Medical Terminology: Pain Management

1. What is Pain Management?
Pain is sensed through nerve endings, which are generously spread throughout the internal tissues and the skin. The brain is the only structure without pain receptors. When pain receptors are stimulated, discomfort or pain results, prompting that action be taken to remove the cause of the pain.
The pain impulse travels along sensory fibers of the spinal nerves to the spinal cord and then to the brain, which interprets the degree and source of the pain. The brain can then signal nerve fibers to release chemicals to inhibit pain signals. Some of the chemicals—enkephalins, serotonin, and endorphins—are able to suppress pain signals and provide endogenous pain control.
Visceral pain is pain from an organ secondary to surgery, cramping, ischemia, stretching, or spasms.
Referred pain is the sensation of pain coming from another part of the body than where it actually originates. It is common for heart pain to be felt in the arm. The pain impulses from the heart travel the same circuit as the receptors in the arm, confusing the interpretation in the brain.
Various individuals can experience different levels of pain with the same injury. Researchers have sought to explain this phenomenon. The gate control theory postulates that there is a “gate” in the spine that controls the impulses from the finger on the hot stove to the brain. The brain controls this gate to allow through total or partial signals.
However, the interpretation is based on current emotions, memories, expectations, ideals, and cultural biases. If your mind is busy elsewhere, the pain may be somehow lessened, for example, the Lamaze experience through labor and childbirth. This is one of the more popular pain theories, among others. Emotional pain can produce many symptoms, as varied in their presentation as the etiology of the pain.
Pain scales are useful tools to assess severity of pain and quality of life. They help the patient to accurately assess the pain and the impact it is having. Pain scales often are measured on a Likert scale, from 0. (no pain) to 10. (the worst pain ever).
The Wong pain scale for children uses a happy smiling face to a sad, tearful one. Another useful tool is a pain diary, in which the patient records severity, location, activity at the time, precipitating factors, and what if anything relieved the pain. It is a helpful tool to assess worsening or alleviating pain and reactions to pain medications.

2. Acute Pain
Acute pain usually points to an aberration or an illness. It is differentiated from chronic pain by the duration, usually less than 4. to 6. months. Pain nerves are stimulated by pressure, cuts, heat, cold, stabs, surgery, and so on. Other causes include fractures, burns, and bruises.

3. Chronic Pain
Chronic pain is lingering pain after identification of etiology of the initial onset. It may be less intense after 4. to 6. months, or may be the same degree of pain.
- Arthritis
- Backaches
- Cancer
- Headaches
- Neurogenic pain
- Psychogenic pain

4. Peripheral Neuropathy
This is the degeneration or disease of the peripheral nerves that affect motor and/or sensory nerves. The peripheral nerves include all but the brain and spinal cord. The neuropathies are poorly understood. When peripheral nerves are damaged, the brain becomes confused when processing communication from the damaged nerves.
Pain or numbness may be out of proportion to the damage or may be present where skin and tissue are intact. Peripheral neuropathy may affect motor nerves, sensory nerves, or both. It is often a sequelae (secondary result) of poorly controlled diabetes, autoimmune diseases, hypothyroidism, toxic substances, HIV/AIDS, vitamin deficiencies, alcohol abuse, or some infections.

5. Phantom Limb Pain
Pain, mild to severe, felt in the area where an extremity has been amputated, is called phantom limb pain. The nerve endings at the surgical site continue to relay pain signals to the brain. The missing limb could be the result of surgical amputation or trauma.

6. Substance Use Disorders
Substance abuse is defined as an irresistable urge for drugs, alcohol, or other substances, including physical, physiologic, and psychological longings, and a need for more and greater dosages to satisfy the cravings.
Abused substances produce euphoria and intoxication that include changes in mental status, decreased coordination, and slurred speech. Seizures and loss of consciousness are late signs. Usual abused substances include alcohol, club or illegal drugs, and cigarettes. However, food, caffeine, and sex may be included in some definitions.
Research shows a varied set of internal and external circumstances leading to drug abuse. There seems to be a genetic factor involved, as well as environmental and social elements. Individuals may slowly begin a habit for pleasure, depression, hunger issues, weight reduction, societal pressures, or to escape from pressure. Teen use often begins early.

7. Drug Addiction
Drug addiction is the chronic overuse and abuse of legal or illegal substances causing interpersonal, social, and family problems. Addiction occurs when the use of the substance causes an abnormal physical or psychological dependence in which sudden discontinuance causes severe trauma. This differs from tolerance, in which the desired effectiveness of the drug diminishes over time.
Larger quantities of the drug must be used to achieve the same effect. Severe addiction is usually characterized by the inability to carry out work requirements, school responsibilities, or family obligations and duties. Some patients who take pain medications other than directed or to achieve a sensation different than pain relief are more at risk for addiction. Addiction is a multifaceted problem caused by peer pressure, genetic factors, social nonconformity, stress, depression, and mental anxiety.
Those who have a family member with an addiction or who have themselves had an addiction in the past are at an increased risk. Societal pressures and environmental pressures can influence the probability of becoming addicted. Research has determined that long-term drug use results in changes in brain function, which increases the compulsion to abuse drugs.

