What is Pain?

Pain is so pervasive and enmeshed into our lives that it has now become classified by medical providers to be a fifth vital sign. Pain is a perceived unpleasant sensory and emotional experience associated with a stimulus that may or may not be immediately present. Dorsal horn neurons receive sensory information from primary afferents that innervate the skin and deeper tissues of the body and that respond to specific types of noxious and non-noxious stimuli. These afferents terminate in the dorsal horn with a distribution pattern that is determined by their sensory modality and the region of the body that they innervate. Thus, some pain may be felt in a region that is not provoking the pain. This is commonly labeled as referred pain. The incoming information is processed by complex circuits involving excitatory and inhibitory interneurons, which are then transmitted to projection neurons for relay to several different brain areas for processing and coding. In addition, nociceptive information is conveyed to the ventral horn and contributes to spinally-mediated reflexes that will promote bodily movements to escape the painful stimulus. One common example of this is the flexor-withdrawal reflex when someone touches a hot surface. The brain perceives this pain as something bad and causes a response.

Although, pain is not simply a matter of the present moment. Pain becomes wired into our brain into areas of the limbic system and amygdala that codes these stimuli into memories and emotions that will reside there for the rest of one’s life. How one copes with their pain can become crucial to how the brain chooses to respond to the pain. Physical pain is usually divided into nociceptive, inflammatory, neuropathic pain, and psychological pain. Patients often experience “mixed pain”, where nociceptive, inflammatory and neuropathic components present together with existential pain. Nociceptive pain is commonly treated with opioids and non-steroid anti-inflammatory drugs (NSAIDs) by medical practitioners, whereas steroids and NSAIDs are used to treat inflammatory pain. Western medicine commonly treats neuropathic pain with subgroups of anti-epileptic drugs or tricyclic antidepressants. Additionally, pain is generally split into two main groups; chronic and acute. Chronic pain typically is pain that lasts longer than three to six months and commonly is disabling, nagging, or present with the ability to interfere with everyday life. Conversely, acute pain typically lasts less than three months or commonly until the injured tissues have healed.

The type and duration of pain is not the only factor affecting care. A growing body of evidence points to wide disparities in pain management between racial and ethnically diverse groups. According to researchers from the American Pain Society, the disparities are unmistakable across a range of conditions and types of pain as well as numerous treatment settings. The Institute of Medicine has also reported that minority patients have poorer outcomes for a number of chronic and acute conditions, including pain.  Many members of minority and ethnic groups as well as those concerned with addiction are hesitant to take opioid pain medications out of fear and cultural taboos. These patients are more likely to rely on medication practices that are culture-based and nonpharmacological including medicinal herbs. There is currently no clear roadmap for a comprehensive approach to pain management that includes evidence-based nonpharmacologic strategies. Medical pain management is in crisis; from the pervasiveness of pain to inadequate pain treatment, and the escalation of prescription opioids to an epidemic in addiction, diversion and overdose deaths.

Currently, there are many different treatments for both chronic and acute pain, with chronic pain management tending to be the most difficult to treat for their provocations can often be elusive and insidious. Thus, it becomes increasingly important that the individuals become well informed on the many and varying treatment protocols and methods to reduce or prevent pain from occurring.  These treatments include both pharmacologic and non-pharmacologic interventions. Additionally, chronic pain can pose as a high-impact disruptor of lives and economies and can lead to long lasting emotional disturbances.

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