Pain is classified first and foremeonst into acute and chronic. Then one considers if this is original or recurrent. All this critical information is gained by asking the right questions and observing. When did the pain begin. What is the quality of the pain. What it it’s nature. Is it sharp or dull. Crescendoing or steady. What makes it worse? What makes it better? Where is it on the body. Show me. Tell me. Where does it begin. Does it radiate or move from that place. Has it changed?
With acute paint the response might be exactly the opposite to chronic or recurrent pain. Acute back pain requires rest whereas chronic back pain requires excercise or at least stretching.
Palpation begains as very gently hardly touching the area any more than as a feather might then moving deeper. The examination elicits pain and is meant to especially to discover ‘rebound abdominal pain’ a diagnostic symptom elicited by deep pressure.
The patient today seems to have watched too television or simple misinformation and nonsnese. They want instant relief but don’t even know that a good clinician can’t treat pain unless they have a diagnosis. With appendicitis the pain migrates around the abdominun and the ‘movement and direction’ of the pain make the diagnosis.
Patients commonly think that there’s a ‘magic’ pain killer like a magic bullet, Even opiates which are the ultimate pain medication don’t work well in all cases. NSAIDS and ASA are better for certain musculosketal conditions than opiates. Placebo or mind over matter bedside intervention can reduce pain by up to 80%.. Bleech in the last ccntury showed that anxiety alone could account for 30% of acute pain,
When the pain is maximum the mind shuts off. The body shuts off. Torture is limited by this. The Torturer has to keep waking the patient.
The sense of aloneness that comes with pain is also coupled with a feeling of uniqueness. Some people even think they are more sensitive that others and are making a case against themselves in the midst of pain. All the platitudes, hope, faith make pain less. They work. Too often warmth and fluid are needed more than pain medication, For some pain warmth and fluid make pain worse.
The problem with ‘pain’ medication is that it interacts with other medications. So knowing what a person has taken in that last 24 hours is critical. Substances that are abused like alcohol or marijuana are ‘medications’ to the body and influence reactions of the medications given for pain.
Do no harm is critical in medicine.
Be calm. Use one’s mind to calm thee panic. FMRI’s studies show that people indeed can consciously ‘calm’, still the breathing, stop moving. Be patient. It’s all counterintuitive when the body is shouting ‘flee’, “fight’, and thanks to Dr. Google and years of misinformation from Dr. Zuckerberg and social media, the immediate care givers are actually knowledgeable and trying to help you despite fearing the medical team is Dr. Joseph Mengele.
Chronic pain is commonly note to have more volume and excitement. Acute pain is the most painful. Chronic pain is often noted by ‘anger’ in the tone of despair. In Acute Pain there is desperation more than accusation. Recurrent pain is a different kettle of fish and is a specific kind of chronic pain. Given that there is recurrence the examiner is vurious as to what is causing this pain which should have been treated the first time. Why has the pain returned. What is the nature of the condition that it is continuing. Diagnosis becomes very important as important if not more important than with acute pain,.
There is also acute on chronic pain,. This ‘new’ pain might signal some development which could be most significant.
Pain is a symptom as in acute pain but it can be a diagnosis and a disorder as in ‘phantom limb pain’. Pain disorders are forms of ‘chronic pain’ and can reflect brain changes over time.
Patients with addiction histories, such as alcoholics or those who have used opiates or cocaine or marijuana, are very different in their presentation because their pain centres may be under responsive or over responsive. Anaesthetism might need to give them 5 x the normal anesthesia pre surgery because of tolearnacce or they may be very sensitive and go into respiratory arrest with the normal dosage. They are especially difficult to treat as chronic pain patients because ‘acute’ on ‘chronic pain’ is often a problem with these patients.
Chronic pain is commonly associated with depression and anxiety and treating the depression or anxiety is often more effective than using ‘pain killers’.
The pain ‘team’ has for decades included an internists, anesthetist and psychiatrist which indicates the importance of the mind in regards to the body.
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