Physiotherapists Tralee – The Classification of Pain
Classifying pain is helpful to guide assessment and treatment used by physiotherapists Tralee. Pain does not feel the same for everyone. Being able to describe your pain clearly(dull, sharp, burning etc.), how bad it is and when it happens, helps your doctor, physio or nurse to more correctly diagnose your condition. In this article we will give a brief insight into pain classification.
Common types of pain include:
Nociceptive pain : This represents the normal response to noxious insult or injury to tissues such as the skin, muscles, visceral organs, joints, tendons, bones etc.
Neuropathic pain : This is initiated by a primary lesion or disease in the somatosensory nervous system.
Sensory abnormalities range from deficits perceived as numbness to hypersensitivity (hyperalgesia or allodynia), and to paresthesias such as tingling. Examples include, but are not limited to, 1. diabetic neuropathy 2. postherpetic neuralgia spinal cord injury pain 3. phantom limb (post-amputation) pain 4. post-stroke central pain.
Inflammatory pain : This is a result of activation and sensitization of the nociceptive pain pathway by a variety of mediators released by the body at a site of tissue inflammation.
Psychogenic pain : This is pain affected by psychological factors. Psychogenic pain most often has a physical origin either in tissue damage or nerve damage, but the pain caused by that damage is increased or prolonged by factors such as fear, depression, stress, or anxiety. In some cases, pain originates solely from a psychological condition.
There are also well-recognized pain disorders that are not easily classifiable. Understanding the underlying mechanisms is still rudimentary although specific therapies for those disorders are well known. These conditions include cancer pain, migraine and other primary headaches and wide-spread pain of the fibromyalgia type.
Pain Intensity – Physiotherapists Tralee
As well as the type of pain, the intensity is also noted and can be broadly categorized as: mild, moderate and severe. It is common to use a numeric scale to rate pain intensity where 0 = no pain and 10 is the worst pain imaginable. Pain is a subjective experience (the experience is unique for each individual person). This pain rating reflects a patient’s interpretation of what that pain means for him/her at that moment. It is a combination of the patient’s physical discomfort and emotional interpretation. Changes in pain intensity are valuable when measured for single individuals (say to compare pain levels before and after a treatment), but they should not be used to compare pain between different individuals.
Pain is also classified under these three categories
- Acute pain: pain of less than 3 to 6 months duration
- Chronic pain: pain lasting for more than 3-6 months, or persisting beyond the course of an acute disease, or after tissue healing is complete.
- Acute-on-chronic pain: acute pain flare superimposed on underlying chronic pain.
Acute pain typically comes on suddenly and is limited in duration. It is frequently caused by damage to tissue such as bone, muscle, or organs, and the onset is often accompanied by anxiety or emotional distress. Chronic pain lasts longer than acute pain and can be somewhat more resistant to medical treatment. It’s usually associated with a long-term illness, such as osteoarthritis. In some cases, such as with fibromyalgia, pain is just one of the defining characteristic of the disease. Chronic pain can be the result of damaged tissue, but very often it is attributable to nerve damage.
Both acute and chronic pain can be debilitating, and both can affect and be affected by a person’s state of mind. But the nature of chronic pain and the fact that it’s ongoing and in some cases seems almost constant can make the sufferer more susceptible to psychological consequences such as depression and anxiety. At the same time, psychological distress can amplify the pain.
Overview by Physiotherapists Tralee
It is important to understand that pain is a multidimensional phenomenon which can produce strong emotional reactions that adversely affect a patient’s function, quality of life, emotional state, and general well-being. A thorough history and physical exam, including neurological and musculo-skeletal examinations are essential for accurate pain diagnosis and treatment planning. Careful attention to the patient’s reported symptoms helps direct the physical examination and narrow the differential diagnosis of the pain. Additional testing, such as Xray, Mri, laboratory studies or electrodiagnostic testing (EMG/nerve conduction studies), may be ordered as needed based on the results of the history and examinations.
Other Ways Pain Is Classified – Physiotherapists Tralee
Pain is also classified by the type of tissue that’s involved or by the part of the body that’s affected. For example, pain may be referred to as muscular pain or joint pain.
Certain types of pain are referred to as syndromes. For instance, myofascial pain syndrome refers to pain that is set off by trigger points located in the body’s muscles. Fibromyalgia is an example.
Pain Caused by Tissue Damage
Most pain comes from tissue damage. The pain stems from an injury to the body’s tissues. The injury can be to bone, soft tissue, or organs. The injury to body tissue can come from a disease such as cancer. Or it can come from physical injury such as a cut or a broken bone.
The pain you experience may be an ache, a sharp stabbing, or a throbbing. It could come and go, or it could be constant. You may feel the pain worsen when you move or laugh. Sometimes, breathing deeply can intensify it.
Pain from tissue damage can be acute. For example, sports injuries like a sprained ankle or turf toe are often the result of damage to soft tissue. Or it can be chronic, such as arthritis or chronic headaches. And certain medical treatments, such as radiation for cancer, can also cause tissue damage that results in pain.
Pain Caused by Nerve Damage
Nerves function like electric cables transmitting signals, including pain signals, to and from the brain. Damage to nerves can interfere with the way those signals are transmitted and cause pain signals that are abnormal. For instance, you may feel a burning sensation even though no heat is being applied to the area that burns.
Nerves can be damaged by diseases such as diabetes, or they can be damaged by trauma. Certain chemotherapy drugs may cause nerve damage. Nerves can also be damaged as a result of stroke or an HIV infection, among other causes. The pain that comes from nerve damage could be the result of damage to the central nervous system (CNS), which includes the brain and spinal cord. Or it could result from damage to peripheral nerves, those nerves in the rest of the body that send signals to the CNS.
The pain caused by nerve damage, neuropathic pain, is often described as burning or prickling. Some people describe it as an electrical shock. Others describe it as pins and needles or as a stabbing sensation. Some people with nerve damage are often hypersensitive to temperature and to touch. Just a light touch, such as the touch of a bed sheet, can set off the pain.
Much neuropathic pain is chronic. Examples of pain caused by damaged nerves include:
Central pain syndrome. This syndrome is marked by chronic pain that stems from damage to the central nervous system. The damage can be caused by stroke, MS, tumors, and several other conditions. The pain, which is typically constant and may be severe, can affect a large part of the body or be confined to smaller areas such as the hands or feet. The pain often can be made worse by movement, touch, emotions, and temperature changes.
Complex regional pain syndrome. This is a chronic pain syndrome that can follow a serious injury. It’s described as persistent burning. Certain abnormalities such as abnormal sweating, changes in skin color, or swelling may be noticed in the area of the pain.
Diabetic peripheral neuropathic pain. This pain comes from nerve damage in the feet, legs, hands, or arms caused by diabetes. Individuals with diabetic neuropathy experience various kinds of pain including burning, stabbing, and tingling.
Shingles and postherpetic neuralgia. Shingles is a localized infection caused by the same virus that causes chickenpox. The rash and associated pain, which can be debilitating, occurs on one side of the body along the path of a nerve. Postherpetic neuralgia is a common complication in which the pain from shingles lasts more than a month.
Trigeminal neuralgia. This condition causes pain as a result of inflammation of a facial nerve. The pain is described as intense and lightning like, and it can occur in the lips, scalp, forehead, eye, nose, gums, cheek, and chin on one side of the face. The pain can be set off by touching a trigger area or by slight motion.
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