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Pain management (also called pain medicine) is the discipline concerned with the relief of pain. Pain has been described as, "An unpleasant sensory and emotional experience associated with either actual or potential tissue damage. It is a very personal and individual experience - defined as whatever the patient says it is, and it exists wherever he or she says it does."
Pain can be acute or chronic. The distinction between acute and chronic pain is not based on its duration of sensation, but rather the nature of the pain itself. Management and therapy is adequated to this distinction.
In general, physicians are more comfortable treating acute pain, which usually is caused by soft tissue damage, infection and/or inflammation among other causes. It is usually treated simultaneously with pharmaceuticals or appropriate techniques for removing the cause and pharmaceuticals or appropriate techniques for controlling the pain sensation, commonly analgesics. Acute pain serves to alert after an injury or malfunction of the body.
- Main article: Chronic pain
General physicians have only elementary training in chronic pain management and patients suffering from it are referred to specialists.
Chronic pain may have no apparent cause or may be caused by a developing illness or imbalance. This disorder can trigger multiple psychological problems that confound both patient and health care provider, leading to various differential diagnoses and to patient's feelings of helplessness and hopelessness. Sometimes chronic pain can have a psychosomatic or psychogenic cause.
Chronic pain was originally defined as pain that has lasted 6 months or longer. It is now defined as "the disease of pain."[How to reference and link to summary or text] Its origin, duration, intensity, and specific symptoms vary. The one consistent fact of chronic pain is that, as a disorder, it cannot be understood in the same terms as acute pain.
The failure to treat acute pain properly may lead to chronic pain in some cases.
Pain management generally benefits from a multidisciplinary approach that includes pharmacologic measures (analgesics such as narcotics or NSAIDs and pain modifiers such as tricyclic antidepressants or anticonvulsants), non-pharmacologic measures (such as interventional procedures, physical therapy and physical exercise, application of ice and/or heat), and psychological measures (such as biofeedback and cognitive therapy).
- Main article: The psychologists contribution to pain management
- Main article: Psychological research in pain management
- Main article: Mindfulness and pain management
Pain management practitioners come from all fields of medicine. Most often, pain fellowship trained physicians are anesthesiologists, neurologists, physiatrists or psychiatrists. Some practitioners focus more on the pharmacologic management of the patient, while others are very proficient at the interventional management of pain. Interventional procedures - typically used for chronic back pain - include: epidural steroid injections, facet joint injections, neurolytic blocks, Spinal Cord Stimulators and intrathecal drug delivery system implants, etc.
Hypnosis as well as diverse perceptional techniques provoking altered states of consciousness have proven to be of important help in the management of all types of pain. Some kinds of physical manipulation or exercise are showing interesting results as well.
For pain management for particular conditions see:
- Back pain
- Phantom limb pain
- Temporomandibular joint disorder
- Somatoform pain disorder
- Linda Lilley, Scott Harrington, Julie Snyder,. Pharmacology and the Nursing Process, 147, Saint Louis: C.V. Mosby. ISBN 0323024084.
- Sarno, John E., MD, et al., The Divided Mind: The Epidemic of Mindbody Disorders 2006 (ISBN 0-06-085178-3)
- Dahl JB, Moiniche S (2004). Pre-emptive analgesia. Br Med Bull 71: 13-27. PMID 15596866.
- Robert Ornstein PhD, David Sobel MD (1988). The Healing Brain, pp 98-99, New York: Simon & Schuster Inc.
- Douglas E DeGood, Donald C Manning MD, Susan J Middaugh (1997). The headache & Neck Pain Workbook, Oakland, California: New Harbinger Publications.
- [Back pain and neck pain information for patients]
- [American chronic pain association]
- [Chronic pain support group]
Pain and nociception
|Head and neck||
Jaw and mouth (Odynophagia ) • Ear (otalgia, otitis media, otitis externa) • Eye (glaucoma) • Head (headache, migraine, tension headache, cluster headache, cerebral aneurysm, sinusitis, meningitis) • Neck (atypical myocardial infarction)
Back (upper back, lower back, spinal disc herniation, degenerative disc disease, coccydynia) • Breast (perimenstrual, breast cancer) • Chest (myocardial infarction, gastroesophageal reflux disease, pancreatitis, hiatus hernia, aortic dissection, asymptomatic pulmonary embolism, Tietze's syndrome) • Shoulder (right side - cholecystitis)
Left and right upper quadrant (peptic ulcer disease, gastroenteritis, hepatitis, pancreatitis, cholecystitis, atypical myocardial infarction, abdominal aortic aneurysm, asymptomatic gastric cancer) • Left and right lower quadrant (appendicitis, ulcerative colitis, Crohn's disease, ectopic pregnancy, endometriosis, pelvic inflammatory disease, diverticulitis, urolithiasis, pyelonephritis, colorectal cancer)
Small joints (osteoarthritis, rheumatoid arthritis, systemic lupus erythematosis, gout, pseudogout • Large joints (osteoarthritis, septic arthritis, hemarthrosis, osteonecrosis) • Back joints (ankylosing spondylitis, inflammatory bowel disease) • Other (psoriatic arthritis, Reiter's syndrome)
cold pressor test, congenital insensitivity to pain, dolorimeter, HSAN (Type I, II congenital sensory neuropathy, III familial dysautonomia, IV congenital insensitivity to pain with anhidrosis, V congenital insensitivity to pain with partial anhidrosis), neuralgia, pain asymbolia, pain disorder, paroxysmal extreme pain disorder • Allodynia, breakthrough pain, chronic pain, hyperalgesia, hypoalgesia, hyperpathia, phantom pain, referred pain
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