Pain – A Vital Sign That Is Occasionally Every Patient’s And Healthcare Worker’s Nightmare - By Dr Abidan Chansa

Pain is one of the main reasons people visit health facilities—but it’s different for everyone. What hurts one person may barely bother another. Simply put, pain is “an unpleasant experience linked to real or potential tissue damage.”

Pain comes in different forms:

• Acute pain: sudden, short-term, like cuts, surgery, or fractures.

• Chronic pain: lasts over six months, seen in arthritis, cancer, or nerve injuries.

• Nociceptive pain: from tissue damage—sharp, throbbing, or dull.

• Neuropathic pain: from nerve problems—burning, tingling, or electric shock.

• Mixed pain: a combination, like common lower back pain.

But pain isn’t just physical. “Total pain” shows it’s also emotional, social, and spiritual. Ignoring these makes relief harder, even with strong painkillers.

Managing pain starts with proper assessment, followed by a personalized plan to tackle both the body and the mind.

Among the most common reasons for seeking healthcare services is pain. Individual patients perceive it differently, their experiences differ and the causes are too many.

But what is pain?

Pain has been broadly defined as “An unpleasant sensory and emotional experience associated with, or resembling actual or potential tissue damage” – (International Association for the Study of Pain).

Pain is very subjective, varies from individual to another and it is what the person experiencing it says it is. It therefore makes the discussion around experiences of pain in the health facility by patients who seek health services quite diverse and half a time emotive.

There are, however, means of grading the pain by healthcare workers using tools that mostly depend on the report of the intensity of the pain by the sufferer. For children, these tools involve pictorial representation of the mood of the model child. What is obtained is called initial pain score. The subsequent pain scores is guide of how effective or ineffective the therapy is.

But what are the different types of pain in medical terms?

The various types of pain can be categorized based on the time the pain has been there and by the mechanism (medical term ‘pathophysiology’) that brings about the pain.

A. By Duration

Acute Pain:
This is by sudden onset with a short duration lasting from minutes to less than 6 months. Acute pain results from injury which can be from cuts, surgery, needles, fractures, or accidents. It could also result from other problems like heart attacks, pneumonia, obstruction of the intestines, inflammation of internal organs etc.

Chronic pain:
This is pain that lasts over six months. This pain may persist way beyond normal healing of the initial medical or surgical condition. The good examples are pain that results from chronic arthritis, cancer, amputation of a limb, or entrapment of the nerves.

B. By Mechanism

Nociceptive Pain:
Results from body tissue damage. This process stimulates the pain receptors in the part of the body that is injured or damaged and the signal is sent to the brain.

Somatic pain:
Is pain from the skin, muscles or bones. It is sharp, aching and throbbing.

Visceral pain:
Is pain from internal organs and is dull, deep and vague.

Neuropathic Pain:
Is pain that comes from damage or disease of the nervous system (nerves, spinal cord, brain).

Sufferers describe this as burning, electric shock, tingling and numbness. It can also occur as a result of certain chemicals and drugs altering the internal physiological processes of the body (side effects of drugs). This can result from diseases like herpes zoster (shingles), diabetic neuropathy etc.

The commonest drug that brings about this type of pain is in the TB treatment regimen. That is the reason that patients taking TB treatment are given Vitamin B6 to prevent the pain.

Mixed Pain:
Is pain that has elements of both nociceptive and neuropathic pain (common in conditions like low back pain).

Lower back pain is common in most individuals and can have a number of causes. It is imperative that those who suffer from lower back pain seek medical attention so that they are thoroughly evaluated; the correct cause identified and appropriate treatment is commenced or given.

What are the common causes of pain?

There are so many medical conditions that can cause pain. Basically, when someone is unwell, they have some level of pain. The concept of TOTAL PAIN explains the feelings that patients may have at the time of illness.

This concept was first described by one of the pioneers and prominent figures of the practice of Palliative Care, Dame Cicely Saunders. She used the term “total pain” to suggest that pain can be understood as having physical, psychological, social, emotional, and spiritual components.

The combination of these elements is believed to result in a “total pain” experience that is individualized and specific to each patient’s particular situation.

Most times in the practice of medicine, healthcare workers tend to find that patients that have conditions like cancer, for example, have many aspects of their lives that may influence the way they cope with the physical pain, that is a major component of the pain experience.

Unresolved psychological, spiritual and others may compound physical pain to the point that physical pain may not be alleviated by conventional strong prescribed pain killers. It thus is imperative that the concept of total pain is understood by all (health practitioners, patients and their families and carers).

How is pain treated or managed?

A general guide is the comprehensive assessment of the patient. After the patient is assessed, then the plan of management is made and implemented.