You are on page 1of 10

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such

damage.[1] It is the feeling common to such experiences as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone".[2] Pain motivates us to withdraw from potentially damaging situations, protect a damaged body part while it heals, and avoid those situations in the future.[3] It is initiated by stimulation of nociceptors in the peripheral nervous system, or by damage to or malfunction of the peripheral or central nervous systems.[4] Most pain resolves promptly once the painful stimulus is removed and the body has healed, but sometimes pain persists despite removal of the stimulus and apparent healing of the body; and sometimes pain arises in the absence of any detectable stimulus, damage or pathology.[5] Pain is the most common reason for physician consultation in the United States.[6] It is a major symptom in many medical conditions, and can significantly interfere with a person's quality of life and general functioning.[7] Social support, hypnotic suggestion, excitement in sport or war, distraction, and appraisal can all significantly modulate pain's intensity or unpleasantness.[8] Classification The International Association for the Study of Pain (IASP) classification system describes pain according to five categories: duration and severity, anatomical location, body system involved, cause, and temporal characteristics (intermittent, constant, etc.).[9] This system has been criticized by Woolf and others as inadequate for guiding research and treatment,[10] and an additional category based on neurochemical mechanism has been proposed.[11] Chronic pain may be classified as"cancer" or "benign".[12] [edit] Duration 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 rheumatoid arthritis, peripheral neuropathy, cancer and idiopathic pain, may persist for years. Pain that lasts a long time is called chronic, and pain that resolves quickly is called acute. Traditionally, the distinction between acute and chronic pain has relied upon an arbitrary interval of time from onset; the two most commonly used markers being 3 months and 6 months since the onset of pain,[11] though some theorists and researchers have placed the transition from acute to chronic pain at 12 months.[13] 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.[12] A popular alternative definition of chronic pain, involving no arbitrarily fixed durations is "pain that extends beyond the expected period of healing."[11] Region and system Pain can be classed according to its location in the body, as in headache, low back pain and pelvic pain; or according to the body system involved, such as myofascial pain (emanating from skeletal muscles or the fibrous sheath surrounding them), rheumatic pain (emanating from the joints and surrounding tissue), neuropathic pain (caused by damage to or malfunction of any part of the nervous system), or vascular (pain from blood vessels).[11] [edit] Cause The crudest example of classification by cause simply distinguishes "somatogenic" pain (arising from a perturbation of the body) from psychogenic pain (arising from a perturbation of the mind: when a thorough physical exam, imaging, and laboratory tests fail to detect the cause of pain, it is assumed to be the product of psychic conflict or psychopathology).[11] Somatogenic pain is divided into "nociceptive" (caused by activation of nociceptors) and "neuropathic" (caused by damage to or malfunction of the nervous system).[14] [edit Nociceptive Nociceptive pain is initiated by stimulation of peripheral nerve fibers that respond only to stimuli approaching or exceeding harmful intensity (nociceptors), and may be classified according to the mode of noxious stimulation; the most common categories being "thermal" (heat or cold), "mechanical" (crushing, tearing, etc.) and "chemical" (iodine in a cut, chili powder in the eyes). Nociceptive pain may also be divided into "visceral," "deep somatic" and "superficial somatic" pain. Visceral pain originates in the viscera (organs) and often is extremely difficult to locate, and nociception from some visceral regions produces "referred" pain, where the sensation is located in an area distant from the site of injury or pathology. Deep somatic pain is initiated by stimulation of nociceptors in ligaments, tendons, bones, blood vessels, fasciae and muscles, and is dull, aching, poorly-localized pain. Examples include sprains and broken bones. Superficial pain is initiated by activation of nociceptors in the skin or superficial tissues, and is

