What is pain who can describe it
Interventional pain therapy | Definition of pain
Pain - a complex phenomenon of our perception
- Definition: The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or described in terms of, actual or threatened physical damage." This describes a very complex phenomenon of our perception at the interface between body and mind. This definition shows that pain is not just a sensory sensation like warmth or touch. The perception of pain requires awareness and experience and is therefore linked to the waking state. Pain is thus a product of our brain and must be distinguished from the processes of sensory perception in the periphery. The registration of damaging stimuli and their transmission to the central nervous system is considered to be a pain sensation.
The differentiation between pain as a conscious perception and pain sensation as a peripheral registration of a damaging stimulus explains the fact that pain can be described by the patient without an immediate pain stimulus being present - pain as a product of the brain.
- Acute pain: The acute pain has a meaningful and life-sustaining function. It is used to report damage to the organism. Such a perception of pain triggers appropriate protective reactions, such as pulling your hand away from a hot stove. This prevents further damage to the organism. The acute pain also promotes wound healing, e.g. by immobilizing an injured extremity due to pain. The acute pain is mostly recognized as meaningful. The psychological processing of acute pain is therefore relatively easy. The patient can recognize the healing process by the often rapidly decreasing pain intensity. Acute pain conditions are understandable and understandable for most people. Therapy for acute pain is usually not a major therapeutic problem.
- Chronic pain: Chronic pain, on the other hand, has lost this meaningful reporting, protective and healing function. Chronic pain becomes an independent pain disorder. Chronic pain is often referred to as pain that has persisted for more than 6 months.
Chronic pain leads to physical, psychological and social wear and tear on the patient. Pain-related depressive moods, irritability, weakness, lack of interest and reduced social contact can occur. The attention is directed away from the environment and towards one's own body. Chronic pain conditions are difficult to understand for most people and find little understanding in the long run. The therapy of chronic pain conditions often raises major therapeutic problems.
Physiology of Pain
- Stimulating the pain receptors: Mainly in the skin, but also in other tissues, there are pain receptors (nociceptors) that register an injury and pass it on to the central nervous system. The pain receptors are free nerve endings. Many pain receptors react to different stimulus qualities, e.g. to mechanical stimuli (pressure, pull) and thermal stimuli (heat, cold). A pain stimulus can not only act on the body from the outside, chemical pain stimuli can also be triggered in the body itself by the body's own substances (inflammation mediators).
- Pain conduction: Pain stimuli are conducted from the body periphery to the spinal cord via two types of nerve fibers. The so-called delta fibers transmit sharp, circumscribed, rapid pain, while C-fibers, on the other hand, conduct dull, painful, painful pain to the spinal cord. In certain areas of the spinal cord, the excitation is now switched to a second nerve cell. The pain stimulus is guided by ascending pathways via the brain stem to the thalamus (switching station of the brain). From the thalamus there are connections to the cerebral cortex, where the origin of the pain is recognized. From the thalamus there are also connections to the limbic system, where the pain is consciously perceived and can trigger associated emotions. There are also connections to the pituitary gland, from where the body's own morphine is released into the blood when there is pain.
Numerous structures of the central nervous system are involved in the processing of pain. A real pain center does not exist!
- Processing of pain impulses: For a long time it was assumed that these anatomical pain pathways were hardwired. Today we know that they are regulated and continuously modulated by descending nerve tracts and a series of hormones. The whole pain system is extremely plastic. The sensory experience leaves its mark on all switching levels via various mechanisms. One speaks of the pain memory, which sometimes only lasts for a short time, but sometimes remains burned in irreversibly.
It is known from daily experience that there is by no means a linear relationship between stimulus intensity and perceived pain intensity. For example, fear or motivation can strongly influence the subjective pain intensity. The pain impulses are modulated on many levels of the central nervous system.
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