Chronic pain is the most common underlying cause of suicide
If you suffer from pain, this article should help you understand the clinical terms for the different types of pain and perhaps communicate with your doctor more effectively.
Pain is an unpleasant feeling that is conveyed to the brain by sensory neurons. The discomfort signals actual or potential injury to the body. Pain is more than a sensation, or the physical awareness of pain. It also includes perception, the subjective interpretation of the discomfort. Perception gives information on the pain’s location, intensity and something about its nature. The various conscious and unconscious responses to both sensations and perception, including the emotional response, add further definition to the overall concept of pain.
Pain arises from any number of situations. Injury is a major cause, but pain may also arise from an illness. It may accompany a psychological condition, such as depression, or may even occur in the absence of a recognizable etiology.
Acute pain is a direct biological response to disease, inflammation, or tissue damage and usually lasts less than one month. It may be either continuous or recurrent. Acute pain serves the long term well being of humans and the higher animals by alerting them to an injury or condition that needs treatment. In humans, acute pain is often accompanied by anxiety and emotional distress; however, its cause can usually be successfully diagnosed and treated. Some researchers use the term “eudynia” to refer to acute pain.
In contrast, chronic pain has no useful biological function. It may be defined in a broad sense as pain that lasts longer than a month following the healing of a tissue injury; pain that recurs or persists over a period of three months or longer; or pain related to a tissue injury that is expected to continue or worsen. Chronic pain may be either continuous or intermittent. In either case, it frequently leads to weight loss, sleep disturbances, fatigue, and other symptom of depression. A recent article in the New York Times states that chronic pain is the most common underlying cause of suicide. Unlike acute pain, chronic pain is resistant to most medical treatments. It is at times called “maldynia” and is considered a disorder in its own right.
Pain caused by organic disease is termed somatogenic pain. Somatogenic pain is divided into nociceptive pain and neuropathic pain. Nociceptive pain occurs when pain sensitive nerve endings called nociceptors are activated or stimulated. Most nociceptors are located in skin, joints, muscles and the walls of internal organs. Nociceptors are specialized to detect different types of painful stimuli, e.g., heat or cold, pressure, toxic substances, sharp blows or inflammation.
In contrast to nociceptive pain, neuropathic pain results from damage to or a malfunction of the nervous system itself.
Psychogenic pain is distinguished from somatogenic pain by the influence of psychological factors on the intensity of a person’s pain or degree of disability. The person is genuinely experiencing pain. They are not malingering but the pain has no organic explanation or a weak explanation.
It is important to recognize that some pain syndromes may involve more than one type of pain. An example would be a cancer patient who maybe suffering from neuropathic pain as a side effect of the cancer treatment (chemotherapy-radiation) as well as nociceptive pain associated with the actual pressure from the tumor on nociceptors in blood vessels or other organs.
To understand pain completely, we must be familiar with the science. And, if you suffer from pain, this article should help you understand the clinical terms for pain.
Dr. Joseph Andris, D.O., is a board certified anesthesiologist. For the past nine years, he has been practicing in the San Francisco Bay Area. He serves as director of the OR as well as assistant chief of anesthesia at Kaiser Permanente's San Rafael campus. Dr. Andris attended Villanova University and the Philadelphia College of Osteopathic Medicine. He completed residencies in both internal medicine and anesthesiology at West Virginia University, where he also taught as an assistant professor while practicing medicine.
