Our experience with pain is very personal in our journey through life. It can have an effect our physical disorders, emotions, social interaction and personal economics. This diary will focus on understanding and qualifying pain with minimal information on specific treatment options. When giving examples of altering pain the emphasis will be on non drug/herb therapy. Since these techniques may be used to augment or replace drug therapy and drug information for treatment is more readily available. I am happy to answer drug related questions in the comments.
As our healthcare becomes more fragmented into specialties, individually we become more responsible in coordinating care and making choices for the total body and mind. We all do Selfcare to varying degrees.
Healthcare profession will provide treatment options and referrals within their specialty norms. If you want to try something outside their norms you will need to seek those options on your own. Depending on the healthcare professionals practice setting they may not be able to easily coordinate with your other providers. For example, if you are seeing a Pain Specialist for peripheral neuropathy, at one clinic, and Internist for diabetes, at another, they may not see each others notes or treatment plans. Who should be told first, you are experiencing increasing numbness in your hands and feet? One is more likely to address pain control and the other blood sugar control as a first option.
KosAbility is a Sunday 7 pm Eastern/4 pm Pacific volunteer diarist community of, by & for people living with disabilities, who love someone with a disability, or who want to know more about the issues. Our use of "disability" includes temporary as well as permanent health/medical conditions, and small, gnawing problems as well as major, life-threatening ones. Our use of "love someone" extends to cherished members of other species.
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PAIN
P – personal
A – Alert for
I – Injury
N – Notification
Pain is your body’s communication that an injury is going to happen, an injury is happening or is about to happen. How you respond to that message is pain management. The core of the process is identifying the source of pain, avoiding the source of pain, decreasing the communication of pain, changing the awareness of pain and creating an environment to improve healing of the damaged area.
EVALUATION OF PAIN
Changes in existing pain or pain located in a new area should be evaluated as a new medical event by yourself or your health provider. It is too easy to pass it off as part of a chronic pain syndrome.
A friend and I got together to go shopping and I noticed her limping. When I asked her what was wrong she let me know she had episodes of shooting pain in her foot and ankle periodically since childhood. She limped the whole outing. Three days later, she confessed to me when she took her shoes off at the end of the day of shopping, there was a goat head seed stuck in the bottom of her shoe causing the pain.
Pain Scale
To understand pain someone is experiencing we are primarily reliant on the description provided by the patient and their opinion of its intensity. It is surprising how many professional lectures include the phrase “Believe the patient” as an option for evaluating therapy.
To assist in quantifying pain in a consistent manner the adaptation of a pain scale reporting tool has been adapted by the medical system. It helps, but the rating of a persons number is subjective and reliant on the persons imagination of the worst possible pain. Each of us has different abilities of imagination and actual experiences with pain. One persons opinion of 5 or 6 will be different than another’s.
When communicating to about pain try to include information that effects the interpretation of the number. Describe what the intensity a number means to you, an 8 means a root canal without anesthetic or a 4 means I can walk around the house from room to room, but can not walk the length of a store. Describe activity level changes if relevant. Pain scale may still be at 4, but now you mowing are the lawn.
It may be acceptable to stabilize at a pain level if you are able to perform specific daily and life activities. Focusing on activities may be a better method of evaluating pain control in context of living life.
Use common medical words to describe the pain. It assists identifying the source, possible treatment choices for pain an monitor therapy effectiveness.
aching, pounding, agony, sharp, annoying, shooting, annoying, sore, burning, stabbing, cramping, tender, debilitating, tingling, numb, throbbing
Use details when describing what alters the pain. If I don’t move it does not hurt. If I lift my hand above my shoulder I get shooting pain. The pain shifts from aching to stabbing if I go on a car ride. The pain increases after I eat something with tomato sauce. Pain goes from a level 6 to level 3 for 6 hours, when I take 200 mg of ibuprofen. The pain gets worse when I use a heating pad. Feet tingle and go numb most evenings. When have a headache and check my blood pressure it is 160/98.
PAIN IN THE BODY
At its core the pain nerves in the body are activated via a stimulus, an electrical impulse is sent up the nerve, the electrical impulse is sent to the spinal cord, the electrical impulse is transferred to a new nerve in the pathway via chemical messengers, and the information is processed subconsciously and consciously in the brain. Each of these steps provides an opportunity for treating or minimizing pain.
Activating the Nerve
A pain nerve is activated by a mechanical source or a chemical source produced by the body or absorbed into the body. The mechanical source may be a temperature or pressure change. Some of the chemical sources are histamines, prostaglandin’s, serotonin and substance P. Inflammation and tissue damage release a number of chemical pain stimulators. The gastrointestinal tract is the source of numerous chemical stimulators and inhibitors from our food and bacterial flora.
The threshold of stimulation a nerve requires to activate and send a pain message is increased and decreased by the body/mind and some drug/herb therapy. The immune system has multiple methods to lower the threshold of nerve pain activation.
Electrical Impulse
The electrical impulse of the two type of pain nerves travel to the brain at different speeds. Mechanical stimulation is relayed quickly the pain and will be prioritized over pain due to inflammation or tissue damage.
This prioritization of fast and slow pain signal is part of the therapeutic success of heat, massage, light touch and counterirritants. TENS units are used to interfere with the electrical signaling of pain messages.
Spinal Cord
All pain nerves in the body converge to the spinal cord to transmit the message to the brain. Medical intervention at the spine may physically effect pain in the larger area served by the nerve branch. Intervention can be used as a diagnostic tool or pain relief.
Gate Theory of Pain explains another prioritization of pain signals as the activated nerves compete for transmission to the brain and how far to open the gateway.
Factors that tend to open the gate are type of injury, anxiety, worry, depression, boredom, consciously watching for pain, decreased physical fitness and some drug/herbs.
Factors that tend to close the gate are happiness, laughter, relaxation, rest, intense concentration, distracting activities, exercise and drug/herbs.
Processing Pain Information
The majority of the processing of pain and the bodies response is performed without us being consciously aware of the pain. The conscious perception of pain is effect by drug/herbs, emotions and physical well being. Pain can also be expressed as a change in our mood, ability to concentrate, easily angered or dementia, rather than the feeling of hurt or pain.
Referred pain
The body cavity and organs are not well populated with pain nerves. The pain messages from these areas of the body are generally expressed at the body surface. A classic example is a heart attack felt as pain in the jaw, right arm or nausea.
IDENTIFYING A PAIN PATTERN
Pain management begins with understanding the pain being experienced, physical conditions that may be related to the pain and outside factors that influence the pain.
Acute Pain: generally begins suddenly is associated with a threat to the body or events, is generally less than 6 months and is resolved when the underlying condition is resolved.
Chronic Pain: pain continues past healing of underlying condition or a condition that is not resolvable.
A person can have a mixture of acute and chronic pain. Drug/herb treatment for pain can mask or lower the intensity of unrelated pain. The body’s communication system regarding injury has been compromised. Steps should be taken to self monitor for potential problems. Visual observations of cuts and scratches for infection. Know body positions during physical activity to avoid damaging a joint. If acute pain occurs make assessment judgments on needing medical intervention based on the amount of pain drug/herb currently being taken.
For variable or chronic pain a pain diary for 1 week or 5 flare-up episodes can be used to evaluate the factors exacerbating or relieving the pain.