What is Pain?

As my granddad used to say, pain is pain, grin and bear it. Well I found out that was wrong and found pain to be quite the conundrum. It is a big problem that I have been working on for twenty one years to try to help.

Early on in my years working as an orderly, and later in my first years of medical school, nothing scared me more than a pain patient. I didn’t know how to console them or how to treat them. I had learned about diagnosis and therapy but I didn’t understand the acute and chronic pain experience at all. We had little training on pain, and it was one of the major reasons people were coming to university hospital. The first thing I learned about pain was to listen and communicate with the patients and then they taught me a whole lot.

Well let’s talk about the basics of pain. First of all, a fancy definition from the International Association for the Study of Pain: “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”.  That definition isn’t bad, but can be hard to understand.

Pain is an individual experience. I can’t examine a patient and really know what their pain is like. I have to listen and help them document their experience to better understand it. I also have to educate the patient so we can better communicate and understand the pain and attack it together.

Types of Pain

Pain can be divided into many categories, but let’s start with two that have to do with the length of time you have pain.

1. Acute pain which comes on suddenly and signals that something is wrong. A good example of this type of pain is an injury that results in a broken bone or a kidney stone. It is short in duration from minutes to weeks and usually only a few hours. You can have recurring or relapsing acute pain in some disorders like kidney stones.

2. Chronic pain is confusing and complicated. The cause is sometimes difficult to determine and often there are multiple causes, some of which may have been contributed by the therapy or surgery. Chronic pain can change everything. It is persistent, lasting months or years, and sometimes debilitating and difficult to provide therapy for, requiring multiple modalities. Chronic Pain syndromes may include arthritis, fibromyalgia, diabetic neuropathy, failed back syndrome and complex regional pain syndrome to name a few.

Physiological Types of Pain

Functional or physiological explanations like nociceptive and neuropathic often help us categorize and understand pain, here are two brief definitions.

Nociceptive Pain

This pain can occur as a result from part of the body that is injured, stretched, inflamed or not getting enough oxygen or blood. The key part is little receptors, called “nociceptive” receptors. Nociceptive receptors are stimulated by what is going wrong and send a painful message to the brain. This is seen in broken bones, distended organs or heart attacks.

Neuropathic Pain

Neuropathic pain results from injury to nerves in either the brain, spinal cord or nerves. It can be described as burning, tingling, shooting, stabbing, or shocking. Lots of people with chronic pain suffer from neuropathic types of pain.

Well, pain and especially chronic pain is much more complicated than that but this is a good beginning. Until next blog, I hope everyday is a better one.

Dr. Kent



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