Experiencing Pain or Expressing It?

Understanding the Brain's Influence

Pain is a brain output; education is key to understanding and managing it

In America, chronic pain is a widespread and burdensome issue affecting millions of individuals. According to recent statistics:

Chronic pain affects approximately 50 million adults in the United States, making it one of the most common reasons for seeking medical care.

It's estimated that chronic pain costs the U.S. economy billions of dollars annually in healthcare expenses, lost productivity, and disability benefits.

Back pain is among the most prevalent forms of chronic pain, with around 80% of adults experiencing it at some point in their lives.

Despite its prevalence, chronic pain is often under-treated and inadequately managed, leading to significant physical, emotional, and socioeconomic consequences for affected individuals and society as a whole.

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Knowing how to differentiate between sharp and burning pain can help a doctor determine the site and type of pain but not necessarily the cause. Our pain is incredibly multifaceted and more difficult to identify than it is to manage. So let’s break down this complex output that is “pain” as easy as possible.

Experiencing Pain or Expressing It?

We must begin with understanding the concept of nociception. Nociception is the

ypes of Pain

Resources to help you assess your own pain at home!

Due to the incredibly multifaceted nature of pain; most assessments are not the same. Here is a quick list of assessments and what factors they consider.

Assessments That Consider Biological, Sociological, and Psychological Factors: (my recommendation)

  1. Brief Pain Inventory (BPI)

  2. McGill Pain Questionnaire (MPQ)

  3. Pain Disability Index (PDI)

  4. Fibromyalgia Impact Questionnaire (FIQ)

  5. Widespread Pain Index (WPI) and Symptom Severity Scale (SSS) (used in fibromyalgia diagnosis)

Assessments That Consider Primarily Psychological Factors:

  1. Pain Catastrophizing Scale (PCS)

  2. Pain Self-Efficacy Questionnaire (PSEQ)

Assessments That May Consider Some Biopsychosocial Factors, but Not as Comprehensive:

  1. Visual Analog Scale (VAS)

  2. Numeric Rating Scale (NRS)

  3. Roland-Morris Disability Questionnaire

  4. Oswestry Disability Index (ODI)

  5. Neuropathic Pain Questionnaire (NPQ)

  6. Pain Outcomes Questionnaire (POQ)

  7. Headache Impact Test (HIT)

  8. Short Form McGill Pain Questionnaire (SF-MPQ)

  9. WOMAC Osteoarthritis Index

Citations:

  • Bonezzi, C., & Demartini, L. (2020). Insights on the Classification of Pain. Minerva Anestesiologica, 86(1), 54–61.

  • IASP Terminology - International Association for the Study of Pain. (2021). Retrieved from https://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1698

  • Kosek, E., Cohen, M., Baron, R., Gebhart, G. F., Mico, J. A., Rice, A. S., ... & Sluka, A. K. (2016). Do we need a third mechanistic descriptor for chronic pain states? Pain, 157(7), 1382–1386.

  • Nicholas, M., Vlaeyen, J., Rief, W., & Barke, A. (2019). The IASP Classification of Chronic Pain for ICD-11: Chronic primary pain. Pain, 160(1), 28–37.

  • Treede, R. D., Rief, W., Barke, A., Aziz, Q., Bennett, M. I., Benoliel, R., ... & Wang, S. J. (2019). Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain, 160(1), 19–27.

I interviewed Dr’s and Nurses about patient’s understanding about pain.

Here are some of their answers;

(Vascular Surgeon)

I asked my client who is a vascular surgeon how much information his patients come prepared with about their pain and symptoms. He replied 

“Oh, patients are definitely not knowledgeable on the right descriptive words. But it would definitely help if they were.”

I asked him in what other way could this type of awareness from a patient could benefit everyone; He hit me with a really good response 

“More awareness could smooth internetwork communications by narrowing errors for incorrect department referrals”

(Oncology Nurse)

I asked the nurse what questions are probed to gain information on mental stress she paused and said

 “none, no one really cares about mental stress” 

We both paused to absorb that reaction. She added;

 “If patients knew more about their pain symptoms I would spend less time probing questions and more time gathering crucial information with the limited time we get with each patient. To save money for our patients we try to make the most of every minute.”

(Kaiser Permanente Emergency Medical Doctor)

I asked the same question to a Local San Diego CA ER doc and got the same answers.

“No one knows about their pain”

“I have to spend time probing” 

“It would absolutely help in emergency situations if someone could accurately describe what they feel.”

So, is it that easy? Can patient autonomy over pain come through simple tool of education? …

The fascinating world of pain classification.

  1. Nociceptive Pain: This type of pain arises from actual or potential damage to body tissues. It's typically described as a sharp, aching, or throbbing sensation and can be further categorized into:

    • Somatic Pain: Originates from the skin, muscles, bones, or connective tissues. Examples include cuts, bruises, and fractures.

    • Visceral Pain: Originates from internal organs like the stomach, intestines, or bladder. It's often described as dull, deep, and cramp-like, and can be caused by conditions like appendicitis or kidney stones.

  2. Neuropathic Pain: Neuropathic pain results from damage or dysfunction of the nervous system, leading to abnormal signaling. It's often described as shooting, burning, or electric shock-like sensations and can be caused by conditions such as diabetic neuropathy, sciatica, or postherpetic neuralgia (shingles).

  3. Nociplastic Pain: This type of pain is characterized by altered pain processing in the absence of ongoing tissue damage or nerve injury. It's often chronic and may involve abnormalities in the central nervous system's pain processing pathways. Fibromyalgia and irritable bowel syndrome are examples of conditions associated with nociplastic pain.

  4. Idiopathic Pain: Idiopathic pain refers to pain without an identifiable cause or underlying pathology. It's a diagnosis of exclusion, meaning other possible causes of pain have been ruled out, but the source remains unknown.

  5. Acute Pain: Acute pain typically results from tissue damage due to injury, surgery, or illness. It serves as a protective mechanism, alerting the body to potential harm and promoting healing. Acute pain is usually short-lived and resolves once the underlying cause is treated or healed.

  6. Chronic Pain: Chronic pain persists beyond the normal healing time and is often defined as lasting for three to six months or longer. It can result from conditions such as arthritis, migraines, fibromyalgia, or nerve damage. Chronic pain can have a significant impact on quality of life and may require ongoing management.

  7. Referred Pain: Referred pain is felt in a different location from the actual source of the pain. It occurs when sensory nerves from internal organs share pathways with nerves from other areas of the body. For example, pain from a heart attack may be felt in the arm or jaw rather than the chest.

    Why It Matters

Understanding the different types of pain isn't just about semantics—it's about reclaiming control over our well-being. By deciphering the language of pain, we empower ourselves to treat ourselves or advocate for better care and communicate more effectively with healthcare providers (Bonezzi & Demartini, 2020). Armed with knowledge, we can navigate the complex landscape of pain management with confidence and resilience.

So, the next time you feel a twinge or ache, remember: pain is more than just a sensation—it's a story waiting to be told, a journey of discovery into the depths of our physical and emotional well-being. Don’t mute it right away. Listen, assess, and respond appropriately.

Work with your local expert!