Pain – a useful distress

About 30 to 40 % patients coming to any hospital for consultation, come due to complaint of pain.    Pain may be localized to a part or diffusely present, mild to moderate or severe requiring urgent treatment. 

About 30 to 40 % patients coming to any hospital for consultation, come due to complaint of pain.    Pain may be localized to a part or diffusely present, mild to moderate or severe requiring urgent treatment. 

Pain is a protective mechanism of the body which tells a person that something is wrong somewhere  needing   to   be remedied. In contrast persons who suffer from loss of pain sensation such as in diabetes or leprosy often suffer from chronic ulcerations and wounds.

This happens because they are not able to withdraw their limbs following exposure to injury.
Sensation of pain travels from the peripheral nerves to the part of brain, perceiving pain.  Limbic system in  the brain adds to the emotional aspect of pain. This decides the response of people to pain, whether they cry or tolerate it.

Right from infancy to old age a person can suffer from acute or chronic pain depending on the underlying cause. Most commonly, acute pain anywhere in the body is caused due to injury or inflammation. But chronic pain is mostly due to   chronic inflammation or degeneration or malignancy.

 Pain arising  from any limb or peripheral part of the body  is fairly well localized and is aggravated by movement of the affected part.  A person can tell clearly that his hand is aching after being hit by a door accidentally.

 Visceral pain is the one which arises from some inner organ like stomach or intestines. This type of pain is felt  in the abdomen.  It may be referred to another part, such as   the   pain due to inflammation of gall bladder is often   referred to the shoulder. 

Severe agonizing pain can  occur due inflammation of any viscera, e.g., as in acute appendicitis. Visceral pain is commonly associated with nausea, vomiting or bloating sensation.

In contrast, pain occurring due to involvement of nerves is like a severe burning sensation. It is always localized to the affected nerve. This type of pain maybe  acute as in herpes zoster, neuralgias or chronic as in diabetic peripheral neuropathy.

 Pain   is also a very common feature of psychosomatic disorders.  Mimicking pain in any part of the body is common for a malingerer or a person who stands to gain something by pretending to be sick with   it.

Pain being  purely subjective,  it is difficult to  assess that problem is of same magnitude as the person is complaining?  Diagnosis of the cause of pain is mostly made by clinical examination, appropriate X-rays and ultrasonography.

In case of pain arising from limbs, analgesic, anti-inflammatory drugs are very useful for providing relief. Injuries to the limbs like fractures or sprains need splinting, i.e. total immobilization by means of plaster or casts for reducing the pain and also healing.

Hot compression if done in case of muscular pains is also very effective in amelioration of pain but should be avoided in cases of trauma.

Hot compression is also very useful in cases of colicky pain, particularly in pain due to indigestion or gaseous distension.  Antispasmodic drugs containing atropine, hyoscine  are  used to alleviate this kind of pain.  

One needs to be careful with these kinds of drugs because they can cause and aggravate constipation and even lead to   paralytic ilieus a condition similar to acute intestinal occlusion and needing surgery.

Many of the conditions causing visceral pain are corrected by surgery as in case of gall bladder or kidney stones.
Neuralgias or pain caused by nerve involvement need carbamazepine or gabba pentin for relief.

 Use of pain killers like aspirin, Ibuprofen, e.t.c., should be  restricted  as when used for long they tend to produce gastric ulcers and kidney failure.   

Some persons use sedatives like diazepam to get rid of pain. But they only they make a patient, “sleep off”, pain and are addictive.   

One need not become overtly anxious on experiencing pain somewhere. It is a signal from the body alerting one to be cautious and rectify anything wrong.

The author is a specialist in Internal Medicine.
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