Types of PainBy

Dr Parneet Singh

"Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage”

Pain derived from latin word ‘poena’ which means penalty or punishment

Pain is a symptom

Definition

Indian association for study of pain

Visual Analogue Scale(VAS)

1. Superficial Pain

2. Segmental Pain

3. Deep Pain

4. Psychogenic Pain

Types of Pain

Due to direct irritation of peripheral nerve endings

It can be chemical/mechanical/thermal /electrical

Pain is sharp

Can be pointed with finger tip

Superficial Pain

Due to irritation of a sensory nerve trunk or root

Located in particular dermatone of body supplied by affected sensory nerve trunk or root

Segmental Pain

Due irritation of deep structures like deep fascia, muscles, bones, joints or viscera

Vague pain

Can be referred to other part of body due to common area of representation in spinal cord

Deep Pain

Pain arises from the brain

Can be functional pain due to emotions or hysteria

Psychogenic Pain

Protective mechanism that alerts the individual to a condition or experience that is immediately harmful to the body

Sudden onset This type of pain mobilises the individual to prompt action to

relieve it Psychological and behavioural response to acute pain- Fear - General sense of unpleasantness or unease- Anxiety

Acute Pain

Chronic pain is persistent or intermittent usually defined as lasting at least 6 months

The main behaviour changes are: - Depression - Attempt to keep pain - related behaviour to a

minimum - Sleeping disorders - Preoccupation with the pain

Chronic Pain

1. Vague aching pain-Mild continuous pain with no specific features

2. Burning Pain-like burning sensation when in contact with hot object. Seen in peptic ulcer or reflux oesophagitis

3. Throbbing Pain-Throbbing sensation seen in pyogenic abscesses

4. Scalding Pain-type of burning sensation like felt during micturation in cystitis or urethritis

On Basis of Nature of Pain

5. Pins and Needles Sensation-injury to peripheral nerve

6. Shooting Pain-like in case of Sciatica

7. Stabbing Pain- sudden, severe, sharp and short lived pain as in acute perforation of peptic ulcer

8. Constricting Pain-like something s encircling and compressing the part like in angina pectoris

9. Distension-Experienced in diseases encircled or restricted by wall eg hollow viscus

10. Colic-Occurs when the muscular wall of a hollow tube is attempting to force certain content out of the tube

Pain appears and goes off suddenly

Pain is gripping

Four types-Ureteric colic, Biliary colic, Intestinal colic and Appendicular colic

11. Twisting Pain-sensation as if something is twisting in the body like in volvolus of intestine or torsion of testis

12. ‘Just A Pain’-sometimes the patient does not describe nature of the pain and says it as “JUST A PAIN”

13. Radicular pain - caused by compression, inflammation and/or injury to a spinal nerve root arising from common conditions including herniated disc, foraminal stenosis and peridural fibrosis.

1. Radiation of Pain

2. Referred Pain

3. Shifting or Migration Pain

On the Basis of Movement of Pain

Extension of pain to another site while pain at original site persists

The radiating pain has almost the same character

Eg Duodenal ulcer pain penetrates posteriorly

Pain in epigastrium remains but at the same time radiates to the back

Radiation of Pain

Pain is felt at a distance from the source while no pain at site of disease

Eg- Inflamation of diaphragm causes pain at tip of the shoulder

Pain in hip joint can be referred to knee joint

Referred Pain

Pain is felt at one site in the beginning then pain shifts to another site and pain at original site disappears

When abdominal organ becomes diseased original pain occurs at site of distribution of somatic segment

As parietal peritoneum is involved the pain is experienced at site of organ

Eg-Acute appendicitis pain is experienced at umbilical region(T9-T10) but later on goes to right iliac fossa

Shifting or Migration of Pain

Thank You

SomatosensorySystem

Brain

Somatosensory Cortex

Thalamus

Spinal Cord

Dorsal Horn Ventral Root

PNS

Afferent NeuronEfferent Neuron

A-delta FibersC-Fibers

The Nervous System and Pain

•Glutamate - Central•Substance P - Central•Brandykinin - Peripheral•Prostaglandins - Peripheral

Pain Initiators

•Serotonin•Endorphins•Enkephalins•Dynorphin

Pain Inhibito

rs

The Neurochemicals of Pain