Pain is not only emotion as it is both a sensory and emotional experience. An individual can feel pain after being physically hurt (sensory) such as falling, burning skin after long hours of training, or touching something hot. Being physically hurt will trigger an emotion afterward .
Therefore, a difference exists between pain and the cause of the pain. The link between the two is mediated by our nervous system through a process known as nociception.
It was estimated that 20.4% of adult individuals had chronic pain and that 7.4% of adult individuals had chronic pain which limited their activities, such as working, in the past 3 months .
1- What is emotional pain?
Emotional pain can be defined by the heartache we feel when losing someone or something that was important to us.
2- Is pain an emotion or feeling?
A Feeling is the outcome or expression of our interpretation of an emotion that was caused by pain (physical or psychological).
3- What is the worst mental pain?
They are several mental conditions that are characterized by unbearable psychological and emotional pain that is characterized by suicidal thoughts (suicidal ideation).
4- What are Nociceptors?
Nociceptors can be mechanical, thermal, mechano-thermal, polymodal, or silent.
Mechanical nociceptors respond to mechanical damage or pressure, while thermal nociceptors respond to cold or hot temperatures.
Mechano-thermal nociceptors respond to both mechanical and thermal stimuli, while silent nociceptors respond to inflammatory mediators.
5- What Are the Types of Pain?
- Acute Pain
Acute pain is caused by spasms of skeletal muscles and the activation of the sympathetic nervous system that is due to an injury or a trauma. The duration of the pain is short and disappears with the healing of the injury.
- Chronic Pain
Chronic pain is also caused by an injury or a disease, but the pain would continue even after the healing period.
- Nociceptive Pain
Nociceptive pain is caused by an injury, trauma, chemicals, or surgery that results in the activation and release of inflammatory mediators by nociceptor neurons (sensory neurons) which activate inflammation in the injured area .
- Neuropathic Pain
Neuropathic pain is due to direct damages or compression of the sensory nerves associated with sciatica, neuropathies such as phantom limb pain, Wallerian degeneration, segmental demyelination, or diabetic neuropathies.
5- Are There Other Classifications of Pain?
Allodynia is a pain that is caused by a stimulus that is not the one that initiated the pain, such as feeling pain after a gentle shake of hands or light touch on the back.
Analgesia is characterized by the inability to feel the pain caused by a stimulus (cause) that should normally have caused pain.
Hyperpathia is a neuropathic pain characterized by an abnormal, repetitive, and elevated pain reaction to the stimulus (cause).
Causalgia is neuropathic pain that combines a sensation of burning pain, hyperpathia, and allodynia.
Dysesthesia is an unpleasant and abnormal sensation such as cold sensation, tingling, burning, numbness, tickling, or pain that is caused by nerve trauma or irritation.
Hyperalgesia is characterized by an abnormally increased sensitivity to pain due to the release of inflammatory hormone-like substances, known as prostaglandins, that increase the sensitivity of the nociceptors.
Hyperalgesia can be caused by fibromyalgia, diabetes, infection, trauma, postherpetic neuralgia, and complex regional pain syndrome.
Hyperesthesia is characterized by an increased sensitivity to stimuli associated with senses such as hearing, tasting, touch, smelling,
Hyperesthesia is caused by excessive stimulation of the nervous system such as overconsumption of caffeine.
Unlike analgesia characterized by the inability to feel pain, hypoalgesia is associated with a reduced response to a painful stimulus.
6- What Are the Symptoms of Pain?
The symptoms of pain are categorized corresponding to the pain intensity, duration, and pain-related disability . These categories allow the classification of pain into mild, moderate, or severe using assessment methods:
- Visual Analogue Scale
This method consists in drawing a line between two points. The first point is the “no pain” and the second point is the “as bad as it could be”.
The individual in pain is requested to mark the level of pain within the two endpoints.
- Graphic Rating Scale (GRS)
This method represents a drawing of a line with levels from 1 to ten representing the intensity of pain. No pain is represented by the number 0 and “as bad as it could be” is represented by the number 10.
The individual in pain is requested to indicate the number from 0 to 10 which represents the level of pain experienced by the individual.
- Verbal Rating Scale
This method evaluates the pain experienced by the patient using adjectives to describe the level of pain.
- Pain Drawing
In this method, the patient is requested to indicate the location of the pain on a drawn human body.
- McGill Pain Questionnaire (MPQ)
This questionnaire assesses the pain-rating index, the number of words describing the pain, and the level of pain on a scale of 1-5.
8- What Is the Treatment of Pain?
Pain is mainly managed.
- Non-pharmacological Management
Non-pharmacological management involves:
– Exercise such as swimming, walking, yoga, Pilates, and exercise bike.
– Physical therapy through physiotherapists and occupational therapists who will help with stretching and pain-relieving exercises.
– Psychological management through social support, psychologists, and psychotherapists.
- Pharmacological Management
For mild and moderate pain, non-opioid analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are used.
Although there is a high risk of dependency, opioid analgesics (e.g., morphine) are used for the treatment of severe pain.
Although the risk factors in the progression from acute to chronic pain are well known, identifying patients who are predisposed to this progression through assessing the status of the acute pain, the physiological and reactivity of the patients to pain, should help better manage this switch from acute to chronic pain.