I will be covering this topic as under, Part 1: Definition of Pain Introduction Measurement of pain and disability - Scales Components

ents of Pain Observable pain behaviors Types: Acute and Chronic Pain concept.
Part 2: Properties of Pain Pathways of Pain Mechanism References
Tuesday, December 03, 2013

Pain

Definition of Pain: The International Association for the study of Pain (IASP) has defined pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.

Tuesday, December 03, 2013

Pain

 It

is clear from this definition that tissue damage and pain perception are not necessarily correlated , and the patients account of pain should be accepted as his or her own perception of the problem. Moreover, pain perception is the sum of complex sensory, emotional and cognitive processes, represented by the biopsychosocial model of pain.
Tuesday, December 03, 2013

Pain

 Pain

is always subjective. Each individual learns the application of the word through experiences related to injury in early life. Biologists recognize that those stimuli which cause pain are liable to damage tissue. Experiences which resemble pain but are not unpleasant, e.g., pricking, should not be called pain.
Tuesday, December 03, 2013

Pain

Pain in the medical model, is considered a symptom of disease to be diagnosed and treated. Unfortunately, a cause and a diagnosis cannot always be established. The words pain and suffering have often been used synonymously but the experience of suffering has been differentiated from pain
Tuesday, December 03, 2013

Pain

Suffering has been defined as including the experience of pain but as also including vulnerability, dehumanization, a lost sense of self, blocked coping efforts, lack of control over time and space and an inability to find meaning or purpose in the painful experience.

Tuesday, December 03, 2013

Pain

 Measurement

of Pain and Disability: There is no simple method of measuring pain. The intensity of an individuals pain is based on what is verbally or nonverbally communicated about the experience Patients often express difficulty describing pain, and two people may have very different descriptions for pain that accompanies a similar injury
Tuesday, December 03, 2013

Pain

 Pain

intensity can be measured by using ratings such as a visual analog scale(VAS). A VASconsists of a 10 cm line on which 0 cm is no pain and 10 cm is pain as bad as it could be. The patient marks the point along the line that best represents his or her pain, and the score is measured from the no pain end of the scale.
Tuesday, December 03, 2013

Pain

 Numeric

scales (e.g., 1 to 10) and descriptive rating scales (e.g., no pain, mild, moderate, severe pain) are also used.
analog scales are sensitive to treatment effects, can be incorporated into pain diaries and can be used with children.

Visual

Tuesday, December 03, 2013

Pain

 Scales:
The

McGill Pain Questionnaire was created to measure the motivational affective and the cognitive evaluative qualities of pain, in addition to the sensory experience. The questionnaire was designed to capture the multi dimensional nature of pain and to provide quantitative measures of clinical pain that can be treated statistically
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The questionnaire enables the patient to choose from 78 adjectives (arranged in 20 groups) that describe pain. The form is designed to assess the sensory (groups 1 to 10), affective (groups 11 to 15), and evaluative (group 16) dimensions of pain and to produce a pain rating index. There are also sections for the location and temporal characteristics of pain and a rating for present pain intensity.

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 Turk

and Rudy have developed the Multiaxial Assessment of Pain (MAP) classification and have tested it on several pain populations. Their assessment included a 61 item questionnaire, the West Haven- Yale Multidimensional Pain Inventory (WHYMPI), which measures adjustment to pain from a cognitive behavioral perspective

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 The

following three distinct profiles emerged:

1. dysfunctional,
2. interpersonally distressed 3. adaptive copers

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 Dworkin,

LeResche and colleagues hae developed a method for assessing dysfunctional chronic pain as part of a classification system, the Research Diagnostic criteria. They used the Graded Chronic Pain Severity scale, the depression and vegetative symptom scales from the symptom check list 90 revised (SCL-90-R) and a jaw disability checklist
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 All

three of these scales are based on questionnaires that are completed by the patient. The criteria were developed to advance the research in temporomandibular disorders.

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 The

Graded Chronic Pain severity Scale has four grades of disability and pain intensity based on seven questions, of which three are related to pain intensity and four are related to disabiity.

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The SCL-90-R depression scales are used to identify patients who may be experiencing significant depression, a problem commonly associated with chronic pain.

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Components of Pain: (World Health Organisation)

Total Pain: 4 parts a. Depression b. Physical source c. Anger d. Anxiety

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 Depression:

loss of social position, job, income, role in family, Helplessness, disfigurement, body image, insomnia. Physical source: Cancer, noncancer pathology, side effects of cancer, symptoms of debility, chronic fatigue

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 Anxiety:

Fear of pain, fear of hospital, loss of dignity, loss of control, loss of bodily function, uncertainty about future, worry about family, guilt and sadness, spiritual unrest, fear of death Anger: Bureaucratic bungles, let down by friends, Delays in diagnosis, unavailable doctors, therapeutic failure.
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Observable Pain Behaviors:

Guarding-abnormally slow, stiff, or interrupted movement Bracing- Stiff, pain-avoidant posturing while in a static position Rubbing- Touching, rubbing or holding of the painful area Sighing- Pronounced exhalation of air Grimacing- Obvious facial expression of pain.
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 Acute
Acute

Pain vs Chronic Pain:

Pains refers to pains that are of short duration. They are often closely related to somatic tissue changes such as those produced by trauma or disease. Chronic Pain refers to pains of long duration and these pains take on a different therapeutic meaning.
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Chronic Pain: Although a precise definition of chronic pain has not been established, a distinction between acute and chronic pain has emerged.

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Chronic Pain is now recognized as a complex disorder that is influenced by biologic factors and by a range of psychosocial factors, including emotion, psychological distress, family and work environment, cultural background, the meaning of the pain and appraisals of the controllability of pain.

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 Chronic

Pain has been defined as pain that persists past the normal time of healing, but this may not be an easy determination. Recently, pain lasting longer than 3 months has been used to define chronic pain.
In

the IASP publication on classification, Merskey describes chronic pain as a persistent pain that is not amenable, as a rule, to treatments based on specific remedies, or to the routine methods of pain control such as non narcotic analgesics

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Classification Schemes: Scheme for coding chronic pain diagnoses (IASP-classification) Axis Definition 1 Region 2 Systems 3 Temporal characteristics of Pain 4 Patients statement of intensity 5 Etiology

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Classification of idiopathic orofacial pain: Daily pain that is deep and poorly localized, persisting for most or all of the day. Pain at onset confined to a limited area on one side of the face and that may spread to the upper and lower jaws or a wider area of the face or neck. Pain not associated with sensory loss or other physical signs, and laboratory investigations do not demonstrate relevant abnormality.

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Classification of cranial neuralgias, nerve trunk pain and Deafferentiation pain: Persistent Trigeminal neuralgia Glossopharyngeal neuralgia Nervus intermedius neuralgia Superior laryngeal neuralgia Occipital neuralgia Central causes of head and facial pain other than tic douloureaux Atypical

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 Classification

origin: Muscle Tension Delusional or hallucinatory Hysterical, conversion, or hypochondriacal Associated with depression

of pain of psychological

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Orofacial pain is linked to cardiac ischaemia, temporal arteritis, intracranial tumor, carcinoma of the infratemporal fossa, multiple sclerosis, neurogenic disorder, tumor invasion of nerve.

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Systemic diseases associated with headache and orofacial pain Pagets disease Metastatic disease Hyperthyroidism Multiple myeloma Hyperparathyroidism Vitamin B deficiencies Systemic lupus erythematosus Vincristine therapy for cancer Folic acid and iron deficiency anaemias.

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 To

be continued in the 2nd part on 15th July 2006 (Saturday) Thank you.

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