All too often.[21] “The term 'psychogenic' assumes that medical diagnosis is so perfect that all organic causes of pain can be detected. or prolonged by mental. we are far from such infallibility. crushing. Examples of injuries that produce superficial somatic pain include minor wounds and minor (first degree) burns. or a knife twisting in the flesh. or behavioral factors. Surgical treatment rarely provides lasting relief. or. increased. emotional. Onset may be immediate or may not occur until years after the disabling injury. Some investigators have argued that it is this neuroticism that causes acute injuries to turn chronic. [edit] Psychogenic Main article: Psychogenic pain Psychogenic pain.[20] People with long term pain frequently display psychological disturbance. 1996. 65 percent reported it.[24] . specialists consider that it is no less actual or hurtful than pain from any other source. Vigorous vibration or electrical stimulation of the stump. When long term pain is relieved by therapeutic intervention.”[17] Bumping the "funny bone" elicits peripheral neuropathic pain. they recognize the sensation of pain but suffer little.[19] Sufferers are often stigmatized. weeks or.” Ronald Melzack. If the pain is continuous for a long period. and stomach pain are sometimes diagnosed as psychogenic. or current from electrodes surgically implanted onto the spinal cord all produce relief in some patients. well-defined and clearly located. and six months later.” or “pins and needles. so that touching them evokes pain in the phantom limb. also shows striking improvement once pain has resolved. but clinical evidence points the other way.. 72 percent of patients had phantom limb pain.[21] [edit] Phantom pain Main article: Phantom pain Phantom pain is pain from a part of the body that has been lost or from which the brain no longer receives physical signals. It is a type of neuropathic pain. because both medical professionals and the general public tend to think that pain from a psychological source is not "real". with elevated scores on the Minnesota Multiphasic Personality Inventory scales of hysteria.sharp.[23] [edit] Pain asymbolia Main article: Pain asymbolia Although unpleasantness is an essential part of the IASP definition of pain. Self-esteem. to chronic pain causing neuroticism. it is possible to induce a state described as intense pain devoid of unpleasantness in some patients.[22] Some amputees experience continuous pain that varies in intensity or quality.” “tingling. and is divided into "peripheral" (originating in the peripheral nervous system) and "central" (originating in the brain or spinal cord). often low in chronic pain patients. Phantom limb pain is a common experience of amputees.[23] Local anesthetic injections into the nerves or sensitive areas of the stump may relieve pain for days.[15] [edit] Neuropathic Main article: Neuropathic pain Neuropathic pain is caused by damage to or malfunction of the nervous system.[20] Such patients report that they have pain but are not bothered by it. phantom body pain in areas of complete sensory loss. others experience several bouts a day. the loss of sensation and voluntary motor control after serious spinal cord damage.” “electrical. sometimes permanently. weeks or even longer of partial or total relief from phantom pain. may be accompanied by girdle pain at the level of the spinal cord damage.” “stabbing. depression and hypochondriasis (the "neurotic triad"). is pain caused. despite the drug wearing off in a matter of hours. also called psychalgia or somatoform pain. back pain. However.[18] Headache. often to normal levels. or not at all. visceral pain evoked by a filling bladder or bowel.. the diagnosis of neurosis as the cause of pain hides our ignorance of many aspects of pain medicine. Phantom body pain is initially described as burning or tingling but may evolve into severe crushing or pinching pain. and small injections of hypertonic 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. or phantom limb pain may accompany urination or defecation. in five to ten per cent of paraplegics. with morphine injection or psychosurgery. regrettably.[16] Peripheral neuropathic pain is often described as “burning. It is often described as shooting. fire running down the legs.[23] Paraplegia. scores on the neurotic triad and anxiety fall. burning or cramping. One study found that eight days after amputation. or it may occur only once every week or two. parts of the intact body may become sensitized.

