What Is Pain?

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What Is Pain?

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You know what pain is. Everyone does. But defining it in words isn’t easy.

The word “pain” comes from the Latin word “poena,” meaning penalty or

punishment, and unfortunately pain still carries that connotation. Medical

definitions tend to be circular, relying on words like “discomfort” or

“distress” that essentially just say “pain” in some other way. Researchers often

use the definition developed by the International Association for the Study of

Pain: “Pain is an unpleasant sensory or emotional experience associated with

actual or potential tissue damage, or described in terms of such damage.”

Loeser, a University of Washington physician, has divided pain into four

components: detection of damage to human tissue, the brain’s perception of that

damage, the emotional response to that perception (which he labels “suffering”),

and the behaviors in response to those emotions and perceptions. For most

people, particularly people who are feeling pain, the only

definition that really matters is that it hurts. Or as two prominent pain

researchers wrote several years ago: Pain is “whatever the experiencing person

says it is, existing whenever he [or she] says it does.”

Types of pain. Pain is most often classified according to how long it lasts

and what causes it. Using this yardstick, there are three basic types of pain:

transient, acute, and chronic.

Transient pain. The everyday bumps, nicks, and little cuts of life cause

transient or fleeting pain. One example of transient pain is an occasional, mild

headache that’s relieved by over-the-counter drugs. You probably wouldn’t go to

a doctor for transient pain unless it was somehow associated with a significant

injury.

Acute pain. Acute pain — pain that begins abruptly and has a foreseeable end —

is more complicated. It’s the body’s natural response to an adverse chemical,

thermal, or mechanical stimulus. Examples include any kind of injury, surgery,

or childbirth (see Pain with a purpose). The boundary between acute pain and

long-lasting or chronic pain is sometimes blurry. Pain experts agree that acute

pain associated with tissue injury can persist anywhere from less than one month

to more than six months. However, any pain that continues for more than a few

months causes physical and emotional changes that muddy the distinction between

acute and chronic. Moreover, even brief periods of acute pain are capable of

causing the kind of long-term changes to nerve cells that can permanently excite

them and lead to chronic pain.

Chronic pain. This type of pain can start with an injury or disease but

persists well after the injury is healed or the disease is cured or goes away.

Some pain experts prefer the term “persistent pain.” One prominent pain

researcher wrote that with chronic pain, “it is almost as if the brain develops

a memory for pain, much like the skill of learning to ride a bicycle is never

unlearned.” Cancer, arthritis, diabetes, and a variety of other conditions are

frequent sources of chronic pain. The presence of chronic pain is a key part of

the definition of certain ailments, such as low back pain, some forms of

headaches, and fibromyalgia. Many types of chronic pain stem partly or entirely

from damage to the nerves themselves — a condition known as neuropathic or nerve

pain. In particular, the pain feelings associated with certain types of

diabetes, shingles, and AIDS are characteristic of nerve pain.

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