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This article is about physical pain. For mental or emotional pain, see. For other uses, see.PainA woman grimacing while having blood drawnTypesPhysical,MedicationPain is a distressing feeling often caused by intense or damaging stimuli. The 's widely used definition defines pain as 'an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage'. In medical diagnosis, pain is regarded as a of an underlying condition.Pain motivates the individual to withdraw from damaging situations, to protect a damaged body part while it heals, and to avoid similar experiences in the future. Most pain resolves once the is removed and the body has healed, but it may persist despite removal of the stimulus and apparent healing of the body. Sometimes pain arises in the absence of any detectable stimulus, damage or disease.Pain is the most common reason for physician consultation in most developed countries.
Painful definition is - feeling or giving pain. How to use painful in a sentence. Endless, painful vs painful, endless - English Only forum exactly how painful the bite is or the effect it can have - English Only forum felt so painful - English Only forum find his waist painful - English Only forum found out the hard and painful way - English Only forum I became nervous to a most painful degree. English Only forum.
It is a major symptom in many medical conditions, and can interfere with a person's and general functioning. Simple pain medications are useful in 20% to 70% of cases. Psychological factors such as, hypnotic suggestion, excitement, or distraction can significantly affect pain's intensity or unpleasantness. In some debates regarding or, pain has been used as an argument to permit people who are terminally ill to end their lives. Main article:Pain is usually transitory, lasting only until the noxious stimulus is removed or the underlying damage or pathology has healed, but some painful conditions, such as, and pain, may persist for years. Pain that lasts a long time is called or persistent, and pain that resolves quickly is called. Traditionally, the distinction between acute and chronic pain has relied upon an arbitrary interval of time between onset and resolution; the two most commonly used markers being 3 months and 6 months since the onset of pain, though some theorists and researchers have placed the transition from acute to chronic pain at 12 months.: 93 Others apply acute to pain that lasts less than 30 days, chronic to pain of more than six months' duration, and subacute to pain that lasts from one to six months.
A popular alternative definition of chronic pain, involving no arbitrarily fixed durations, is 'pain that extends beyond the expected period of healing'. Chronic pain may be classified as or else as benign.
Allodynia is pain experienced in response to a normally painless stimulus. It has no biological function and is classified by stimuli into dynamic mechanical, punctate and static. In osteoarthritis, NGF has been identified as being involved in allodynia. The extent and intensity of sensation can be assessed through locating trigger points and the region of sensation, as well as utilising phantom maps. Main article:is pain felt in a part of the body that has been, or from which the brain no longer receives signals. It is a type of neuropathic pain.The of phantom pain in upper limb amputees is nearly 82%, and in lower limb amputees is 54%. One study found that eight days after amputation, 72% of patients had phantom limb pain, and six months later, 67% reported it.
Some amputees experience continuous pain that varies in intensity or quality; others experience several bouts of pain per day, or it may reoccur less often. It is often described as shooting, crushing, burning or cramping.
If the pain is continuous for a long period, parts of the intact body may become sensitized, so that touching them evokes pain in the phantom limb. Phantom limb pain may accompany or.: 61–9injections into the nerves or sensitive areas of the stump may relieve pain for days, weeks, or sometimes permanently, despite the drug wearing off in a matter of hours; and small injections of saline into the soft tissue between vertebrae produces local pain that radiates into the phantom limb for ten minutes or so and may be followed by hours, weeks or even longer of partial or total relief from phantom pain. Vigorous vibration or electrical stimulation of the stump, or current from electrodes surgically implanted onto the spinal cord, all produce relief in some patients.: 61–9produces the illusion of movement and touch in a phantom limb which in turn may cause a reduction in pain., the loss of sensation and voluntary motor control after serious spinal cord damage, may be accompanied by at the level of the spinal cord damage, evoked by a filling bladder or bowel, or, in five to ten per cent of paraplegics, phantom body pain in areas of complete sensory loss. This phantom body pain is initially described as burning or tingling but may evolve into severe crushing or pinching pain, or the sensation of fire running down the legs or of a knife twisting in the flesh.
