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What is Pain?

"Those not suffering from chronic pain have never felt what you feel.  It is a physically different experiance.  If you tell someone about something they've never had, they have trouble believe you, then you should be looking for a new doctor.  They are starting to learn that everything that the patients have told them for the last 100 years is the truth.  That's a scary thought, because people have been called liars and other names...  Our most important teachers are the patients"  Who knows better about is going own then the person that is going through it every day. "The medical definition of pain is that it is that it's an unplessant, emotional; condition, in the pressence or absence of tissue damage.  The nursing definition of tissue damage.  The nursing definition of pain is far more interesting  and says 'If your patient says they are in pain, they are in pain.  'Nurses are visionary leaders in pain trestment today.                                                     

Dr. Brookoff's definatiion of pain is:  Pain does not have a moral value........  Life is good....to be cherished, promoted and spported.  We as physicians, should not be moralizing about pain or it's treatments.  We should be asking 'Has pain changed the lives of our patients?  If it has,  we have to work to rstore their lives." 

 Three Types of Pain: 

- Everyone has had somaticpain.  When you cut yourself, it hurts intensely and then a few minutes late, it doesn't hurt as much.  We don't suffer for days and days with this pain.  We don't lose our emotional composure and it turns itself off ecentuall...

- Visceral pain has a more agonizing quality.  It's carried to a different part of the brain then the somatc.  It goes to the part of the brain that deals with emotions.  So peole with visceral pain have emotional emotional......they get more upset.  It's unfortunate that when you go to the doctor with visceral pain, they often get mad at you because you're emotional.  The emotions are a physical quality of the pain.  It doesn't mean that you are weak.

- There's another type of pain that may be happening it is called neuropathic pain that may be happening it is called neuropathic pain.  It is due to nerve damage.  If we let the pain go on too long,  the nerves get damaged, changed, and they then carry pain messages more intensively.  So when somebody is having pain that is bad its an emergency.  We have to get them out of pain before it can become ingrained and harder to get out.

- What is "Breakthrough" pain?

- Breakthrough pain comes hard and fast.   It can be stantaneous intensifying of all-over-dull pain, or it may come as a localied sharp stabbing or fiery sensation.

It can summon someone out of a deep sleep or freeze him mid-motion like a vicious bolt out of the blue.  It's unpredictability and severity make an immediate antidote imperative.  Guarding against the possibility of breakthrough pain should  be a part of any rescription for end-of-life pain, or severe chronic pain.

Speed is of the essence in devising a weapon for breakthrough pain.  Additionally, the fastest treatment has been doses of potent opioids (such as morphine) administered blood vessel heading for the brain.  AA remarkably effective way to do this called patient-controled analgesia device (PCA).

A PCA device lets the patient control the fflow of pain medication and is especially effective against breakthrough pain.  It is regularl used by patients recovering from surgery and can also be used by soeone at home with a terminal, or chronic illness/injury.  This is another reason for patients that have severe chronic pain have a chance at using something like Intrathecal Drug Delivery (Internal Infusion Pain Pump), or Neurostimulator.  When you start to have breakthrough pain quite often then it is time for the pump to be turned up.  Their are several alternatives to treating breakthrough pain, you just have to start just have to find what works best for you.  Because quality of life means so much, waiting in constant fear for breakthrough to hit is not something that anyone wants to live through.

 

Pain Management and IC by Dr. Daniel Brookoff

http://www.ic-network.com/handbook/brookoff.html