Pain: An Unpleasant Experience

Pain and Its Importance

Pain is an unpleasant experience resulting from the interaction of various neurochemical and neuroanatomic systems in a range of cognitive and affective processes. These experiences can be either sensory or emotional. It serves an important function of alerting the body about physiological problems. The pain consequences can range from mild to debilitation discomfort. When the body experiences noxious stimuli from an internal or external source, the pain message is transduced via the neural pathways and is then transmitted to the autonomic and central nervous system via the peripheral nervous system through nociception process. Nociceptors act as the mediating receptors and whose termination is in the dorsal horn section of the spine. (Ringkamp, Dougherty & Raja, 2018). Exposure to noxious chemicals or extreme mechanical stimulation like cutting activates the nociceptors. The result of the damage affecting peripheral nerves causes peripheral neuropathic pain while nociceptive pain is a response to noxious stimuli. In most cases, pain is eliminated by the removal of the original cause since its stimulus is not readily susceptible to removal. Physicians, therefore, tend to treat pain as a symptom.

The Conceptualization of Pain

The ability to conceptualize pain from threat and translate them into a challenge gives a sense of accomplishment and helps to develop positive qualities such as strengthened defense mechanism and self-control. The degree of how much attention pain is assigned is determined by the pain’s threat value. Since pain is aversive, it presents a possibility for redemption and atonement after a regression. Pain also improves the attention to signals from the body and therefore enhances pleasant sensation. Individuals who develop pain adaptive feature have faster pain facilitation due to robust pain response system, faster pain reduction to stable noxious stimuli as well as a prolonged pain inhibition resulting from a higher threshold to pressure in areas that have been exposed to stimulation.

The Nature of Pain

When an individual experiences pain and reports it, then, he or she has the introspective knowledge of the pain. Hence, pain is regarded as private, subjective and a state that cannot be hallucinated. Clinically, pain is rated numerically on a scale from 1 to 10 before administering analgesics. In this case, pain is quantified but at the same time, reduces the pain experience to a number that may have been compromised by the patient through manipulation. This resolution of handling pain remains primitive. Children are made to recognize pain intensity through identification with cartoon faces. This is only an approximation of the pain experience and therefore, better ways to understand and elicit pain should be established.

The Bio-Psychosocial Model of Pain

Bio-psychosocial models approach considers pain as an experience that results from the interaction of the biological, psychological, and social factors. The psychological aspect involves the cognitive, behavior, and mood. All bio-psychosocial models of illness focus on pain as a type of behavior. This means that individuals may perceive and respond to bodily changes differently. These differences can be understood in terms of social and psychological processes. In relation to chronic pain, the fear avoidance model suggests that anxiety and pain-related fear play a basic role in the maintenance and development of the process that disables chronic pain (Robins, Perron, Heathcote & Simons, 2016). The sensitization model explains pain as a somatic process associated with the bio-psychosocial factors that maintain the sensitization. In the brain, the relevance of the goal of stimuli from the sensation guides the attention to either distinguish or select it from the environmental background in which it is rooted. Attention permits the assessment of the relevant stimuli. Pain experience depends on the degree of attention. When attention is concentrated on pain, the pain experience is said to be more intense and less intense when the attention is distracted.

Neurological Processes of Pain

Pain experience has a major relation to sensory modalities. A number of nerve endings and receptors in the body tissues only react to harmful stimuli. The primary afferent receptor comprises of a nerve attached it besides the sensitive nerve ending in the tissue (Ringkamp, Dougherty & Raja 2018). It connections the second order pain message transmission neurons located in the spinal cord which relays the pain experience over a specific pathway to the complex centers in the brain.

The primary afferent fibers transmit the impulse from the periphery via the dorsal root ganglion to the dorsal horn of the spinal cord. Descending pathways from the brainstem nuclei control the spinal processing when activated. Some of the polymodal receptors can be selectively activated by noxious mechanical and thermal stimuli. The pain message is carried by the spinal cord from its receptors to the brain. It is then received by the thalamus which sends it to the cerebral cortex for processing. The parts in the brain involved in pain awareness include the frontal lobe which is involved with impulse control and problem-solving. The anterior cingulate cortex processes the affective component of pain while the insula cortex deals with the subjective emotional experience. The amygdala is a limbic brain area that responds to disorders such as anxiety, depression, and modulation of pain. The thalamus receives projections from different ascending pathways. It processes nociceptive information before transmitting it to various regions of the cortex (Price, Huq, Sivanesan & Sarantopoulos, 2018). The periaqueductal gray is located in the midbrain and is an important region in descending pain modulation as well as pain copying. Nucleus cuneiformis plays a role in motor and sensory integration significant to pain message transmission. The rostral ventromedial medulla consists of the nucleus which projects to the spinal cord to diminish nociceptive traffic and in turn change the experience of pain.

