3/20/21

Types of Pain and how Physical and Emotional Pain Correlate As the disaster duo

What are the Types of Pain One Can Have and How Do We Accurately Assess the Level  of Pain?


Pain is a concept that is different to all people. Many medical facilities use a rating scale of 1-10 to rate your pain. Does this seem like an accurate assessment to you? When asked this question, how do you answer? Most of us think for a minute and pause. Next, we look at the attending physician with a little bit of confusion as to how they will rate your rating. If you say a 5 does that mean you feel "manageable pain"? If you say 10, are you feeling like you are being dramatic when you are truly feeling completely drained  physically, emotionally and all of your thoughts and focuses are on this pain.  Can you truly rate it a 10? 



The Famous 1-10 Scale of Pain Assessment 




Number scales are extremely difficult to use to assess pain. Many chronic pain patients feel some kind of confusion when it comes to the rating scale. We are so afraid of being” rated back” or not taken seriously because each day we feel chronic pain.


Emotional Pain Scale 


When we have chronic pain, it often comes with emotional pain which has yet another chart. This is also incredibly  complex and can be a result of chronic physical pain or vice versa. Chronic emotional pain can also turn to chronic physical pain and the two occur together in most occurrences. This is why handling a chronic pain patient's emotional state is just as important as monitoring and treating the physical pain of a patient.


The correlating Duo 


Serious anxiety and emotional distress can cause some serious pain. The lingering effects of a depressed state will inevitably lead to physical health problems. Chronic physical health problems lead to an unsteady mind state. We cannot generally have one type of pain without the other. If somebody is bedridden and unable to do the things that they find pleasurable in life than they are more likely than not, suffer much in the same way that a person who is grieving suffers. They will grieve the way they used to live their life and how they have to adjust to their new normals. We will discuss how to effectively handle emotions later on in this course as well as Many effective mental health coping mechanisms actually work to treat physical pain because you are treating the emotional pain that is correlating with it. That is why there are mental health professionals that work at pain management clinics. They play a vital role in treating both kinds of pain. Having a healthy emotional state can greatly decrease your physical pain.


When You Deal With Both Types of Pain, Rating it on a Scale Makes it Even Harder


Because emotional and physical pain go hand in hand when dealing with a chronic pain condition, rating our pain on a scale can be a cumbersome task at best . This can make it even more difficult to describe exactly how we are feeling when no one else can even have a clue as to how we are actually feeling both physically and emotionally. Some types of pain can not yet be accurately assessed by a physician. Even with all the medical advancements we have today, some conditions can only be assessed by how we tell the doctor we feel. 


Reasons we Need Pain Scales for Certain Types of Pain 


 We can understand why a pain chart is there. In an acute pain situation, it's more useful. An example would be, you were climbing a ladder and fell off. This causes an ankle injury. The doctor takes an x-ray and sees that bones are broken. So, when in an acute situation saying that you feel a level of pain of an 8 or 9 because you have a newly fractured bone, the pain scale makes sense. It can be measured by a scan of the bones so the number you say correlates with the scientific evidence in front of the person treating you. A broken ankle can not be ignored. It interferes with tasks. It interferes with your concentration level as well as your basic needs. It also requires bedrest and elevation of the limb to heal so based on this pain scale you would be in a level of pain of a 10.


Acute and chronic Pain Correlate Together as Well


In an emergency setting we may not know the doctor treating us. If something isn't broken but you have acute pain like a migraine, that can be a more complicated assessment. It is not pain that lasts forever, Pain may be both chronic and acute at the same time. Some days you feel less bad and can deal and others you have migraines that come on abruptly. Sometimes they can be managed by over the counter medications, or prescriptions from a general practitioner.  Other days, the migraines are so bad that they are considered a "10" and require emergency treatment. Migraines are both acute and chronic at the same time  


Chronic pain is a condition that lasts for more than three months and various treatments can manage it but there is no exact cure.It causes underlying anxiety, depression, fatigue and a loss of interest in activities that you once enjoyed. You may feel stress that a certain situation or food may possibly trigger an acute migraine bad enough that emergency medical assistance is necessary. This causes you to avoid certain activities and things you enjoy and now you are dealing with emotional symptoms triggered by your chronic pain condition. 


