and goes to various parts of the brain but mostly ends in the lower regions of the brain associated with chronic suffering pain (Copstead & Banasik, 2013; Guyton & Hall, 2006). As a result of the many synapses and slower transmission time, pain Perception Pain perception refers to the way the brain processes the information it receives from nociceptive impulses. Perception of pain is influenced by anxiety, fear, and prior experiences (Copstead & Banasik, 2013). Pain perception makes the pain experience unique to every individual. Pain threshold is the amount of painful stimulation needed to provoke the perception Modulation Pain can be modulated in various ways. The gate control theory of pain by Melzack & Wall (1965) assumes that perceived pain could be either increased or decreased via a gate closing or opening at the dorsal horn of the spinal cord. The gate takes into account various sensory inputs; the gate is then opened or closed accordingly allowing or stopping the transmission of pain impulses. For example, when a person stubs her toe or bangs her elbow, she rubs the injured area and gets pain relief by interrupting the pain pathway through touch. Descending modulation is a process that occurs from pathways that descend from the forebrain and brain stem to the spinal Chronic pain Chronic pain can have additional complicating factors. Some causes of chronic pain include specific diseases such as arthritis, cancer, stomach ulcers, multiple sclerosis, or HIV/AIDS (WebMD, 2018). However, in many cases chronic pain can not be attributed to a structural cause, or pain persists long after an injury has healed. Pain research over the past few decades, assisted by the development of new neuroimaging technology, has revealed new findings on the role of the brain and the nervous system. The following phenomena may occur with chronic pain (WebMD, 2018): ● Some individuals can experience pain from stimuli that are not normally painful, such as a light touch. This is referred to as allodynia (IASP, 2018). A thorough pain assessment is key to understanding the extent and nature of a person’s pain and facilitates diagnosis and treatment. In addition to a thorough history and physical, the initial pain assessment should be well documented and include the following information: ● Pain location. ● Pain intensity (can utilize a pain scale, such as visual analog or numerical rating). ● What exacerbates the pain. ● What relieves the pain. ● The quality of the pain (throbbing, dull, sharp). The patient should be asked to rate his or her pain. Pain is subjective, and individuals can interpret pain in light of their life experiences. Therefore, there are no objective assessments that can identify or measure pain. Healthcare providers must accept a patient’s statement of pain and its characteristics. There are a number of pain-rating scales that can help a patient tell you about the severity of his/her pain. Examples of such scales include: ● Numeric scale : The patient identifies their pain by choosing a number from zero to ten, with zero indicating no pain and ten indicating the worst possible pain. This tactic is generally most effective with adults. The scale can be represented as a ruler with numbers drawn in, or answered verbally if the patient is of an appropriate age (i.e., older teen or adult, and not cognitively impaired). For example, “On a scale of zero to ten, with zero being no pain, and ten being the worst pain you can have, how bad is your pain?”
transmitted via the paleospinothalamic pathway is more difficult to localize, which may account for patients being unable to provide specific information about pain location.
of pain and is similar in most people (Copstead & Banasik, 2013). Pain tolerance varies from person to person and is influenced by genetics, culture, gender, age, and previous experience with pain (Copstead & Banasik, 2013). Pain expression is how the pain is communicated-crying, grimacing, moaning (Copstead & Banasik, 2013). cord. The periaqueductal gray (PAG) region receives information from higher brain centers and facilitates an analgesic effect (Ossipov, et al., 2014). The rostroventromedial medulla region (RVM) facilitates or inhibits nociceptive inputs that will result in pain or inhibit pain (Ossipov et al., 2014). Serotonin, endogenous opioids, and norepinephrine are neurotransmitters released through descending modulation and interrupt pain impulses by stopping the release of substance P (a neurotransmitter for pain), thereby halting the transmission of the pain impulse (Copstead & Banasik, 2013). ● Central sensitization can occur in individuals with chronic pain. This occurs when nociceptive neurons in the central nervous system are hyperresponsive to input (IASP, 2018). In other words, the brain may have unusually strong reactions to pain signals. ● Psychosocial factors may influence the way people experience and react to pain. Individuals who have experienced abuse or neglect as children are at an increased risk of experiencing chronic pain as adults when compared to those who were not abused during childhood (Davis et al., 2005).
PAIN ASSESSMENT
● Onset of pain. ● Duration of pain. ● If pain affects sleep vement (ICSI), 2016; National Pharmaceutical Council. [NPC], 2001)
For those experiencing chronic pain, the health professional will want to know if there is a history of depression or anxiety, any history of physical, sexual, or emotional abuse, and any history of chemical dependence.
PAIN SCALES
● Faces pain scale-revised : A face scale is drawn with numbers accompanying each face. The first face is “happy” with a smile. The faces are progressively more “sad,” indicating discomfort, with a face showing a frown and grimacingrepresenting the most pain. This scale is primarily used with pediatric patients, but can also be used for patients with verbal communication barriers. See Resources section for more information. ● Thermometer pain scale : This visual scale is a picture of a thermometer with numbers ranging from zero to ten. Each number has a word beside it to describe pain, i.e.: 0 = no pain; 1 = slight pain; 8 = terrible pain; etc.
Page 63
Book Code: PTNC1023
EliteLearning.com/ Physical-Therapy
Powered by FlippingBook