Theories of Pain Perception

Specificity theory is among the modern theories that explain the pain perception by the brain. In this theory, specific pain receptors transmit pain messages to different parts of the brain that interpret pain perception. This is true since different fibers eventually transmit pain signals to the brain, though it does not give a justification for the extensive range of psychological aspects affecting the human perception of the pain experience. A different theory that explains the perception of pain is the pattern theory. This theory does not recognize the brain as having control of the pain, though the pain messages are transmitted to the brain after stimuli combine together resulting in a specific pattern. Essentially, pain cannot be treated in either scientific or naturalistic terms without understanding what Science is. With the context of medicine at the end of the eighteenth century, it was able to dissociate pain from the context of theodicy since it could eventually be treated scientifically. Both pain and disease are considered to be situated in the body because the body and its processes are perceived inconsistent, universalizable terms. Through the medical knowledge of pain, its scientific truth requires the abstraction of the body from the individual as well as the pathological information from the entire ordinary body functions which led to the modern problematic view to pain experience.

Methods of Pain Management

Medication has been the most common form of pain management, in spite of there being other ways such as cognitive techniques and acupuncture. Analgesics are well understood as drugs used to relieve pain and are commonly termed as painkillers. This method has not been the most preferred and instead, acupuncture has been suggested as an alternative. It is a traditional technique of pain management, originally used by the Chinese. It involves the insertion of thin needles into various regions of the body in which its effects tend to releases the endogenous opiates which have a similar property to opium components (Halperin, 2016). Other popular methods of dealing with pain are relaxation, meditation, hypnosis, and cognitive therapy. The Lamaze technique has been found to be the best cognitive method for alleviating pain during childbirth. Traditionally, studies on pain management have focused on the peripheral and the spinal cord regions. These parts have been thought to be the critical focus areas for understanding pain. The viewpoint has been changing rapidly due to the imaging technology of the human brain which has shown that the brain plays an important role in pain, especially chronic pain.

Medical Cannabis as a Pain Management Option

The cannabis plant has widely been used over many years to treat various illnesses. It contains different chemical compounds such as tetrahydrocannabinol which gives a feeling of relief and improvement of health over a range of illnesses when in contact with the endocannabinoid system in the human body. Other chemical compounds such as terpenes, flavonoids, and cannabidiol have been found to have therapeutic properties. Cannabis has neurological beneficial effects on Tourette syndrome, Hunting’s disease, and Alzheimer’s disease. Additionally, during chemotherapy for cancer, cannabis is also used to treat the side effects such as vomiting and nausea. Positive health effects of cannabis on chronic pain with a neuropathic origin have also been proven medically. Medical cannabis has led to a reduction in the use of conventional opioid pain medication (Aguilar, Gutiérrez, Sánchez & Nougier, 2018). Drug dependence on stimulants such as cocaine and opioids in therapy can be reduced by substitution with cannabis as well as to address sleeping and post-traumatic stress disorder.

Alternative Approaches to Pain Management

Ideally, the use of analgesics should be avoided where possible since most of them are addictive. For instance, heroin is made from morphine, therefore the addictive effect in morphine is also found in heroin. The adapted approach should be patient-centered for the purpose of efficiency. Regardless of the initial cause, the focus should be aimed at restoring the individual’s state of health. Relaxation techniques such as rhythmic exercise and meditation can be appropriate to evoke relaxation response, reduce stress by a boost of energy as well as general improvement of physical and mental health. Hypnosis can also be used as a substitute to alleviate the sensory or effective component of pain. It may also be applicable by teaching the patient self-hypnosis and can be useful in pain reduction outside the clinical session.

References

Aguilar, S., Gutiérrez, V., Sánchez, L., & Nougier, M. (2018). Medicinal cannabis policies and practices around the world.

Halperin, A. K. (2016). 15 Complementary and Alternative Medicine in the Management of Chronic Pain. Clinician’s Guide to Chronic Headache and Facial Pain, 208.

Price, C., Huq, Z., Sivanesan, E., & Sarantopoulos, C. (2018). 1 Pain Pathways and Pain Physiology. Perioperative Pain Management for General and Plastic Surgery.

Ringkamp, M., Dougherty, P. M., & Raja, S. N. (2018). Anatomy and Physiology of the Pain Signaling Process. In Essentials of Pain Medicine (Fourth Edition) (pp. 3-10).

Robins, H., Perron, V., Heathcote, L., & Simons, L. (2016). Pain neuroscence education: State of the art and application in pediatrics. Children, 3(4), 43.