Onset may be immediate or may not occur until years after the disabling injury. Surgical treatment rarely provides lasting relief.: 61–9 Breakthrough Breakthrough pain is transitory pain that comes on suddenly and is not alleviated by the patient's regular pain management. It is common in cancer patients who often have background pain that is generally well-controlled by medications, but who also sometimes experience bouts of severe pain that from time to time 'breaks through' the medication.
The characteristics of breakthrough vary from person to person and according to the cause. Management of breakthrough pain can entail intensive use of, including. Asymbolia and insensitivity. A patient and doctor discuss congenital insensitivity to painThe ability to experience pain is essential for protection from injury, and recognition of the presence of injury. Episodic may occur under special circumstances, such as in the excitement of sport or war: a soldier on the battlefield may feel no pain for many hours from a traumatic amputation or other severe injury.Although unpleasantness is an essential part of the definition of pain, it is possible to induce a state described as intense pain devoid of unpleasantness in some patients, with injection. Such patients report that they have pain but are not bothered by it; they recognize the sensation of pain but suffer little, or not at all.
Indifference to pain can also rarely be present from birth; these people have normal nerves on medical investigations, and find pain unpleasant, but do not avoid repetition of the pain stimulus.Insensitivity to pain may also result from abnormalities in the. This is usually the result of damage to the nerves, such as, , or in countries where that disease is prevalent. These individuals are at risk of tissue damage and infection due to undiscovered injuries. People with diabetes-related nerve damage, for instance, sustain poorly-healing foot ulcers as a result of decreased sensation.A much smaller number of people are insensitive to pain due to an inborn abnormality of the nervous system, known as '. Children with this condition incur carelessly-repeated damage to their tongues, eyes, joints, skin, and muscles. Some die before adulthood, and others have a reduced life expectancy.
Most people with congenital insensitivity to pain have one of five (which includes and ). These conditions feature decreased sensitivity to pain together with other neurological abnormalities, particularly of the. A very rare syndrome with isolated congenital insensitivity to pain has been linked with mutations in the gene, which codes for a sodium channel necessary in conducting pain nerve stimuli.
Functional effects Experimental subjects challenged by acute pain and patients in chronic pain experience impairments in attention control, problem solving, and information processing speed. Acute and chronic pain are also associated with increased depression, anxiety, fear, and anger.If I have matters right, the consequences of pain will include direct physical distress, unemployment, financial difficulties, marital disharmony, and difficulties in concentration and attention. — Harold Merskey 2000 On subsequent negative emotion Although pain is considered to be aversive and unpleasant and is therefore usually avoided, a which summarized and evaluated numerous studies from various psychological disciplines, found a reduction in.
Across studies, participants that were subjected to acute physical pain in the laboratory subsequently reported feeling better than those in non-painful control conditions, a finding which was also reflected in physiological parameters. A potential mechanism to explain this effect is provided by the.Theory Historical. Portrait of by, 1647-1649In 1644, theorized that pain was a disturbance that passed down along nerve fibers until the disturbance reached the brain. Descartes's work, along with Avicenna's, prefigured the 19th-century development of specificity theory.
Specificity theory saw pain as 'a specific sensation, with its own sensory apparatus independent of touch and other senses'. Another theory that came to prominence in the 18th and 19th centuries was intensive theory, which conceived of pain not as a unique sensory modality, but an emotional state produced by stronger than normal stimuli such as intense light, pressure or temperature. By the mid-1890s, specificity was backed mostly by physiologists and physicians, and the intensive theory was mostly backed by psychologists. However, after a series of clinical observations by and experiments by, the psychologists migrated to specificity almost en masse, and by century's end, most textbooks on physiology and psychology were presenting pain specificity as fact. Regions of the cerebral cortex associated with pain.(1874) 'intensive' theory, that a pain signal can be generated by intense enough stimulation of any sensory receptor, has been soundly disproved. Some sensory fibers do not differentiate between noxious and non-noxious stimuli, while others, respond only to noxious, high intensity stimuli.
