In treating chronic pain, it's important to understand the different potential types and mechanisms of pain.
Referred pain is felt some distance from where the pain actually originates. In other words, the site of the pain is not necessarily the source. Osteoarthritis of the hip, for example, causes pain to be experienced in the knee. In acupuncture, a form of Chinese medicine, kidney problems can be indicated by pain in the knees.
Phantom pain occurs when you have had a limb, breast, or other body part removed by surgery. People describe the pain or unpleasant sensations as if they were coming from the absent body part, but phantom pain is real and not in patients' minds.
Somatic pain is caused by activation of a pain receptor. Remember, pain nerve endings, called nociceptors, are programmed to respond to various stimuli, such as heat, cold, and other physical sensations. The characteristics of the pain are very well localized aching, throbbing, and a gnawing feeling. Examples include joint and bone pain. This type of pain is generally very responsive to nonsteroidal anti-inflammatory drugs (NSAIDS) like aspirin, and when they are no longer helpful, one can use opiate medications to treat this type of pain.
Visceral pain is also caused by activation of a pain receptor. The patient often feels achy, vaguely localized pain. It commonly originates in the abdomen or the chest, it does not feel as if it is limited to only one area. A good example of visceral pain is chest pain due to a heart attack. In this case, the pain occurs in the chest, but it can go up the neck and down the arm, too. This type of pain is a little more difficult to treat, but it can respond to opiates and adjuvant medications.
Neuropathic pain is caused by destruction of a nerve in either the peripheral or central nervous system. Neuropathy can be best thought of as a seizure of a nerve. People often describe a severe, sharp, shooting, or stabbing pain or a burning, numb, or tingling sensation.
Myofascial pain is muscle pain that occurs in conjunction with other pains. The trigger point is a localized, highly irritable spot in a taut band of skeletal muscle. Palpation of these trigger points will alter the pain, causing it to increase or radiate. You may feel as if you are having a muscle spasm.
Reprinted from: Healing Pain: The Innovative Breakthrough Plan to Overcome Your Physical Pain and Emotional Suffering by Ann Berger, MSN, MD and C. B. deSwaan © 2006 Ann Berger and C. B. deSwaan. (March 2006; $14.95US/$19.95CAN; 1-59486-012-2) Permission granted by Rodale, Inc., Emmaus, PA 18098. Available wherever books are sold or directly from the publisher by calling (800) 848-4735 or visit their website at www.rodalestore.com.
Authors
Ann Berger, MSN, MD, is one of the foremost specialists in pain management in the nation. A medical oncologist specializing in pain treatment, she has written and edited numerous books on pain and palliative care for patients and health-care providers. Dr. Berger is also senior editor of the most widely used textbook on palliative care, Principles and Practice of Palliative Care and Supportive Oncology. She currently resides in Darnestown, Maryland.
C. B. deSwaan is a New York City-based freelance writer specializing in nonfiction. She has written 20 books with expert collaborators, including the best-selling Men Are Just Desserts and Smart Cookies Don't Crumble.