We all feel pain differently


 Not one person feels pain the same way that another person feels it. Human beings are completely unique in this way. When it comes to chronic pain,because we are so used to feeling like we are in a level of pain like a 10, we may assess our pain differently to a doctor and say it is a six. A migraine is not something that can be seen on an X-ray or a chart. The same thing applies with conditions like fibromyalgia and neurological conditions that affect our lives on a deep level but no doctor can find any evidence of the condition. This is when we have to explore the various treatments that come with chronic long lasting pain that some days may be manageable at home while other times it is not. 


Developed Tolerance to Pain 


When we have chronic pain, we begin to develop a tolerance to it physically, but mentally and realistically,  we are on the level ten on both the 1-10 pain and emotional scales. When something can not be clearly identified by research and lab testing, we may feel like our care providers don't understand how truly bad we are feeling. This is when those  with chronic pain who have a high pain tolerance feel like the pain scale backfires. We can be at a normal person’s eight, where they might be crying and writhing, and yet we are still sitting up, or reclining on the hospital bed, and may be able to even crack a joke here or there as a method of dealing with it.  They ask your pain level and you freeze up because you feel like the above image, hopeless, miserable, feel like crying but there's no more tears to give and you don’t know what number is appropriate.


 To you, there  is pain you can deal with and pain you can’t, and your pain is getting to the point you can’t – that’s why you are there. So you throw out a number. You don’t want to sound dramatic so you low-ball it and the doctor isn’t seeing a patient in that much pain, so what happens? You feel like you wasted a trip and are more exhausted because you weren't having a screaming episode in front of the doctor. So what are we supposed to do, lie there moaning and putting on a huge display to get our needs met?


Communicating With Your Providers is a Key Factor in Treating Your Pain 


In order to effectively treat chronic pain, one has to be able to learn to effectively communicate with the ones treating them. Becoming educated on effective communication methods with the people in your life that help you deal with your emotional  and physical pain can provide you with many more options for treating how you feel. Good communication skills can make a world of difference for chronic pain sufferers. You will learn how to communicate with your doctors and other providers in a way that opens up decreased pain on all levels after this course. A good way to start this is to start giving constructive feedback on how your pain management plan is working.  A fantastic start to this is telling your doctor specific things such as what is shown below are helpful. 

  • How is my life going in general?

  • What does my pain limit me from doing that I would like to be doing if I wasn't hurting constantly. 

  •  What does a typical day look like? 

  • What parts of my day have changed because of the pain I am in ?

  • Am I a possible danger to myself because of the pain? 

  • How much time each day am I spending in bed?

  • Can I go to work full-time, part-time or not at all?

  • What do I reasonably hope to gain from the visit? 

  • Do I feel lonely, anxious, hopeless, irritable or a variety of other mental states that I should tell my provider?


Additional Types of Pain


We have discussed acute as well as chronic pain and touched a bit on how they can intertwine and affect each other. There are various types of pain however that can greatly interfere in one's life. 




Neuropathic pain:

Nerve Pain can be one of the most sensitive types of pain there is. It occurs when there is damage to the nerves or other parts of the nervous system. Some common symptoms of this variety of pain are-

  • Often described as shooting, stabbing, pins and needles, or burning pain

  • Can affect sensitivity to touch

  • Common type of chronic pain

  • Can be intermittent as when one feels like they are doing okay one day and the next can also be so  severe that it makes performing everyday tasks difficult. 

  • Can lead to mobility issues


Understanding Nociceptive pain


This is often the type of pain that causes permanent damage to some area of the body or body tissue. 