At the peripheral end of the nociceptor, noxious stimuli generate currents that, above a given threshold, send along the nerve fiber to the spinal cord. The 'specificity' (whether it responds to thermal, chemical or mechanical features of its environment) of a nociceptor is determined by which it expresses at its peripheral end. Dozens of different types of nociceptor ion channels have so far been identified, and their exact functions are still being determined.The pain signal travels from the periphery to the spinal cord along an or fiber. Because the A-delta fiber is thicker than the C fiber, and is thinly sheathed in an electrically insulating material , it carries its signal faster (5–30 ) than the unmyelinated C fiber (0.5–2 m/s).
Pain evoked by the A-delta fibers is described as sharp and is felt first. This is followed by a duller pain, often described as burning, carried by the C fibers.
These 'first order' neurons enter the spinal cord via.These A-delta and C fibers 'second order' nerve fibers in the (laminae II and III of the ). The second order fibers then cross the cord via the and ascend in the. Before reaching the brain, the spinothalamic tract splits into the, and the,.Second order, spinal cord fibers dedicated to carrying A-delta fiber pain signals, and others that carry both A-delta and C fiber pain signals to the have been identified. Other spinal cord fibers, known as, respond to A-delta and C fibers, but also to the large A-beta fibers that carry touch, pressure and vibration signals. Pain-related activity in the thalamus spreads to the (thought to embody, among other things, the feeling that distinguishes pain from other such as itch and nausea) and (thought to embody, among other things, the affective/motivational element, the unpleasantness of pain). Pain that is distinctly located also activates and somatosensory cortex.In 1955, DC Sinclair and developed peripheral pattern theory, based on a 1934 suggestion. They proposed that all skin fiber endings (with the exception of those innervating hair cells) are identical, and that pain is produced by intense stimulation of these fibers.
Another 20th-century theory was, introduced by and in the 1965 article 'Pain Mechanisms: A New Theory'. The authors proposed that both thin (pain) and large diameter (touch, pressure, vibration) nerve fibers carry information from the site of injury to two destinations in the of the spinal cord, and that the more large fiber activity relative to thin fiber activity at the inhibitory cell, the less pain is felt.
See also:, andA person's self-report is the most reliable measure of pain. Some health care professionals may underestimate pain severity. A definition of pain widely employed in nursing, emphasizing its subjective nature and the importance of believing patient reports, was introduced by in 1968: 'Pain is whatever the experiencing person says it is, existing whenever he says it does'. To assess intensity, the patient may be asked to locate their pain on a scale of 0 to 10, with 0 being no pain at all, and 10 the worst pain they have ever felt.
Quality can be established by having the patient complete the indicating which words best describe their pain. Visual analogue scale. Main article:The visual analogue scale is a common, reproducible tool in the assessment of pain and pain relief. The scale is a continuous line anchored by verbal descriptors, one for each extreme of pain where a higher score indicates greater pain intensity. It is usually 10 cm in length with no intermediate descriptors as to avoid marking of scores around a preferred numeric value.
When applied as a pain descriptor, these anchors are often 'no pain' and 'worst imaginable pain'. Cut-offs for pain classification have been recommended as no pain (0-4mm), mild pain (5-44mm), moderate pain (45-74mm) and severe pain (75-100mm).
Multidimensional pain inventory The Multidimensional Pain Inventory (MPI) is a questionnaire designed to assess the state of a person with chronic pain. Combining the MPI characterization of the person with their is recommended for deriving the most useful case description. Assessment in non-verbal people. See also: andpeople cannot use words to tell others that they are experiencing pain. However, they may be able to communicate through other means, such as blinking, pointing, or nodding.With a non-communicative person, observation becomes critical, and specific behaviors can be monitored as pain indicators. Behaviors such as facial grimacing and guarding (trying to protect part of the body from being bumped or touched) indicate pain, as well as an increase or decrease in vocalizations, changes in routine behavior patterns and mental status changes.
Patients experiencing pain may exhibit withdrawn and possibly experience a and decreased nutritional intake. A change in condition that deviates from baseline, such as moaning with movement or when manipulating a body part, and limited are also potential pain indicators. In patients who possess language but are incapable of expressing themselves effectively, such as those with dementia, an increase in confusion or display of aggressive behaviors or agitation may signal that discomfort exists, and further assessment is necessary. Changes in behavior may be noticed by caregivers who are familiar with the person's normal behavior., but lack the language needed to report it, and so communicate distress by crying. A non-verbal pain assessment should be conducted involving the parents, who will notice changes in the infant which may not be obvious to the health care provider. Are more sensitive to painful stimuli than those carried to full term.Another approach, when pain is suspected, is to give the person treatment for pain, and then watch to see whether the suspected indicators of pain subside.
