Encyclopedia of Health and Medicine

U–V
understanding pain Though there are numerous
physiologic mechanisms responsible for PAIN, the
actual experience of pain is subjective. Not only
do people perceive similar pain differently but the
intensity and nature of pain varies within an individual.
Many people find it difficult to express to
their doctors how much pain they are experiencing,
or may not themselves fully understand the
intensity of their pain. Pain thresholds—the levels
at which pain becomes intolerable— vary widely.
The Subjective Nature of Pain
Despite all that doctors understand about the
causes and mechanisms of pain, every person
experiences pain differently. Numerous factors
frame an individual’s perceptions and experiences
of pain. Key among them are
• fear about the cause of the pain
• knowledge (or lack of knowledge)
• about the mechanisms of pain
• expectations about treatments for pain
• the presence of other health conditions and
their symptoms
• the appropriateness of treatment for any
underlying condition that might be causing the
pain
• the appropriateness of treatment for the pain,
including ANALGESIC MEDICATIONS (pain relief
medications)
• attitudes of others, including family members
and health care providers, about the pain
Though specific kinds of pain, such as postoperative
pain (pain during recovery from surgery)
typically have certain characteristics, pain varies in
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intensity among individuals as well as in the same
person.
Chronic Pain
CHRONIC PAIN is the most frustrating kind of pain
because it is dysfunctional—that is, it exists without
purpose—and often does not respond consistently
to pain treatment approaches. The body’s pain
response is a protective mechanism intended to
draw conscious attention to an injurious process
within the body and to enforce restricted use of the
affected area of the body to facilitate healing.
Chronic pain exists beyond this design, often developing
as an extension of purposeful pain (EUDYNIA)
to become nonpurposeful (MALDYNIA) though
sometimes arising for no apparent reason.
Chronic pain can be quite debilitating. Health
experts estimate that more than 70 million Americans
live with chronic pain that is intense enough
to interfere with their participation in common
functions and activities. Though movement such
as walking often improves chronic pain regardless
of its source, the effort of engaging in even modest
physical activity can feel overwhelming.
Referred Pain
A person experiences referred pain at a location
some distance from the source of the pain. The
location is sometimes so far removed from the
source of the pain that the person does not connect
the pain with its cause. For example, gall
stones in the GALLBLADDER (cholelithiasis) often
cause pain in the upper back beneath the shoulder
blade. Pain associated with HEART ATTACK may
occur as referred pain to the left arm, shoulder,
neck, and lower jaw.
Referred pain often adds challenge to diagnosing
the underlying cause of the pain. Even doctors