Pain and its Management
Pain is an actual or anticipated unpleasant physiologic response to injury or disease. Pain is both a real sensation and an emotion. It has both subjective and objective components, making pain especially difficult to adequately treat in all patients. In fact, reports indicate that pain is inadequately treated in up to fifty percent of all patients who undergo surgery. Poor pain control following trauma can lead to severe psychological distress, and in its most extreme form, Post Traumatic Stress Disorder (PTSD). When compared to other sensory systems, pain is considerably more complex and subjective. Physical injury or disease does not need to be present to experience pain. In both clinical and laboratory settings, a patient’s perception of pain bears a poor relationship to the level of painful stimulation that is applied. In other words, the severity of pain that is perceived by one person may be considerably different compared to that of another person, even though the injury is exactly the same. A number of factors contribute to the severity of an individual’s pain experience. These include prior painful experiences, severity of injury, prior analgesic use, sedative use, alcohol and illicit drug use, psychological makeup, social background, and even the time of day. Genetic mediation and variation also play an important role in individual pain sensitivity and inhibition. Therefore, it is important to understand that pain management must be individualized in terms of amount, type of pain medicine, frequency of administration, and choice of accompanying sedatives. It is also important to understand that optimal pain management in the critically injured patient often requires a balance between pain relief and avoiding further life-threatening hemodynamic instability. There are different models that try to explain the complex experience of pain. There are many different types of pain, including post-operative, musculoskeletal, pain related to cancer, headache, and neuropathic pain conditions. The measurement of pain has been brought to the attention of all medical providers with the discussion of pain as “the fifth vital sign” (the other four being blood pressure, heart rate, temperature, and respiratory rate). However, unlike these four vital signs, the subjective nature of pain causes much more difficulty in measuring its severity and ensuring optimal pain relief. The basic physiology of pain is now better understood. Pain treatments address the different body regions that are linked with pain sensation and processing. Common treatments include medications, patient controlled analgesia, nerve blocks, TENS, surgery, implantable devices, physical therapy, and psychological care. Pain management, particularly patients with chronic pain, should consider the whole person and include the best treatments for that individual.