Other reporting barriers The way in which one experiences and responds to pain is related to sociocultural characteristics, such as gender, ethnicity, and age. An aging adult may not respond to pain in the same way that a younger person might. Their ability to recognize pain may be blunted by illness or the use of. Depression may also keep older adult from reporting they are in pain. Decline in may also indicate the older adult is experiencing pain. They may be reluctant to report pain because they do not want to be perceived as weak, or may feel it is impolite or shameful to complain, or they may feel the pain is a form of deserved punishment.Cultural barriers may also affect the likelihood of reporting pain.
Sufferers may feel that certain treatments go against their religious beliefs. They may not report pain because they feel it is a sign that death is near. Many people fear the stigma of addiction, and avoid pain treatment so as not to be prescribed potentially addicting drugs. Many Asians do not want to lose respect in society by admitting they are in pain and need help, believing the pain should be borne in silence, while other cultures feel they should report pain immediately to receive immediate relief.Gender can also be a perceived factor in reporting pain. Gender can be the result of social and cultural expectations, with women expected to be more emotional and show pain, and men more stoic. As a result, female pain is often stigmatized, leading to less urgent treatment of women based on social expectations of their ability to accurately report it. This leads to extended emergency room wait times for women and frequent dismissal of their ability to accurately report pain.
Diagnostic aid Pain is a symptom of many medical conditions. Knowing the time of onset, location, intensity, pattern of occurrence (continuous, intermittent, etc.), exacerbating and relieving factors, and quality (burning, sharp, etc.) of the pain will help the examining physician to accurately diagnose the problem. For example, chest pain described as extreme heaviness may indicate, while chest pain described as tearing may indicate. Physiological measurement brain scanning has been used to measure pain, and correlates well with self-reported pain.
Mechanism Nociceptive. Mechanism of nociceptive pain.Nociceptive pain is caused by stimulation of that respond to stimuli approaching or exceeding harmful intensity , and may be classified according to the mode of noxious stimulation. The most common categories are 'thermal' (e.g. Heat or cold), 'mechanical' (e.g. Crushing, tearing, shearing, etc.) and 'chemical' (e.g.
In a cut or chemicals released during ). Some nociceptors respond to more than one of these modalities and are consequently designated polymodal.Nociceptive pain may also be classed according to the site of origin and divided into 'visceral', 'deep somatic' and 'superficial somatic' pain. (e.g., the heart, liver and intestines) are highly sensitive to stretch, and, but relatively insensitive to other stimuli that normally evoke pain in other structures, such as burning and cutting. Is diffuse, difficult to locate and often to a distant, usually superficial, structure. It may be accompanied by nausea and vomiting and may be described as sickening, deep, squeezing, and dull. Deep somatic pain is initiated by stimulation of nociceptors in ligaments, tendons, bones, blood vessels, and muscles, and is dull, aching, poorly-localized pain. Examples include and broken bones.
Superficial somatic pain is initiated by activation of nociceptors in the skin or other superficial tissue, and is sharp, well-defined and clearly located. Examples of injuries that produce superficial somatic pain include minor wounds and minor (first degree). Neuropathic. Main article:Neuropathic pain is caused by damage or disease affecting any part of the involved in bodily feelings (the ). Neuropathic pain may be divided into peripheral, or mixed (peripheral and central) neuropathic pain. Neuropathic pain is often described as 'burning', 'tingling', 'electrical', 'stabbing', or 'pins and needles'. Bumping the ' elicits acute peripheral neuropathic pain.Nociplastic Nociplastic pain is pain characterized by a changed (but without evidence of real or threatened tissue damage, or without disease or damage in the ).This applies, for example, to patients.Psychogenic.