pressure or vibration" fibers may inhibit the signal carried by the thinner "pain" fibers . to a mechanical behavioral response . The thin fibers impede the inhibitory cells (tending to leave the gate open) while the large diameter fibers excite the inhibitory cells (tending to close the gate). Episodic analgesia may occur under special circumstances. diabetes mellitus.[26] A small number of people suffer from congenital analgesia ("congenital insensitivity to pain"). pain begins. we rub a smack. pressure. the less pain is felt.that pain is the direct product of a noxious stimulus activating a dedicated pain pathway. and information processing speed. not the receptor type.the ratio of large fiber signal to thin fiber signal determining pain intensity. and inhibitory cells can shut the gate. determines whether nociception occurs. etc. vibration") nerve fibers carry information from the site of injury to two destinations in the dorsal horn of the spinal cord: the "inhibitory" cells and the "transmission" cells. In 1953. a genetic defect that puts these individuals at constant risk from the consequences of unrecognized injury or illness. "Particles of heat" (A) activate a spot of skin (B) attached by a fine thread (cc) to a valve in the brain (de) where this activity opens the valve. provided the stimulation is intense enough: the pattern of stimulation (intensity over time and area). hence. mental flexibility. The job of the inhibitory cells is to inhibit activation of the transmission cells. Effects Experimental subjects challenged by acute pain and patients in chronic pain experience impairments in attention control. allowing the animal spirits to flow from a cavity (F) into the muscles that then flinch from the stimulus. So. problem solving. activated by a noxious event. or more rarely leprosy. Willem Noordenbos observed that a signal carried from the area of injury along large diameter "touch. Signals from both thin and large diameter fibers excite the transmission cells.[31] [edit] Dimensions . skin. activity from many sensory fibers might accumulate in the dorsal horns of the spinal cord and begin to signal pain once a certain threshold of accumulated stimulation has been crossed. but have a reduced life expectancy. and move the hand and turn the body protectively. They may attain adulthood. The authors had conceived a neural "circuit diagram" to explain why we rub a smack. and when the output of the transmission cells exceeds a critical level.[edit] Insensitivity to pain The ability to experience pain is essential for protection from injury. turn the head and eyes toward the affected body part. 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. eyes.[29] [edit] Gate Control Melzack and Wall introduced their "gate control" theory of pain in the 1965 Science article "Pain Mechanisms: A New Theory". Alfred Goldscheider (1894) proposed that over time. This was the first theory to offer a physiological explanation for the previously reported effect of psychology on pain perception. The underlying premise of this model .[28] [edit] Pattern Specificity theory (dedicated pain receptor and pathway) has been challenged by the theory. along a thread or chain of nerve fibers to the pain center in the brain. When thin (pain) and large (touch. excite a spinal cord transmission cell. and muscles. and recognition of the presence of injury. the more large fiber activity relative to thin fiber activity coming from the inhibitory cell's receptive field. working memory. from a receptor in the skin. This was taken as a demonstration that pattern of stimulation (of large and thin fibers in this instance) modulates pain intensity.remained the dominant perspective on pain until the mid-nineteen sixties.) fibers. it may trigger a signal back down the spinal cord to modulate inhibitory cell activity (and so pain intensity).[27] [edit] Theory [edit] Specificity Descartes' pain pathway. In his 1664 Treatise of Man. joints.[28] They pictured not only a signal traveling from the site of injury to the inhibitory and transmission cells and up the spinal cord to the brain. Children with this condition incur carelessly repeated damage to their tongue. insensitivity to pain may also be acquired following conditions such as spinal cord injury. The transmission cells are the gate on pain.[25] However. depending on the state of the brain. that a pain signal can be generated by stimulation of any sensory receptor. René Descartes traced a pain pathway. but also a signal traveling from the site of injury directly up the cord to the brain (bypassing the inhibitory and transmission cells) where.[30] The authors proposed that thin ("pain") and large diameter ("touch. proposed initially in 1874 by Wilhelm Erb. they also act on its inhibitory cells.

