U–V

understanding pain Though there are numerous
physiologic mechanisms responsible for PAIN, the
actual experience of pain is subjective. Not only
do people perceive similar pain differently but the
intensity and nature of pain varies within an indi-
vidual. Many people find it difficult to express to
their doctors how much pain they are experienc-
ing, or may not themselves fully understand the
intensity of their pain. Pain thresholds—the levels
at which pain becomes intolerable— vary widely.

The Subjective Nature of Pain
Despite all that doctors understand about the
causes and mechanisms of pain, every person
experiences pain differently. Numerous factors
frame an individual’s perceptions and experiences
of pain. Key among them are

• fear about the cause of the pain


• knowledge (or lack of knowledge)


• about the mechanisms of pain


• expectations about treatments for pain


• the presence of other health conditions and
  their symptoms


• the appropriateness of treatment for any
  underlying condition that might be causing the
  pain


• the appropriateness of treatment for the pain,
  including ANALGESIC MEDICATIONS (pain relief
  medications)


• attitudes of others, including family members
  and health care providers, about the pain

Though specific kinds of pain, such as postoper-
ative pain (pain during recovery from surgery)
typically have certain characteristics, pain varies in

intensity among individuals as well as in the same

person.

Chronic Pain

CHRONIC PAINis the most frustrating kind of pain

because it is dysfunctional—that is, it exists without

purpose—and often does not respond consistently

to pain treatment approaches. The body’s pain

response is a protective mechanism intended to

draw conscious attention to an injurious process

within the body and to enforce restricted use of the

affected area of the body to facilitate healing.

Chronic pain exists beyond this design, often devel-

oping as an extension of purposeful pain (EUDYNIA)

to become nonpurposeful (MALDYNIA) though

sometimes arising for no apparent reason.

Chronic pain can be quite debilitating. Health

experts estimate that more than 70 million Ameri-

cans live with chronic pain that is intense enough

to interfere with their participation in common

functions and activities. Though movement such

as walking often improves chronic pain regardless

of its source, the effort of engaging in even modest

physical activity can feel overwhelming.

Referred Pain

A person experiences referred pain at a location

some distance from the source of the pain. The

location is sometimes so far removed from the

source of the pain that the person does not con-

nect the pain with its cause. For example, gall

stones in the GALLBLADDER (cholelithiasis) often

cause pain in the upper back beneath the shoulder

blade. Pain associated with HEART ATTACK may

occur as referred pain to the left arm, shoulder,

neck, and lower jaw.

Referred pain often adds challenge to diagnos-

ing the underlying cause of the pain. Even doctors

386