Main article:Psychogenic pain, also called psychalgia or somatoform pain, is pain caused, increased, or prolonged by mental, emotional, or behavioral factors. Headache, back pain, and stomach pain are sometimes diagnosed as psychogenic. Sufferers are often stigmatized, because both medical professionals and the general public tend to think that pain from a psychological source is not 'real'. However, specialists consider that it is no less actual or hurtful than pain from any other source.People with frequently display psychological disturbance, with elevated scores on the scales of, depression and (the '). Some investigators have argued that it is this neuroticism that causes acute pain to turn chronic, but clinical evidence points the other direction, to chronic pain causing. When long-term pain is relieved by therapeutic intervention, scores on the neurotic triad and fall, often to normal levels., often low in chronic pain patients, also shows improvement once pain has resolved.: 31–2 Management. Further information: andInadequate treatment of pain is widespread throughout surgical wards, and accident and, in, in the management of all forms of chronic pain including cancer pain, and in.
This neglect extends to all ages, from newborns to elderly. And are more likely than others to suffer unnecessarily while in the care of a physician; and women's pain is more likely to be undertreated than men's.The advocates that the relief of pain should be recognized as a, that chronic pain should be considered a disease in its own right, and that should have the full status of a.
It is a specialty only in China and Australia at this time. Elsewhere, pain medicine is a subspecialty under disciplines such as,.
In 2011, alerted that tens of millions of people worldwide are still denied access to inexpensive medications for severe pain. Medication Acute pain is usually managed with medications such as. When added to pain medications such as, may provide some additional benefit. Can be used instead of opioids for short term pain. Management of, however, is more difficult, and may require the coordinated efforts of a team, which typically includes, clinical, and.Sugar when taken by mouth reduces undergoing some medical procedures (a of the heel, and ). Sugar does not remove pain from, and it is unknown if sugar reduces pain for other procedures.Sugar did not affect pain-related in the brains of newborns one second after the heel lance procedure.
Sweet liquid by mouth moderately reduces the rate and duration of crying caused by immunization injection in children between one and twelve months of age. Psychological Individuals with more experience less cancer pain, take less pain medication, report less labor pain and are less likely to use during childbirth, or suffer from chest pain after.can significantly affect pain intensity. About 35% of people report marked relief after receiving a injection they believed to be.
This effect is more pronounced in people who are prone to anxiety, and so anxiety reduction may account for some of the effect, but it does not account for all of it. Placebos are more effective for intense pain than mild pain; and they produce progressively weaker effects with repeated administration.: 26–8 It is possible for many with chronic pain to become so absorbed in an activity or entertainment that the pain is no longer felt, or is greatly diminished.: 22–3(CBT) has been shown effective for improving quality of life in those with chronic pain but the reduction in suffering is modest, and the CBT method was not shown to have any effect on outcome.
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(ACT) may also be effective in the treatment of chronic pain.A number of meta-analyses have found to be effective in controlling pain associated with diagnostic and surgical procedures in both adults and children, as well as pain associated with cancer and childbirth. A 2007 review of 13 studies found evidence for the efficacy of hypnosis in the reduction of chronic pain under some conditions, though the number of patients enrolled in the studies was low, raising issues related to the statistical power to detect group differences, and most lacked credible controls for placebo or expectation. The authors concluded that 'although the findings provide support for the general applicability of hypnosis in the treatment of chronic pain, considerably more research will be needed to fully determine the effects of hypnosis for different chronic-pain conditions.' Alternative medicine An analysis of the 13 highest quality studies of pain treatment with, published in January 2009, concluded there was little difference in the effect of real, faked and no acupuncture.
However, more recent reviews have found some benefit. Additionally, there is tentative evidence for a few herbal medicines. There has been some interest in the relationship between and pain, but the evidence so far from for such a relationship, other than in, is inconclusive.For chronic (long-term), produces tiny, short-term improvements in pain and function, compared and other interventions. Spinal manipulation produces the same outcome as other treatments, such as general practitioner care, pain-relief drugs, physical therapy, and exercise, for acute (short-term) lower back pain. Epidemiology Pain is the main reason for visiting an emergency department in more than 50% of cases, and is present in 30% of family practice visits. Several studies have reported widely varying prevalence rates for chronic pain, ranging from 12 to 80% of the population. It becomes more common as people approach death.
