Mumbles of a Medic: No Pain, No Gain


(As seen in Pegasus Pages, June 2013)

Mumbles of a Medic, by aspiring medic, Sahaj Kaur

‘The pain is there to help you; stop moaning’

This was a stimulus for a previous BioMedical Admissions Test essay question and it got me thinking, to what extent is this statement true?

Pain is something inexplicable that we have all experienced to varying degrees throughout our lives, whether it is the pinch of having an injection or something larger like an operation. It is the No. 1 reason for consultation in the USA and can significantly interfere with someone’s quality of life, if untreated. The International Association for the Study of Pain states that ‘pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage’. It exists to motivate the individual to withdraw from damaging situations, to protect a damaged body part while it heals and avoid similar experiences in the future. Mostly pain resolves itself once the stimulus for the pain is removed and the body has healed; however, problems arise when this pain persists, either during or after treatment.

Pain can be classified is different ways: acute pain is short term, lasting only throughout the expected treatment or healing time. Chronic pain may persist for years due to conditions such as rheumatoid arthritis. Nociceptive pain is caused by stimulation of peripheral nerve fibres responding only to stimuli approaching or exceeding harmful intensity; for instance, thermal, mechanical and chemical stimuli. Neuropathic pain is caused by damage affecting any part of the nervous system involved in the somatosensory system (bodily feelings) and is often described as burning or tingling. Phantom pain is felt in a part of the body that has been lost or from which the brain no longer receives signals; it is neuropathic and is common in amputees. And lastly, psychogenic pain is caused or increased by mental, emotional, or behavioural factors and this pain includes headache and back pain. This latter sort of pain is sometimes overlooked as the general public seems to think that pain from a psychological source is not real. On the contrary, studies have shown that it is no less actual or hurtful than pain from any other source.

Even though unpleasant, the ability to experience pain is essential for protection and recognition of the presence of injury. Episodic analgesia may occur under special circumstance, such as in excitement of sport or war where the sufferer may feel no pain upon a severe injury. This is only temporary. Pain asymbolia and insensitivity can be induced through morphine injection or can occur due to abnormalities in the nervous system, for example, spinal cord injury, diabetes mellitus, and leprosy, where the sufferer reports recognising the feeling of pain but pain which is devoid in unpleasantness. These individuals are at risk of tissue damage due to the undiscovered injury. A much smaller number of people are insensitive to pain due to an inborn abnormality of the nervous system, known as ‘congenital insensitivity to pain’. Children with this condition incur repeated damage to their tongue, eyes, joints, skin, and muscles and some die before adulthood, whilst others have a reduced life expectancy.

Pain is very important from an evolutionary perspective. It is not only important for alerting us to any damage to ourselves but it can be vital to the process of healing. Several studies have shown that pain plays an important role in regulating the body’s inflammatory cycle; when a joint in infected, the body sends neutrophils to the site of infection. When nerves around the joint fire pain signals, these prevent more neutrophils from entering the inflamed area, preventing overreaction. People whose joint injuries are insufficiently painful in the first place are at a greater risk of developing chronic problems such as arthritis because neutrophils wreak havoc on the joints if they are not eradicated, which can cause serious chronic pain, by which time, it is too late to reverse the damage done. The answer may involve reducing pain killer usage earlier on.

Another study conducted in mice has shown that a ‘Substance P’ is released by nerves in response to injury, heat or chemical pain. The levels of this substance were increased following a temporary block of blood flow (simulating a blood clot or heart attack), causing the bone marrow to become sensitive to this substance which can promote tissue healing and the formation of new blood vessels. This response was impaired if the mice were given morphine. Preliminary experiments in humans suggest a similar process, meaning that the pain response is actually vital in recovery and blocking it could be harmful.

After this discussion, it would seem that pain is unavoidably necessary and that we must abandon all analgesics and tell patients to ‘man up’. Yet there needs to be a delicate balance between hurting the patient a little in order to aid their recovery (walking on a newly healed ankle to strength it) and ensuring that their quality of life doesn’t suffer due to the pain. A types of pain that falls into this ‘bad’ pain category is chronic cancer pain, caused by tumours pressing on bones or nerves, or chemotherapy drugs which causing burning sensations; these are useless in their function and lower the patient’s standard of living, therefore must be treated at any cost.

However, mostly, pain is constructive and disappears of its own accord, so before you reach for that pack of painkillers, remember that ‘the pain is there to help you; stop moaning!’

Image: LTD Team at Edge Hill University on Flickr (CC BY-NC-SA 2.0).

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