Pain: What is it? How does it work? How is it treated?

A widely accepted definition of pain is: “pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage” (IASP, p 448).    “The perception of pain is called nociception and it depends on specifically dedicated receptors and pathways. Nociceptive impulses arise from skin, muscle, joints, arteries, and the viscera (internal organs and tissues) are transmitted from unspecialized nerve endings called   nociceptors, which respond to chemical, mechanical and thermal stimuli” (Huether & Defriez).

These nociceptors unlike other specialized receptors such as those for smell and vision, are able to detect many types stimuli making them very versatile. These receptors when stimulated carry information to the spinal cord and this information then goes up to the brain for interpretation. Specific types of stimulation send info up specific pathways in the cord to the brain. This stimulation to the receptors may be from situations in the involved tissues such as crushing, hypoxia or ischemia (too little oxygen), pricking, cutting, freezing, burning, stretching, bleeding, contraction, spasm or many other irritants. Any and all of these situations can cause the receptors to “fire”, sending nerve impulses to the spinal cord and up to the brain.

Treatments whether physiotherapy, rehabilitative or prescription medications are thus aimed at fixing the cause of the bad nerve stimulation in an ideal situation by “stopping” the crushing, hypoxia, pricking, burning from occurring in the first place or if unable to suppress the signals or fix the cause of the pain, the focus then shifts from fixing to masking or altering those receptors or the signals going to the spinal cord and/or brain. The OTC or prescription medications used may work on many levels. They can work at the receptor level, the nerves to or from, the spinal cord or the brain.

Pain is a complex issue and effects many patients. There are many methods to help a person with pain. It is best to use the safest or lower risk alternatives first such as doing nothing at all, physiotherapy, exercise, massage, manipulation etc.  When the lowest risk options are not successful or only partially successful one may move to medium risk options such as prescription medications or injections. The last option is the highest risk options such as surgery and other procedures that are sometimes irreversible and have the potential to cause other problems. If it comes to surgery, and the patient is picked properly and matched with a skilled surgeon this is often successful, but all other options should be exhausted prior to this last option.

If you need help with pain, I can help you in most cases. You and I may choose passive and active physiotherapy or prescription medications or both We will be determine how to address it  after we have discussed in detail what symptoms you are experiencing. We will do an exam to determine what tissues are affected and try the safest methods first. We may choose a combination of more than one type of treatment and we often do. I will work with you to figure out the best likelihood to help you the fastest and most lasting way to achieve relief.

Call Dr Brown for an immediate appointment 817-274-2343

References

  1. International Association for the Study of Pain (IASP) 
  2. Pathophysiology the Biological Basis for Disease in Adults and Children, Huether &Defriez.