In 1968 Melzack and Casey described pain in terms of its three dimensions: "Sensory-discriminative" (sense of the intensity. while others. and "Cognitiveevaluative" (cognitions such as appraisal. This is followed by a duller pain.[34] Some of these thin fibers do not differentiate noxious from non-noxious stimuli. Some individuals in all cultures have considerably higher than normal pain perception and tolerance thresholds. People with congenital insensitivity to pain have reduced life expectancy.[33] Because the A-delta fiber is thinly sheathed in an electrically insulating material (myelin)." (p. Pain evoked by the (faster) A-delta fibers is described as sharp and is felt first. toothache) might be. and avoid that harmful situation in the future. while suggestion and placebos may modulate the affective-motivational dimension and leave the sensory-discriminative dimension relatively undisturbed. genetics.Craig and colleagues have identified fibers dedicated to carrying A-delta fiber pain signals. slerance threshold" is reached when the subject acts to stop the pain. The "pain perception threshold" is the point at which the stimations to other mental states.[38] Melzack and Casey's 1968 picture of the dimensions of pain is as influential today as ever. but “higher” cognitive activities (the cognitive-evaluative dimension) can influence perceived intensity and unpleasantness.g.D.[40] Idiopathic pain (pain that persists after the trauma or pathology has healed. carried by the C fibers.[42] [edit] Diagnosis . location. "Affective-motivational" (unpleasantness and urge to escape the unpleasantness). that a pain signal can be generated by intense enough stimulation of any sensory receptor. Thus. but also by influencing the motivational-affective and cognitive factors as well.0 m/s).5–2. cultural values. For instance. [edit] Thresholds Variations in pain threshold or in pain tolerance occur between individuals for various reasons including cultural background. vital to healthy survival. For example.[33] The thin (A-delta and C) peripheral nerve fibers carry information regarding the state of the body to the spinal cord. nociceptors. has been soundly disproved. firmly framing theory and guiding research in the functional neuroanatomy and psychology of pain. quality and duration of the pain). and others dedicated to carrying C fiber pain signals up the spinal cord to the thalamus in the brain. surgical intervention and the like. among other things." (p. it carries its signal faster (2. may be an exception to the idea that pain is helpful to survival. and tendencies to protect the affected body part while it heals. the feeling that distinguishes pain from other homeostatic emotions such as itch and nausea) and anterior cingulate cortex (thought to embody. and gender. or that arises without any apparent cause). In pain science.[37] Koji Inui and colleagues have recently shown that pain reduction due to non-noxious touch or vibration can result from activity within the cerebral cortex. Cognitive activities "may affect both sensory and affective experience or they may modify primarily the affective-motivational dimension. although John Sarno argues that such pain is psychogenic.[41] It is not clear what the survival benefit of some extreme forms of pain (e.5–35 m/s) than the unmyelinated C fiber (0. often described as burning. and the intensity of some forms of pain (for example as a result of injury to fingernails or toenails) seems to be out of all proportion to any survival benefits.[36] Pain-related activity in the thalamus spreads to the insular cortex (thought to embody. [edit] Evolutionary and behavioral role Pain is part of the body's defense system. distraction and hypnotic suggestion). excitement in games or war appears to block both dimensions of pain. heat and arm-muscle cramp than those who experience painful heart attacks. ethnicity. and Italian women tolerate less electric shock than Jewish or Native American women.[35] A. among other things. 435) [edit] Theory today Regions of the cerebral cortex associated with pain. producing a reflexive retraction from the painful stimulus. patients who experience painless heart attacks have significantly higher pain thresholds for electric shock. Wilhelm Erb's (1874) early pattern theory hypothesis.[32] They theorized that pain intensity (the sensory discriminative dimension) and unpleasantness (the affective-motivational dimension) are not simply determined by the magnitude of the painful stimulus. the motivational element of pain).[34] and pain that is distinctly located also activates the primary and secondary somatosensory cortices. thresholds are measured by gradually increasing the intensity of a stimulus such as electric current or heat applied to the body. with minimal contribution at the spinal level. people of Mediterranean origin report as painful certain radiant heat intensities that northern Europeans describe as warmth. respond only to painfully intense stimuli. enlisted as a protective distraction to keep dangerous emotions unconscious. 432) The paper ends with a call to action: "Pain can be treated not only by trying to cut down the sensory input by anesthetic block. There is significant variation in pain perception and tolerance thresholds between cultural groups.[3][39] It is an important part of animal life.

