Thursday, March 11, 2010


We all know from first hand experience what pain is. Although noxious, pain is beneficial because it warns of impending tissue damage. Even single cell organisms without nerves sense and try to avoid damage (called negative chemotaxis). There are two pathways in the spinal cord that carry pain messages to the brain – one is fast conducting, the other is slow conducting. This is why if you touch a hot frying pan you first feel a stab of pain, followed by a much different pain (which, for a split second, you realize will happen). Although we think of pain as a sensation associated with touch, it occurs when other sensory systems are threatened too. We squint in discomfort when strong light hits our retina or we plug our ears at loud sounds.

Most pain resolves as soon as the offending stimulus is removed. However, chronic pain may produce nervous system changes that become permanent, leaving behind lingering discomfort. In other words, making pain for pain’s sake.

Damage to joints (for example, in the low back) can set up inflammation, which, in turn, causes pain, resulting in a regenerative vicious cycle. Inflammation is a complex chemical and cellular response of the body. Drugs like aspirin, naproxsen (Aleve), ibuprofen (known as non-steroidal anti-inflammatory (NSAID) drugs) decrease pain by partially blocking the chemical reactions that promote inflammation. It is a common misnomer to refer to NSAIDs as “pain medication.” They’re not. Any relief of pain they provide is secondary to reducing inflammation.

True pain medications such as narcotics (e.g., morphine, codeine) do not block pain sensors or the nerves. Rather, they blunt the brain’s awareness of pain and thereby make it more tolerable. They also cause a feeling of well-being that reduces suffering. Pain and suffering are not the same. Suffering is an emotional reaction to pain.

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