Pain is a common everyday experience, with as many as 87% of patients experiencing moderate or severe intensity at some time during their stay in hospital and 20-25% of the general population in Scotland reporting significant or severe pain lasting many months. It is essential in alerting us to actual or potential tissue damage. Failure of this mechanism can allow gradual damage to occur which may result in loss of function (e.g. Charcot’s joint) and in the acute situation can even result in delayed diagnosis of life-threatening conditions. But if it is possible to have pain without tissue damage or vice versa, what is pain? The International Association for the Study of Pain (IASP) defines it as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” The inseparable emotional experience is very distressing but is functional in eliciting a behavioural response to remove the stimulus, limit further injury and optimises recovery. The assessment and management of pain and its impact on patients depends on its duration- acute pain (of recent onset) is thus discussed separately from chronic pain (of more than 3 months duration). Although each pain problem needs to be considered individually, division into types of pain based on aetiology is useful for management decisions: nociceptive, due to stimuli from somatic or visceral nociceptors; neuropathic, due to damage to nerves (although use of this term differs); and psychogenic (of psychological origin). Pain is, however, influenced by many of factors, and a biopsychosocial model of total pain is used, particularly in palliative care literature to describe the experience which results from the interplay of physical, psychological, social and spiritual pain. But how well do we understand the way in which this experience comes about, and how can we use this to treat pain?

Pain Essay (PDF)