emphasizing its subjective nature and the importance of believing patient reports. Many people fear the stigma of addiction and avoid pain treatment so as not to be prescribed addicting drugs. (b) interpersonally distressed. Gender differences are usually the result of social and cultural expectations.) of the pain will help the examining physician to accurately diagnose the problem. In patients who possess language but are incapable of expressing themselves effectively.[46] [edit] Other barriers to reporting An aging adult may not respond to pain in the way that a younger person would. or they may feel the pain is deserved punishment for past transgressions. A change in condition that deviates from baseline such as moaning with movement or when manipulating a body part.[46] [edit] As an aid to diagnosis Pain is a symptom of many medical conditions. Behaviors such as facial grimacing and guarding indicate pain. and 10 the worst pain they have ever felt. intensity. who will notice changes in the infant not obvious to the health care provider. pattern of occurrence (continuous.See also: Pain scales A person's self report is the most reliable measure of pain. believing the pain should be borne in silence. with women expected to be emotional and show pain and men stoic. Depression may also keep the older adult from reporting they are in pain. Analysis of MPI results by Turk and Rudy (1988) found three classes of chronic pain patient: "(a) dysfunctional. Many Asians do not want to lose respect in society by admitting they are in pain and need help. Religious beliefs may prevent the individual from seeking help. walking. existing whenever he says it does". For example. location. people who perceived the severity of their pain to be high. Quality can be established by having the patient complete the McGill Pain Questionnaire indicating which words best describe their pain. etc. Decline in self-care activities (dressing. relatively low levels of pain and perceived interference. etc. such as those with dementia. the patient may be asked to locate their pain on a scale of 0 to 10. including agitation. and specific behaviors can be monitored as pain indicators. Patients experiencing pain may exhibit withdrawn social behavior and possibly experience a decreased appetite and decreased nutritional intake. A non-verbal pain assessment should be conducted involving the parents. exacerbating and relieving factors. They may feel certain pain treatment is against their religion. keeping pain to themselves. and reported low levels of activity. Pre-term babies are more sensitive to painful stimuli than full term babies. chest pain described as extreme heaviness may indicate myocardial infarction. etc. an increase in confusion or display of aggressive behaviors.) may also be indicators that the older adult is experiencing pain. and relatively high levels of activity. The older adult may also quit doing activities they love because it hurts too much. while other cultures feel they should report pain right away and get immediate relief. people with a common perception that significant others were not very supportive of their pain problems. They may not report pain because they feel it is a sign that death is near. as well as an increase or decrease in vocalizations. or may feel there is something impolite or shameful in complaining about pain. with 0 being no pain at all. while chest pain described as tearing may indicate aortic dissection. Knowing the time of onset.[48] [edit] Management . changes in routine behavior patterns and mental status changes. sharp.[46] Gender can also be a factor in reporting pain.[47] Cultural barriers can also keep a person from telling someone they are in pain.[11] [edit] Assessment in nonverbal patients See also: Pain and dementia and Pain in babies When a person is non-verbal and cannot self report pain. intermittent. Infants feel pain but they lack the language needed to report it. The older adult may refrain from reporting pain because they are afraid they will have to have surgery or will be put on a drug they become addicted to. reported that pain interfered with much of their lives.[44] To assess intensity. They may not want others to see them as weak. and quality (burning. patients who reported high levels of social support.[7] [edit] Multidimensional pain inventory The Multidimensional Pain Inventory (MPI) is a questionnaire designed to assess the psychosocial state of a person with chronic pain. and limited range of motion are also potential pain indicators. was introduced by Margo McCaffery in 1968: "Pain is whatever the experiencing person says it is."[45] Combining the MPI characterization of the person with their IASP five-category pain profile is recommended for deriving the most useful case description. Their ability to recognize pain may be blunted by illness or the use of multiple prescription drugs. so communicate distress by crying.). and (c) adaptive copers. observation becomes critical. may signal that discomfort exists. reported a higher degree of psychological distress caused by pain. with health care professionals tending to underestimate severity. and further assessment is necessary.[43] A definition of pain widely employed in nursing. grooming.

