Saturday, March 21, 2009

A FEW THOUGHTS ON THE SIGNIFICANCE OF PAIN

Pain is one of your brain’s interpretations of information received through your nervous system and is the result of some sort of stimulus from outside or from within your body. Most of us have a variety of interpretations available to us, including pain, pleasure, irritation, vibration and others. Pain is the way your brain tells you that something isn’t right and you need to find the cause.

The brain is also frequently capable of discerning the general location of this noxious stimulus. For example, if you feel a pain in your left leg, you initially look at your left leg to see if something from outside your body (exogenous) is causing this pain. If you find the cause, you remove it; a thorn, splinter, bee sting, etc.

Pain from an internal cause (endogenous) is more difficult to identify. But the solution is the same. Identify the cause and remove it. This is best done using approaches starting with the least invasive and moving one step at a time toward most invasive.

There are many possible causes of internally generated pain but it can be classified into two main categories: Acute and Chronic. Pain can also have a number of different descriptors like sharp, electric, stabbing, burning, throbbing, achy, etc. Each gives us information useful in determining the real cause and location of the pain causing lesion.

Acute pain is frequently exogenous but can also be endogenous. This is usually more severe and immediate in the sense that it often appears quickly and demands immediate attention because it instantly alters your daily activities. Chronic pain can also be severe but is longer term. It doesn’t come as a surprise because the sufferer has had this condition for an extended period. Chronic pain can also interfere with your daily activities but many patients have worked out a way to do at least some of their activities by changing how they accomplish these.

The brain can sometimes be fooled, especially by endogenous pain. Pain can be generated by problems with the bones, joints, muscles, ligaments, tendons, blood vessels, lymphatic vessels or the nerves themselves. The situation can be complicated by pain perceived by the brain as occurring in one location but the cause may be in a completely different one. For example, a tear in one of the muscles may cause that left leg pain but it may also be caused by pressure on the nerve that runs to that region suffering interference at a different location.

One area where this interference frequently occurs is in the spine. There are a number of structures near that nerve where it exits the spine that can put pressure on it. The brain interprets the input as coming from where that nerve terminates rather than at the point of interference. So, leg pain may actually have little or nothing to do with the leg. Physical examination, nerve testing and imaging with x-ray, MRI and CT are invaluable in making the correct diagnosis.

Medications can help with some pain in the sense that the nerve impulses can be interrupted or altered so that the brain no longer interprets pain messages. But these medications are for temporary pain relief only. They do not indentify or eliminate the cause of the pain.

Medications should only be used as a Band-Aid, not as a cure. Hiding your pain with pain relievers, muscle relaxants and anti-inflammatory medications can help you feel better for a little while, but before too long, the continuing damage will worsen to a point that the medications are no longer able mask the pain. Remember that your pain is not caused by a steroid deficiency and that the medications should be used to make you feel more comfortable while you and your physician look for the real cause of the pain.

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