  • Often described as being a sharp, achy or throbbing pain

  • Often caused by an external injury 

  • Often experienced in the joints, muscles, skin, tendons and bones

  • Can be both acute or chronic


Radicular pain:


Very specific type of pain that can occur when the spinal nerve gets compressed or inflamed

Radiates from the back and hip into the legs by way of the spine or spinal nerve root. This can feel both neurologically painful and chronically painful. 


  • Experience tingling, numbness and muscle weakness

  • Commonly known as sciatica because the sciatic nerve being affected

  • Pain is often steady and people can feel it deep in the leg

  • Walking, sitting and some other activities can make it worse 

Post Surgical Pain


When one has an upcoming surgery, generally there is a great amount of fear about the pain they will have. Surgical pain comes from an incision being made that causes damage to the surrounding tissue. Sometimes the procedure itself, such as a cystoscopy can cause pain. This is an exploratory surgery. There is no technical cutting or incisions but the exploratory nature of the procedure itself, causes post surgical pain. This type of pain is caused by the use of force of an instrument that stretches the area being explored further.  

One can also have pain from a breathing tube that has germ inserted. This can cause the throat to experience irritation. 

If it is a long surgery or the positioning necessary for your body to be in, is uncomfortable, this can cause pain as well. 



Superficial Somatic Pain


When you have Somatic pain, this comes from an injury of some kind. They can be as simple as falling off the bike and scraping your knee or having surgery or a biopsy and the cuts and wound area hurts for a while until it heals. It can also be from surgical pain from the incision and for the pressure from the force of a surgery.


Deep Somatic Pain


When you have pain that is deeper than superficial pain it is known as Deep somatic pain. 

This type of pain comes from a torn ligament, a muscle being torn or a tendon or a broken bone. Sprains can also cause this kind of pain. Surgical pain involves both types of deep somatic pain and somatic pain. The deep somatic pain is when incision cuts through tissue that is deep. Superficial somatic pain is from the scarring or injury and the outer layers of the skin. 


Central neuropathic pain 


When the brain or spinal cord is injured central neuropathic pain can occur. A Traumatic brain injury can cause central neuropathic pain and injury to the spinal cord. 



Visceral Pain


Visceral pain is from internal organs and it usually is from a digestive system situation or appendicitis. These are some examples there are other types of visceral pain as well. It is hard to always find the exact location of the pain because it may feel general in the area to the patient. It can sometimes take a while to diagnose this type of pain. It can also be caused by surgical pain and different types of damage to organs and infections as well as cancer. A type of visceral pain that happens during surgery is anytime a surgeon cuts through the G.I. tract, that would be an example of this kind of pain. 


 Referred Pain


When the brain receives a lot of information at once by an area of nerves that is unable to distinguish where it is coming from, it is known as referred pain. An example could be a human being grabbing his left arm because he is having a heart attack. He feels pain in that arm so he grabs it. The pain signals are confused and are sending pain to different areas. The bundle transmission of this pain is causing it to expand and go to different areas because the information is coming in so fast that it can’t distinguish where the body is supposed to hurt.



Peripheral neuropathic pain


 Peripheral neuropathic pain starts with nerves that are not part of the spinal cord or the brain. They are the nerves that are in the extremities of the body. These include your arms and legs. 



Phantom Limb Pain


When someone undergoes an amputation of a body part, they can experience a strange type of pain that is quite unique. This is known as phantom limb pain. The limb is missing but the patient feels pain where the body part used to be. It can also happen in areas that are not limbs like a possible situation where a woman has to have a mastectomy. She may feel pain where her breasts used to be and this is also known as a type of phantom limb pain. It used to be thought of as something psychological but research is finding that this type of pain is legitimate and causes patients a great deal of distress. They can actually become in severe pain that is acute and chronic in nature. Sometimes it will be really bad other times it will be tolerable. It is a serious type of pain that is still being studied to understand how to effectively treat patients with phantom limb pain. 





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