WHAT IS PAIN & THE DIMENSIONS OF PAIN - PART 5 *********************************************** IN PART 4, three well recognized dimensions of “pain perceptions” which arose from the IASP definition of pain, were described. Every pain experience has these dimensions to a greater or lesser extent, depending on an individual’s circumstances and causes for a “pain experience”. So, for one person, a minor injury, painful though it may be (sensory-discriminative dimension), would be interpreted (cognitive-evaluative dimension) as a minor, manageable event, producing little distress (emotional - motivational dimension), whereas, the same kind of injury for another person, might represent “a disaster” or “catastrophe” and be most distressing. There are, however, other “dimensions” to pain, which might affect our “pain experiences” – each in our own ways. For example, there are “spiritual,” “cultural beliefs,” social-behavioral” and “personality” dimensions to our experiences of pain which need to be considered, particularly in chronic pain conditions, which may play a role in our “perceptions of pain”. Whatever is necessary for our whole brain to feed into “pain messages” is what ends up as a person’s particular unique “pain perception,” and such interpretation is done both consciously and subconsciously, and very rapidly during injury and pain events. The brain also has built-in capacities for modulating pain messages – either to increase or decrease the various components of such messages. After the brain’s interpretation of pain messages, on the downward journey to the site of injury, the messages pass through a number of neural structures that have the specific function of influencing the “quality” of the messages. Within the brain itself, pain modulation specifically occurs in the PAG (periaqueductal gray) area, and the medulla; in the spinal cord in specific areas (the locus coeruleus and raphe magnus nuclei), and in the entry and exit zones of the neural pathways of the spinal cord. Events occurring at the site where the pain is felt, certainly after actual tissue injury, also produce pain modulatory effects that need to be understood as our bodies’ own pain (endogenous) modulation systems. These systems work through the presence of chemical substances, called “neurotransmitters,” which act as “chemical messengers” to regulate our nerves function and to mobilize our bodily systems for protection and adaptive survival. Through medications, we can introduce substances from outside ourselves (that is , exogenous substances) which interact with our body’s own chemical messengers in the nervous system to affect their functions by either blocking their actions, reducing their effects, or increasing the effects. In this way, the aim of medications in pain treatments is to reduce painful sensations, and may include medications which are not directly analgesic (pain reducing), but whose effects have been found to influence our endogenous pain modulation systems. Most importantly, what is described here, refers to the abilities of our nervous system to adapt naturally to meet the demands of different situations – just as thin plastic can bend and fold to fit different shapes – so our peripheral and central nervous systems are “plastic” and adapt to present circumstances. Such dynamic adaptation is known as “neural plasticity,” and is a vital feature to be understood in terms of the neural mechanisms associated, in our case, with the sensory system’s responses to causes for “pain.” In the next few pages, it will be important for our exploration of “what pain is” to outline in more detail the neurophysiology of our “pain” sensory systems. By Robin Boell B Soc. Sc. (Hon) Currently studying M Med (Masters) 25 years researcher on pain at various top pain clinics and a very valued member of Victory Over Disability Homes Team.
Posted on: Fri, 08 Nov 2013 13:28:27 +0000
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