genetic and environmental influences that results in psychological dependence on the use of substances for their psychic and physical effects and is characterized by compulsive use despite harm. Addiction may also be referred to by terms such as "drug dependence" and "psychological dependence". Physical dependence and tolerance are expected physiological consequences of extended narcotic therapy for pain and are also part of the addiction process.
Pseudo-addiction is a confusing term regarding drug seeking behavior in pain patients who are receiving inadequate pain management that can be mistaken for addiction. The term can be used by physicians and patients alike to deny the truth of their behavior (ie., co-dependent and addictive). Probably a term of little value.
Substance abuse is the use of any substance(s)/drugs for non-therapeutic purposes or use of medication for purposes other than those for which it is prescribed
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