What is pain?

At the global health agenda turns and twists it’s focus to Non Communicable diseases, there is an increasing realization as to the Chronic nature of these diseases. With this chronicity of time there may also come increased duration of pain and suffering.  At the UN Civil Society Meeting on Non communicable diseases this week, a number of participants including a medical student commented on the need for our medical education system to move away from teaching in the “Acute” settings, and to focus more on the chronic.

It struck me that this really does have an impact on pain.  We, as clinicians, get taught about pain in the acute setting.  The person who presents to the ER with chest pain, the kidney stone, the trauma. These people look uncomfortable and often have an associated sympathetic reaction (with a fast heart rate, increased blood pressure, sweating). So we are trained to identify these people as having a problem and are more likely to believe their pain.

How often do we hear this comment about those with chronic pain?

“They don’t look like they have severe pain.”

Teena may look unwell when she comes to the ER with a sickle call crisis but she may continue to have pain between crises, looking relatively well and normal.  How can she have a pain of 8/10 when she looks so well?

Bernard and Bob both have other signs of advancing disease and we are often much more willing to accept their reports of pain.

What is Pain?  MIchael Cousins gives us the IASP definition.

An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

It is essential that we believe a patient’s report.

Believing their pain report does not mean a clinician is making a decision to prescribe opioids, but does raise the questions within the clinician that they do have to consider the appropriate management.

A final comment, I have not used the word “complain” here.  Even though we talk about the “Presenting Complaint” in medical history, we tend not to like people who complain.  “Reporting pain” is a much less emotive term than the patient “complains of chronic pain.”

About Pain policy & palliative care

Improving global pain relief by achieving balanced access to opioids worldwide


7 thoughts on “What is pain?

  1. Thank you Jim,
    I will sent this information in PC network

    Posted by Nguyen Thi Phuong Cham | June 19, 2011, 12:27 PM
  2. Thank you Jim,
    I will sent this information to Vietnam PC nettwork.
    Best regards,

    Posted by Nguyen Thi Phuong Cham | June 19, 2011, 12:29 PM
  3. Pain is devastating. We don’t have to wait until we experience it to act. We must act now and advocate for pain relief for all.

    Posted by Zipporah Ali | June 20, 2011, 3:03 AM
  4. Torture is a strong word, but definitely the most accurate to describe the suffering of unrelieved pain, Palliative CAre is a strive in some of our countries, while we have touched and changed many lives, there are still a great number of our patients suffering inhuman pain due to lack of the lowest costs medicines, there´s no way that you can just write the prescription without thinking “How much will this cost for them? I dream of a day where pain medicines could be as vaccines, as neccesary and affordable, as well as recognized by our authorities as “ESSENTIAL”, I work hard every day to see this dream come true!

    Posted by Eva Duarte | July 1, 2011, 3:48 PM


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