Pain

Pain is an unpleasant feeling that is carried to the brain by the nervous system. Injury is a major cause, but pain may also arise from an illness. It mayaccompany a psychological condition, such as depression, or may even occur for no obvious reason.

Pain can be classified as acute or chronic (long-lasting) Acute pain often results from tissue damage, such as a skin burn or broken bone. Acute pain canalso be associated with headaches or muscle cramps. This type of pain usuallygoes away as the injury heals or the cause of the pain is removed.

Chronic pain is pain that lingers after an injury heals, or is related to a disease, or has no known cause but will not go away. It is estimated that onein three people in the United States will experience chronic pain at some time in their lives.

Some types of pain are considered abnormal. For example, phantom limb pain occurs after part of the body is amputated. Although the person is missing a body part, the nervous system still perceives pain coming from that part. Another type of pain, allodynia, is unbearable discomfort in response to a normally harmless stimulus, such as the weight of one's clothing on the skin. A somewhat related condition, hyperalgesia, is a feeling of extreme pain from something that should be only mildly painful, such as a pin prick.

Because pain is the most common symptom of injury and disease, the first stepin treating it is to try to find out what is causing it. Sometimes, there isan obvious injury, such as a broken bone. But finding the cause of internalpain can be more difficult. Other symptoms, such as fever or nausea, help narrow down the possibilities. In some cases, such as lower back pain, it may not be possible to find a specific cause. Finding the cause of a specific paincan be further complicated by the fact that pain sometimes originates in onepart of the body but is felt in another part. For example, pain arising fromfluid accumulating at the base of the lung may be felt in the shoulder.

Everyone experiences and describes pain in their own way, so it can be difficult to communicate precisely about its quality and intensity. There are no tests that can show what type of pain a person is having or how severe it is. This is why doctors ask patients a lot of questions about their pain, including where it is located and what type of pain it is -- burning, shooting, stinging, stabbing, throbbing, or aching, for example. Doctors also ask what kindsof things increase or relieve the pain, how long it has lasted, and whetherthere are any variations in it. Sometimes patients are asked to rate their pain on a scale of 0 (no pain) to 10 (the worst pain ever experienced).

Many drugs are available for preventing or treating pain. Drugs from different classes may be combined to handle certain types of pain.

Nonopioid analgesics, such as aspirin, acetaminophen (Tylenol), and ibuprofen(Advil) are most often used for minor pain. These drugs are available without a doctor's prescription, but there are also some prescription-strength medications in this class.

Narcotic analgesics are available only with a doctor's prescription and are used for more severe pain, such as cancer pain. These drugs include codeine, morphine, and methadone. Contrary to earlier beliefs, addiction to these painkillers is not common; people who genuinely need these drugs for pain controltypically do not become addicted.

Anticonvulsants as well as antidepressant drugs, initially developed to treatseizures and depression, respectively, also can be used as pain-killers. Furthermore, it is not unusual for people with chronic or extreme pain to experience some depression, so treatment with antidepressants may serve a dual role. Commonly prescribed anticonvulsants for pain include phenytoin, carbamazepine, and clonazepam. Antidepressants used for this purpose include doxepin, amitriptyline, and imipramine.

Pain that can't be relieved with the drugs discussed above may be treated byinjections of local anesthetics directly into or near the nerve that is transmitting the pain signal. These root blocks may also be useful in determiningthe source of pain.

Drugs are not always effective in controlling pain. Surgical methods are usedas a last resort if drugs and local anesthetics fail.

Alternative treatments are sometimes used to help patients deal with both thephysical and psychological aspects of pain. Some of the most popular treatment options include acupressure and acupuncture, massage, chiropractic, and relaxation techniques, such as yoga, hypnosis, and meditation. Herbal therapies are gaining increased recognition as viable options. For example, capsaicin, the component that makes cayenne peppers spicy, is used in ointmentsto relieve the joint pain associated with arthritis. Contrast hydrotherapy can also be very beneficial for pain relief.

Lifestyles that incorporate a healthier diet and regular exercise can also behelpful. In addition to relieving stress, regular exercise has been shown toincrease endorphins, the body's natural painkillers.

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