|
|
What is Pain?
Pain is an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage. Pain is dynamic. Without treatment, sensory input from injured tissues reaches spinal cord neurons and causes subsequent responses to be enhanced. Pain receptors in the periphery also become more sensitive after injury. No matter how successful or how deftly conducted, operations produce tissue trauma and release potent mediators of inflammation and pain. Pain is just one response to the trauma of surgery, however. In additional to the major stress of surgical trauma and pain, the substances released from injured tissue evoke "stress hormone" responses in the patient. Such responses promote breakdown of body tissue; increase metabolic rate, blood clotting, and water retention; impair immune function; trigger a "fight or flight" alarm reaction with autonomic features (e.g. rapid pulse) and negative emotions. Pain itself may lead to shallow breathing and cough suppression in an attempt to "splint" the injured site, followed by retained pulmonary secretions and pneumonia. Unrelieved pain may delay the return of normal gastric and bowel function in the postoperative patient. The physiological and psychosocial risks associated with untreated pain is greatest in frail patients with other illnesses such as heart or lung disease, those undergoing major surgical such as aortic surgery, and the very young or the very old. In the past, postoperative pain was thought to be inevitable, a harmless though intense discomfort that the patient had to tolerate. Unrelieved pain after surgery or trauma is often unhealthy; fortunately, it is preventable or controllable in an overwhelming majority of cases. Patients have a right to treatment that includes prevention or adequate relief of pain.
Citation: Acute pain Management Guideline Panel. Acute Pain Management: Operative or Medical Procedures and Trauma. Clinical Practice Guideline. AHCPR Pub. No. 92-0032. Rockville MD: Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services, Feb. 1992.