Management of pain is very important in the clinical setting. A good assessment of pain is necessary to identify the type of pain and cause of the pain. It is a subjective experience and therefore there is a necessity of individualised pain management. Pain has an inter-relationship with the injury response and has physiological and psychological effects on the patient. These effects may lead to a poorer outcome in the patient therefore optimal pain management is important. Multi-modal pain management is effective and the pathophysiology of pain helps understand the use of different analgesic drugs.
Acute Pain and Chronic Pain
The International Association of the study of pain has defined pain as ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’ (Merskey & Bogduk, 1994). Pain can be nociceptive pain or neuropathic pain. . Nociceptive pain could be somatic or visceral pain where somatic pain is usually described as a sharp, hot, stinging, well localised pain associated with local tenderness. Visceral pain is dull, cramping and colicky pain that is often poorly localised (Scott & McDonald, 2008). It is important to identify the cause of pain as it will help with effective individualised pain management. Neuropathic pain is ‘pain initiated or caused by a primary lesion or dysfunction in the nervous system’ (Loeser & Treede, 2008). These types of pain can be either acute or chronic pain. In the acute pain setting nociceptive pain is predominant but some patients may also present with neuropathic pain (Gray, 2008). Acute pain can be defined as ‘pain of recent onset and probable limited duration. It usually has an identifiable temporal and causal relationship to injury or disease’. Acute pain serves an important biological function. There is increasing evidence that recognizing acute pain early and effectively will delay or prevent the acute pain sliding into chronic pain or illness. In contrast to acute pain, chronic pain may serve no useful purpose. Chronic pain ‘commonly persists beyond the time of healing of an injury and frequently there may not be any clearly identifiable cause’ (Ready & Edwards, 1992). It possibly may cause extreme emotional, physical economic and social stresses upon the patient, the family and society.
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