Basic Questions
Pain Management

1. What is pain?
Pain is sensed through nerve endings.

2. What chemicals can provide endogenous pain control?
Enkephalins, serotonin, and endorphins are able to suppress pain signals.

3. What is visceral pain?
Visceral pain is pain from an organ secondary to surgery, cramping, ischemia, stretching, or spasms.

4. What is referred pain?
Referred pain is the sensation of pain coming from another part of the body than where it actually originates.

5. What is an example of referred pain?
It is common for heart pain to be felt in the arm. The pain impulses from the heart travel the same circuit as the receptors in the arm, confusing the interpretation in the brain.

6. What does the gate control theory postulate?
The gate control theory postulates that there is a “gate” in the spine that controls the impulses from the finger on the hot stove to the brain. The brain controls this gate to allow total or partial signals through total or partial signals.

7. What is the Lamaze experience?
If your mind is busy elsewhere, the pain may be somehow lessened, for example, the Lamaze experience through labor and childbirth uses relaxation, breathing techniques, and continuous emotional support to direct the mother’s mind away from labor.

8. What are pain scales?
Pain scales are useful tools to assess severity of pain and quality of life. They will help the patient to accurately assess the pain and the impact it is having. Pain scales often are measured on a Likert scale, from 0. (no pain) to 10. (the worst pain ever).

9. What is the Wong pain scale?
The Wong pain scale for children uses a happy smiling face to a sad, tearful one.

10. What is a pain diary?
A pain diary is a diary in which the patient records severity, location, activity at the time, precipitating factors, and what, if anything, relieved the pain. It is a helpful tool to assess worsening or alleviating pain and also reactions to pain medications.

11. What is acute pain?
Acute pain usually points to an aberration or an illness. It is differentiated from chronic pain by the duration, usually less than 4. to 6. months.

12. What are common causes of acute pain?
Pain nerves are stimulated by pressure, cuts, heat, cold, stabs, surgery, and so on. Other causes include fractures, burns, and bruises.

13. What is chronic pain?
Chronic pain is lingering pain after identification of etiology of the initial onset. It may be less intense after 4. to 6. months, or may be the same degree of pain.

14. What are examples of chronic pain?
Some examples of chronic pain are arthritis, backaches, cancer, headaches, neurogenic pain, and psychogenic pain.

15. What is peripheral neuropathy?
This is the degeneration or disease of the peripheral nerves that affect motor and/or sensory nerves. The peripheral nerves include all but the brain and spinal cord. The neuropathies are poorly understood. When peripheral nerves are damaged, the brain becomes confused when processing communication from the damaged nerves.

16. What is a result of peripheral neuropathy?
Pain or numbness may be out of proportion to the damage or may be present where skin and tissue are intact.

17. What is a cause of peripheral neuropathy?
It is often a sequelae (secondary result) of poorly controlled diabetes, autoimmune diseases, hypothyroidism, toxic substances, HIV/AIDS, vitamin deficiencies, alcohol abuse, or some infections.

18. What is phantom limb pain?
Pain, mild to severe, felt in the area where an extremity has been amputated, is called phantom limb pain. The nerve endings at the surgical site continue to relay pain signals to the brain.

19. How is phantom limb pain treated?
Health care providers treat phantom limb pain with the same treatment as if the limb was present because the pain is real caused by pain signals from nerve endings at the surgical site.

20. What is substance abuse?
Substance abuse is defined as an irresistible urge for drugs, alcohol, or other substances, including physical, physiologic, and psychological longings, and a need for more and greater dosages to satisfy the cravings.

21. What results in the use of abused substances?
Abused substances produce euphoria and intoxication, which include changes in mental status, decreased coordination, and slurred speech.

22. What is drug addiction?
Drug addiction is the chronic overuse and abuse of legal or illegal substances causing interpersonal, social, and family problems.

23. When does addiction to drugs occur?
Addiction occurs when the use of the substance causes an abnormal physical or psychological dependence in which the sudden discontinuance will cause severe trauma.

24. How does addiction differ from drug tolerance?
Drug tolerance occurs when the desired effectiveness of the drug diminishes over time.

25. What is severe addiction?
Severe addiction is usually characterized by the inability to carry out work requirements, school responsibilities, or family obligations and duties.