Understanding Pain and its types

PAIN
Its a word that produces a sense of discomfort even when we think about it.By its literal definition,pain is defined as physical suffering or discomfort caused by illness or injury.
The International Association for the Study of Pain's widely used definition states: "Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage."

I relate more with its latter definition as I believe that pain is not only physical,but mental and emotional too.

While coming across pain in all these years,I found out that even pain when happens to any individual causes a blockage in their mental state and hinders whatever they do in a way that they get upset and distressed emotionally.Pain perception would be still associated with the intensity of the pain stimulus and the degree of damage caused to the affected tissue.

According to the gate control theory, pain signals are not free to reach the brain as soon as they are generated at the injured tissues or sites. They need to encounter certain ‘neurological gates’ at the spinal cord (https://en.wikipedia.org/wiki/Spinal_cord) level and these gates determine whether the pain signals should reach the brain or not. In other words, pain is perceived or felt when the gate gives way to the pain signals and it is less intense or not at all perceived when the gate closes for the signals to pass through.

This theory gives the explanation for why someone finds relief by rubbing,massaging or pressing at the site of pain and this is what we need to understand to help ourselves and others help overcome pain.

Various factors determine how the pain signals should be treated at the neurological gates. They are:

• The intensity of the pain signals
• The intensity of the external sensory signals (touch, temperature and pressure), if generated at the site of injury
• The message from the brain itself (to send the pain signals or not),which means modifying the message by providing it an alternate route

Another important aspect we need to understand is that emotions and thoughts play and important role in effecting and producing pain

Pain signal transmission can be largely influenced by emotions and thoughts. People do not feel a chronic pain or, to be more appropriate, the pain does not disturb them when they concentrate on other activities that interest them. Whereas, people who are anxious or depressed feel intense pain and find it difficult to cope up with it. This is because the brain sends messages through descending fibers that stop, reduce or amplify the transmission of pain signals through the gate, depending on the thoughts and emotions of a person.

One of the tremendous advances in pain management research is the advent of Transcutaneous Electrical Nerve Stimulation (TENS). The gate control theory forms the basis of TENS. In this technique, the selective stimulation of the large diameter nerve fibers carrying non-pain sensory stimuli from a specific region nullifies or reduces the effect of pain signals from the region. TENS is a non-invasive and inexpensive pain management approach that has been widely used for the treatment of chronic and intractable pain that are otherwise non-responsive to analgesics and surgical treatments. TENS is highly advantageous over pain medications in the aspect that it does not have the problem of drug interactions and toxicity.

Many other invasive and non-invasive electrical stimulation techniques have been found to be useful in various chronic pain conditions like arthritic pain, diabetic neuropathy, fibromyalgia, etc. The theory has also been extensively studied in the treatment of chronic back pain and cancer pain. However, favorable results are not attained in some conditions and the long term efficacy of the techniques based on the theory is under question.

The gate control theory has dramatically revolutionized the field of pain research and it has sown seeds for numerous studies that aim at presenting a pain-free lifestyle to the patients who suffer from chronic pain.

Referances

Abram SE (1993). 1992 Bonica Lecture. Advances in chronic pain management since gate control. Regional anesthesia, 18 (2), 66-81 PMID: 8098221

Bishop B (1980). Pain: its physiology and rationale for management. Part III. Consequences of current concepts of pain mechanisms related to pain management. Physical therapy, 60 (1), 24-37 PMID: 6243184

Melzack R, & Wall PD (1965). Pain mechanisms: a new theory. Science (New York, N.Y.), 150 (3699), 971-9 PMID: 5320816

Moayedi M, & Davis KD (2013). Theories of pain: from specificity to gate control. Journal of neurophysiology, 109 (1), 5-12 PMID: 23034364

Nizard J, Raoul S, Nguyen JP, & Lefaucheur JP (2012). Invasive stimulation therapies for the treatment of refractory pain. Discovery medicine, 14 (77), 237-46 PMID: 23114579

Nnoaham KE, & Kumbang J (2008). Transcutaneous electrical nerve stimulation (TENS) for chronic pain. The Cochrane database of systematic reviews (3) PMID: 18646088

Tashani O, & Johnson M (2009). Transcutaneous Electrical Nerve Stimulation (TENS) A Possible Aid for Pain Relief in Developing Countries? The Libyan journal of medicine, 4 (2), 62-5 PMID: 21483510