Venting the Pain

Is your pain burning, squeezing, stabbing, aching, or tingling? Is it dull or sharp? Is it constant or intermittent? Is it localized, diffuse, or traveling? If you have had longstanding pain, you may have used these words in an attempt to define your experience. We know that the simple word “pain” is grossly inadequate in describing the vastness and intensity of the pain experience. Recurrent or persistent pain is estimated to occur in nearly half the general population. It is important that you as a pain sufferer know the vocabulary of pain so you can understand the why and wherefore of your situation and communicate it accurately with your treatment providers.

The following is an outline of the basic types of pain as well as a time line for the progression of the pain experience:

TISSUE PAIN: This is called nocioceptive pain because it is the result of tissue damage that activates the nocioceptors, the body’s pain sensory nerves. Tissue pain is usually sharp, dull, or aching, and it can radiate. This type of pain usually responds to nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids. Tissue pain is categorized as either somatic or visceral.

Somatic Pain: This is experienced on the body surface (cutaneous pain) or deep in muscle and skeletal tissues. Surface pain is usually described as sharp as well as burning or tingling. Deep tissue somatic pain is usually dull or aching.

Visceral Pain: This is commonly termed “gut” pain, experienced in the internal areas of the body that are found in the chest cavity, the abdominal cavity, and the pelvic cavity. Visceral pain is usually experienced as deep pressure or squeezing.

NERVE PAIN: This is referred to as neuropathic pain because it is caused by damage to or dysfunction of the nervous system. Neuropathic pain can be either in the central nervous system or peripheral, outside the central nervous system. This pain is severe and feels like burning or like an electrical shock. Often it is not experienced as painful per se, but is felt as unpleasantly tingling. Peripheral nerve pain may be sensitive to even a light touch or clothing on the skin. This type of pain usually does not respond to NSAIDs and opioids. Other medications such as tricyclic antidepressants, anticonvulsants, and sodium channel blockers can be useful in managing nerve pain.

Tissue pain and nerve pain frequently co-exist. Often nerve pain persists even after the somatic pain has been eliminated and the condition or injury that caused both types of pain has been cured. Pain progresses through the following stages:

ACUTE PAIN: Injury leads to inflammation and responses in the nervous system. Pain signals are sent to the brain, and the brain responds by sending signals to the muscles causing tightening to protect the injured area. As tissues heal, inflammation resolves, and the nervous system sends out fewer and fewer signals. Acute pain is associated with an obvious source of pain. The course of the symptoms is generally less than one month. This type of pain responds well to medication. There are usually no psychological symptoms associated with this pain. Sufferers usually cope by reducing physical activity and seeking medical help.

CONTINUOUS PAIN: This is pain form an obvious source—such as cancer—that has been present for over six months. It generally responds well to medication and is sometimes accompanied by psychological symptoms such as depression and anxiety. As the pain persists, secondary pain can appear as the person adjusts posture and gait to avoid the pain. Sufferers add additional coping methods such as counseling and alternative medical treatments.

CHRONIC PAIN: This is pain that can no longer be attributed fully to the original tissue injury. Chronic pain can occur in the absence of ongoing illness or persists after healing is completed. It often begins with an injury that causes inflammation and nerve damage. Chronic pain is defined as pain not associated with an obvious source and persisting longer than six months. Response to pain medication is fair to poor. Chronic pain has an effect on daily activities, work, household chores, and social interactions. Sufferers sometimes give up on treatment and become withdrawn and isolated. Depression, anxiety, and other psychological symptoms usually develop.

If you have found yourself described by any of the above, it is important that you stay engaged in treatment and in your own life. As chronic pain develops, a sense of loss of control and helplessness can set in. Chronic pain sufferers need to use every resource available to manage the pain, maintain emotional stability, and improve their quality of life.

Michele Gargan, PSyD