Hospitals & Health Networks magazine - 2001

Pain Management supplement
Investing in Information Technology Must Be Part of a Long-Term Strategic Plan

By Jan Greene
Introductory section:
Understanding Pain
Pain - you know it when you feel it, right? All you have to do is stub your toe and you know all about pain. But it's not that simple. When you feel pain, a complex set of chemical and electrical reactions are occurring in your brain and nervous system. And if you're unfortunate enough to have become sensitized to pain in some way, you may feel the agony without having done anything - like bashing your big toe -to prompt it.

Understanding how pain works in the body can help anyone working with patients to see why their experiences of pain can be so variable, and why it's always a bad idea to assume you know how someone else feels without asking. Albert Ray, M.D., a Miami pain specialist and president of the American Academy of Pain medicine, explained the science behind pain to attendees of the June 2001 Joint Commission Leadership Summit on Pain Management.

Pain, Ray explained, is split into two categories: Eudynia, or "good pain," the kind of sensation that has its roots in a particular disease process or incident, causes the body to send warning signals to the brain that something is wrong. In other words, there's a "good reason" for the pain. On the other hand, maldynia (bad pain) is when pain becomes the disease. It's caused by sensitization of the nervous system and carries no particular message of significance to the brain. Maldynia is what people with chronic pain suffer.

The experience of pain is split into two parts: the sensory discriminatory dimension and the affective dimension. The sensory dimension is a simple sensation that tells you exactly where the pain hurts - the big toe, for instance. The affective dimension is what makes pain miserable, what Ray calls the "yuck" portion of the pain. It's affected b a person's expectations and past experiences, and explains why someone who is afraid of a shot feels more pain than someone who doesn't fear the needle.

Researchers have found that the nervous system can be oversensitized by repeated pain signals. Similarly, a memory of pain can intensify a current experience of pain. Those factors may explain why a patient may be moaning in pain from an injury that seems minor or nonexistent.

"We sit there and say, 'This patient's a crock, this patient's an exaggerator, this patient's a hysteric, because their pain is way out of proportion to anything I can find on their body physically,'" Ray said. "But they are not crocks, they are not hysterics and they are not exaggerating. They are explaining and living out their pain experience. That affective dimension of pain gets sensitized through a lot of these brain memories."

Understanding that, clinicians can use other techniques to find out more about that person's condition and experiences. "You have to know what the pain means to the patient because their pain experience isn't our pain experience," Ray advised. "We must believe the patient - there's no other way to do it."