[52] and women's pain is more likely to be undertreated than men's. palliative medicine and psychiatry. report less labor pain and are less likely to use epidural anesthesia during childbirth.[56] Sugar taken orally reduces the total crying time but not the duration of the first cry in newborns undergoing a painful procedure (a single lancing of the heel). physiatry. take less pain medication. neurology. or is greatly diminished. The authors concluded that "although the findings provide support for the general applicability of hypnosis in the treatment of chronic pain. and they produce progressively weaker effects with repeated administration.[55] Elsewhere. in the management of all forms of chronic pain including cancer pain. Placebos are more effective in intense pain than mild pain. and most lacked credible controls for placebo and/or expectation. which typically includes medical practitioners. and nurse practitioners.[54] It is a specialty only in China and Australia at this time. It does not moderate the effect of pain on heart rate[57] and a recent single study found that sugar did not significantly affect pain-related electrical activity in the brains of newborns one second after the heel lance procedure[58] but the sample size in that study was small. pain medicine is a subspecialty under disciplines such as anesthesiology.[61] Suggestion can significantly affect pain intensity. accident and emergency departments." (p. clinical psychologists. occupational therapists. bringing up issues of power to detect group differences. intensive care units. and the results will need to be replicated by larger. published in January 2009 in the British Medical Journal. About 35% of people report marked relief after receiving a saline injection they believe to have been morphine. from neonates to the frail elderly. other than in osteomalacia.[62] It is possible for many chronic pain sufferers to become so absorbed in an activity or entertainment that the pain is no longer felt. and that pain medicine should have the full status of a specialty.[53] The International Association for the Study of Pain advocates that the relief of pain should be recognized as a human right. [71] [edit] Society and culture . ranging from 12-80% of the population[70] It becomes more common as people approach death. physiotherapists.[49] Inadequate treatment of pain is widespread throughout surgical wards. considerably more research will be needed to fully determine the effects of hypnosis for different chronicpain conditions.[59] Sweet oral liquid moderately reduces the incidence and duration of crying caused by immunization injection in children between one and twelve months of age.[65] There is interest in the relationship between vitamin D and pain.[63] [edit] Alternative medicine Pain is the most common reason that people use complementary and alternative medicine. though the number of patients enrolled in the studies was low.[64] An analysis of the 13 highest quality studies of pain treatment with acupuncture. are less likely to suffer from chest pain after coronary artery bypass surgery.Main article: Pain management [edit] Medication Acute pain is usually managed with medications such as analgesics and anesthetics. is unconvincing. but the evidence so far from controlled trials for such a relationship.[50] This neglect is extended to all ages. 283)[67] [edit] Epidemiology Pain is the main reason for visiting the emergency department in more than 50% of cases[68] and is present in 30% of family practice visits. more rigorous trials before the results can be meaningfully interpreted. Management of chronic pain. is much more difficult and may require the coordinated efforts of a pain management team. sham and no acupuncture. that chronic pain should be considered a disease in its own right. concluded there is little difference in the effect of real.[69] Several epidemiological studies from different countries have reported widely varying prevalence rates for chronic pain. but it does not account for all of the effect. however.[66] A 2007 review of 13 studies found evidence for the efficacy of hypnosis in the reduction of pain in some conditions. and in end of life care. in general practice. so anxiety reduction may account for some of the effect.[71] In the last two years of life 26% had pain increasing to 46% in the last month.[60] [edit] Psychological Individuals with more social support experience less cancer pain.[51] African and Hispanic Americans are more likely than others to suffer needlessly in the hands of a physician. The placebo effect is more pronounced in people who are prone to anxiety. the researchers used a novel technique to determine pain-related brain activity.