A study of 4,703 patients found that 26% had pain in the last two years of life, increasing to 46% in the last month.A survey of 6,636 children (0–18 years of age) found that, of the 5,424 respondents, 54% had experienced pain in the preceding three months. A quarter reported having experienced recurrent or continuous pain for three months or more, and a third of these reported frequent and intense pain. The intensity of chronic pain was higher for girls, and girls' reports of chronic pain increased markedly between ages 12 and 14. History In 1994, responding to the need for a more useful system for describing, the (IASP) classified pain according to specific characteristics:. region of the body involved (e.g. Abdomen, lower limbs),. system whose dysfunction may be causing the pain (e.g., nervous, gastrointestinal),.
duration and pattern of occurrence,. intensity and time since onset, and.
causeHowever, this system has been criticized by and others as inadequate for guiding research and treatment. Woolf suggests three classes of pain:. nociceptive pain,. inflammatory pain which is associated with tissue damage and the infiltration of immune cells, and. pathological pain which is a disease state caused by damage to the nervous system or by its abnormal function (e.g., etc.). Society and culture. The ceremony as witnessed by, circa 1835.The nature or meaning of physical pain has been diversely understood by religious or secular traditions from antiquity to modern times.Physical pain is an important political topic in relation to various issues, including policy, or,.
In various contexts, the deliberate infliction of pain in the form of is used as retribution for an offence, or for the purpose of disciplining or reforming a wrongdoer, or to deter attitudes or behaviour deemed unacceptable. The, or death by a thousand cuts, was a form of execution in China reserved for crimes viewed as especially severe, such as high treason or patricide.
In some cultures, extreme practices such as or painful are highly regarded. For example, the people of Brazil use intentional stings as part of their initiation rites to become warriors. Non-humans. Main articles: andThe most reliable method for assessing pain in most humans is by asking a question: a person may report pain that cannot be detected by any known physiological measure. However, like infants, animals cannot answer questions about whether they feel pain; thus the defining criterion for pain in humans cannot be applied to them. Philosophers and scientists have responded to this difficulty in a variety of ways. For example argued that animals lack consciousness and therefore do not experience pain and suffering in the way that humans do.
Of, the principal author of two U.S. Federal laws regulating pain relief for animals, writes that researchers remained unsure into the 1980s as to whether animals experience pain, and that veterinarians trained in the U.S. Before 1989 were simply taught to ignore animal pain. In his interactions with scientists and other veterinarians, he was regularly asked to 'prove' that animals are conscious, and to provide 'scientifically acceptable' grounds for claiming that they feel pain. Carbone writes that the view that animals feel pain differently is now a minority view. Academic reviews of the topic are more equivocal, noting that although the argument that animals have at least simple conscious thoughts and feelings has strong support, some critics continue to question how reliably animal mental states can be determined. The ability of invertebrate species of animals, such as insects, to feel pain and suffering is also unclear.The presence of pain in an animal cannot be known for certain, but it can be inferred through physical and behavioral reactions.
Specialists currently believe that all vertebrates can feel pain, and that certain invertebrates, like the octopus, may also. As for other animals, plants, or other entities, their ability to feel physical pain is at present a question beyond scientific reach, since no mechanism is known by which they could have such a feeling. In particular, there are no known nociceptors in groups such as plants, fungi, and most insects, except for instance in.In vertebrates, are that moderate pain by interacting with. Opioids and opioid receptors occur naturally in and, although at present no certain conclusion can be drawn, their presence indicates that may be able to experience pain.
Opioids may mediate their pain in the same way as in vertebrates. Uses, for actual or potential animal pain, the same analgesics and anesthetics as used in humans. Etymology First attested in English in 1297, the word peyn comes from the peine, in turn from poena meaning 'punishment, penalty' (in L.L. Also meaning 'torment, hardship, suffering') and that from ποινή ( poine), generally meaning 'price paid, penalty, punishment'. See also., the tendency to quickly return to a relatively stable level of happiness despite major positive or negative events., the legal term for the physical and emotional stress caused from an injury., the branch of philosophy concerned with suffering and physical painNotes.
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