Why describing pain is tricky

Pain is one of the commonest clinical symptoms in modern medicine. Description of pain poses great challenge to human beings given its mode of appearance.
Dr Joseph Kamugisha
Dr Joseph Kamugisha

Pain is one of the commonest clinical symptoms in modern medicine. Description of pain poses great challenge to human beings given its mode of appearance.

Factors such as origin, nature, intensity and duration of pain are always considered. The tricky part of pain revolves around the makeup of our body system or human anatomy.

The human skeleton is made up of neuro-muscular network with nerves and muscles. The nerves are key human body messengers and are there to report what has happened in every single unit of the body system.

A network of nerves that make our skeletal system is largely inter-related. This facilitates easy and quick transmission and transformation of pain. This kind of pain is called referred pain or pain that has been transmitted from one part of the body to another.

However, there are circumstances when you can have localised pain. It occurs in areas with fewer nerves. Most of the localised pain occurs on the skin surface of the body where there is limited or minimal nerve activity by the peripheral nerves.

For example when you experience a small cut on the skin surface of your thigh, pain remains localised but when injury goes deep to reach the muscular part you will feel pain across the pelvis and areas of the knee joint.

Most of the internal body injuries are manifested in the referral form. Injury to the liver or bile ducts is always manifested on the right upper side of the abdomen, especially radiating toward or moving to the right back of your shoulder.

Likewise, a person can feel pain along her left arm or left jaw in cases of heart dysfunction.

In scientific terms, it means that referred pain occurs in areas of the body that feed sensory nerves into the same area in the central nervous system of a human being.

In this case sensory nerves from your left arm, left jaw, and heart all feed into about the same level of your spinal cord, so when the nerves from your heart send signals of distress to your central nervous system, your brain may register these signals as coming from your left arm or jaw, even without an actual problem in your left arm or jaw.

When you go to the hospital, you will complain of the persistent pain or discomfort in your left arm or jaw. This is why doctors are technically trained to define and describe all these challenges. It is the technical aspect of doctors to assess the problem and the scientific basis of life description has forced traditional healers to disappear from medical interventions.

Traditional healers or herbalist have failed to explain the basis or mechanism of their drug actions as related to human body anatomy or physiology.

Referred pain can be felt anywhere in the human body and commonest at areas where nerves meet or join to form a plexus.

For example, people with dysfunction or problem at the sacro-iliac joints of the pelvis tend to feel pain at the hip level.

Another common experienced site of referred pain is the back of the wrist, where tight forearm extensor muscles that extend up to the elbow cause the brain to sense wrist pain even though the bones, joint spaces, and soft tissues in the wrist are fine.

Pain that is felt within your abdominal and pelvic cavities can originate from a distant tissue or organ as compared to musculoskeletal or skin pain.

 This stems from the development right from the embryo or fetus of life where internal organs are elongated, rotated, and even migrated.

The most sensitive nerve to our internal organs is the vagus nerve. It is there to make sure that every small injury or problem that occurs at cellular or tissue level I our internal organs is reported to the brain.

The problem or basis of misdiagnosis of pain in this situation is that the vagus nerve is charged to monitor and send information from many overlapping tissues in our body system.

The heavy workload makes it not capable to direct the cerebral cortex, the precise location of injury or inflammation in our internal organs.

This makes people to misinterpret the exact location of pain and has been the basis of delayed or misdiagnoses for some chronic diseases like cancer.

Dr Joseph Kamugisha  is a resident oncologist in Jerusalem, Israel

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