such as insects.[73] Bernard Rollin of Colorado State University.[75] In his interactions with scientists and other veterinarians. that physical pain is dealt with in culture.[80] Specialists currently believe that all vertebrates can feel pain.[73][77] The ability of invertebrate species of animals. might too.[76] some critics continue to question how reliably animal mental states can be determined. noting that although the argument that animals have at least simple conscious thoughts and feelings has strong support. like the octopus. In particular. and that certain invertebrates. for actual or potential animal pain. René Descartes for example argued that animals lack consciousness and therefore do not experience pain and suffering in the way that humans do. like infants (Latin infans meaning "unable to speak"). non-human animals cannot answer questions about whether they feel pain. animal rights. and most insects. or other entities.The okipa ceremony as witnessed by George Catlin. the deliberate infliction of pain in the form of corporal punishment is used as retribution for an offence. but which may have substantial side effects .. drug control. Academic reviews of the topic are more equivocal. Identity theorists assert that the mental state of pain is completely identical with some physiological state. or society. Philosophers and scientists have responded to this difficulty in a variety of ways. i. In some cultures. More generally. circa 1835. including pain management policy. since no mechanism is known by which they could have such a feeling. to feel pain and suffering is also unclear. endogenous opioids are neurochemicals that moderate pain by interacting with opiate receptors.[85][86] Opioids may mediate their pain in the same way as in vertebrates.[85] their presence indicates that lobsters may be able to experience pain. thus the defining criterion for pain in humans cannot be applied to them. the principal author of two U.[83] except for instance in fruit flies.e. or to deter attitudes or behaviour deemed unacceptable. and to provide "scientifically acceptable" grounds for claiming that they feel pain.[74] writes that researchers remained unsure into the 1980s as to whether animals experience pain. before 1989 were simply taught to ignore animal pain. Chemotherapy —The treatment of infections or malignant diseases by drugs that act selectively on the cause of the disorder. philosophy. sensory inputs. [edit] In other animals Main article: Pain in animals Portrait of René Descartes by Jan Baptist Weenix 1647-1649 The 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.[87 Acute —A short-term pain in response to injury or other stimulus that resolves when the injury heals or the stimulus is removed. it is often as a part of pain in the broad sense. and behavioral outputs. federal laws regulating pain relief for animals. Philosophy of pain is a branch of philosophy of mind that deals essentially with physical pain. suffering. he was regularly asked to "prove" that animals are conscious. religion. torture.[84] In vertebrates. there are no known nociceptors in groups such as plants. pain compliance.[86] Veterinary medicine uses. The nature or meaning of physical pain has been diversely understood by religious or secular traditions from antiquity to modern times. In various contexts.[72] Physical pain is an important political topic in relation to various issues. the same analgesics and anesthetics as used in humans.[81][82] As for other animals. plants. but it can be inferred through physical and behavioral reactions. However. extreme practices such as mortification of the flesh or painful rites of passage are highly regarded. Functionalists consider that pain as a mental state is constituted solely by its functional role.S. their ability to feel physical pain is at present a question beyond scientific reach. and that veterinarians trained in the U.S. or for the purpose of disciplining or reforming a wrongdoer. by its causal relations to other mental states. Opioids and opiate receptors occur naturally in crustaceans and.[78][79] The presence of pain in an animal cannot be known for certain. fungi.[75] Carbone writes that the view that animals feel pain differently is now a minority view. although at present no certain conclusion can be drawn.

CNS or central nervous system —The part of the nervous system that includes the brain and the spinal cord.Chronic —Pain that endures beyond the term of an injury or painful stimulus. Metastasis —A secondary malignant tumor (one that has spread from a primary cancer to affect other parts of the body. Hepatic capsule —The membranous bag enclosing the liver. pain from a chronic or degenerative disease. Neuropathy —Nerve damage. Also refers to cancer pain. PNS or peripheral nervous system —Nerves that are outside of the brain and spinal cord. without curing. Nociceptor —A nerve cell capable of sensing pain and transmitting a pain signal. Palliative —Serving to relieve. Neurotransmitter —Chemicals within the nervous system that transmit information from or between nerve cells. Radiation . Pharmacological —Therapy that relies on drugs. or alleviate. Non-pharmacological —Therapy that does not involve drugs. and pain from an unidentified cause. Iatrogenic —Resulting from the activity of the physician.

a specific region in the brain. It has been hypothesized that uninterrupted and unrelenting pain can induce changes in the spinal cord. These hormones enhance the pain message and play a role in immune system responses to injury. Once the brain has received and processed the pain message and coordinated an appropriate response. nociceptors that extend from the skin are stimulated by sensations such as pressure. as evidenced by the phantom limb pain experienced by amputees. A pain message is transmitted to the CNS by special PNS nerve cells called nociceptors. Certain neurotransmitters. However. had theorized that the brain. However. the father of modern medicine. The CNS comprises the brain and spinal cord. The radiation. unrelenting pain has been treated by severing a nerve's connection to the CNS. For example. and Greek anatomists had begun to identify various nerves and their purposes. such as inflammation. Hippocrates. Pain is the means by which the peripheral nervous system (PNS) warns the central nervous system (CNS) of injury or potential injury to the body. What is pain? The treatment of pain has been a major endeavor since ancient times. Nociceptors are distributed throughout the body and respond to different stimuli depending on their location. When a nociceptor is stimulated. and chemical changes. temperature. Cancer pain is generally divided into three categories: . especially substance P and calcitonin generelated peptide. such as prostaglandins. which conveys the pain message to the thalamus. Nerve cells in the spinal cord may also begin secreting pain-amplifying neurotransmitters independent of actual pain signals from the body. By 400 B. What is cancer pain? The majority of cancer pain results from a cancerous tumor pressing on organs. destroys or slows the development of abnormal cells. Neurotransmitters are chemicals found within the nervous system that facilitate nerve cell communication. but an impressive 19% was found to be caused instead by treatment of the cancer. The body uses natural pain killers. the lack of any sensory information being relayed by that nerve can cause pain transmission in the spinal cord to go into overdrive. may be released. these natural pain killers may not adequately dampen a continuing pain message. in China. The nociceptor transmits its signal to nerve cells within the spinal cord. as it passes through diseased tissue. was the controlling center of the body. neurotransmitters are released from cells. nerves. or bone. and the PNS is composed of the nerves that stem from and lead into the CNS. depending on how the brain has processed the pain information. acupuncture was being used to reduce pain. Three percent of all complaints of pain were unrelated to either the disease or treatment. In the past. John Bonica and others have shown that a predictable 78% of all cancer pain is indeed related to the disease.C..—A treatment for cancer (and occasionally other diseases) by x rays or other sources of radioactivity. However. both of which produce ionizing radiation. certain hormones. PNS includes all nerves throughout the body except the brain and spinal cord. not the heart. several studies by painpioneer Dr. Stimulus —A factor capable of eliciting a response in a nerve. may play a prominent role in such changes. that are meant to derail further pain messages from the same source. Also. called endorphins. actively enhance the pain message at the injury site and within the spinal cord. Two thousand years ago. primarily cytokines. The pain-relieving properties of opium were already known and were being utilized to stop suffering. Immune chemicals. pain has served its purpose. Evidence is accumulating that unrelenting pain or the complete lack of nerve signals increases the number of pain receptors in the spinal cord.

or surgery.” Intensity Pain “At its least. rubbing. recurrent or chronic Onset and duration Course and daily variation. Chronic Pain Remote. Chronic Pain Acute Pain Recent onset and expected to last no longer than days or Temporal features weeks. stabbing. often ill–defined onset. insomnia.” Pain “At its worst. such as listlessness. weight loss. Associate pain– Pain behaviors.g. Pain “On an average. usually caused by pressure resulting from the invasiveness of the tumor. Familiar or unfamiliar. e.• Visceral pain. aching.g. throbbing. or pain caused by the pressure of a tumor on nerves. or burning). splinting. moaning. Acute vs.” Pain “At present” Topography Focal or multifocal or referred localized or generalized Superficial or deep. anorexia. . duration unknown.. e. May have signs of sympathetic hyperactivity when pain is Associate features severe. Quality Nature of pain (e. Intensity Variable Anxiety may be prominent when pain is severe or cause is Associated affect unknown. chemotherapy. Neuropathic pain. may be related behaviors prominent when pain is severe. • • Somatic pain often resulting from bone metastasis. expansion of the hepatic capsule. sweating. sometimes irritability. or the trauma to nerves resulting from either radiation.g.. or injury caused by radiation or chemotherapy.. hypertension. palpitation. Variable Irritability or depression May or may not give any indication of pain May or may not have vegetative signs. Characteristic Potential Elements Temporal Acute.