Questions and Answers

What is pain?

The International Association for the Study of Pain defines pain as an “unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.”

What does that mean?

Pain is something that we experience in an unpleasant way that usually traces back to something that happened to our body.

How do we feel pain?

The body perceives pain through special cells that transmit the pain message to the brain. The brain is where pain is perceived.

But if we feel pain in our foot, for instance, how does it get to our brain?

If you hurt your foot, the body sends out a signal through the nervous system to the spine. From the spine, the pain signals are transmitted to the brain, which “interprets” them. We may feel pain in our foot, but the pain was perceived in our brain.

How does the signal travel?

The human body is constantly sending and receiving signals. The signals are transmitted chemically through nerve cells called neurotransmitters (that’s a medical word for “nerve transmitter”) to neuroreceptors (that’s a medical word for “nerve receiver”).

If pain is in the mind of the beholder, do individuals feel pain differently?

Pain is subjective. That means that different people perceive and respond to it in different ways. However, just because pain is subjective does not mean pain is not real. Physicians and other healthcare professionals today are trained to respond to pain as the patient reports it.

I don’t like to complain too much. I don’t like to talk to my doctor about pain.

Today we know that pain can be a very important part of your overall symptoms. You should always report pain to your doctor or healthcare professional because it may indicate that your health has changed or that you need different types of care. Furthermore, many people suffer with pain that can be managed. If you don’t mention pain to your doctor, he or she may not offer you treatments that could help you.

How should I report pain? It’s hard to describe.

Many healthcare clinics now use a scale of numbers or even smiley faces so that you can grade your pain from 0 to 10. On that scale, 0 is no pain at all and 10 is the worst pain you’ve ever felt (and you probably would be screaming with level 10 pain). Your healthcare provider may ask you where it hurts and whether the pain is dull or sharp, throbbing, burning, or other such words. Doctors also sometimes talk about acute and chronic pain.

What is the difference between acute and chronic pain?

In medicine, acute usually means something that is happening right now and will be occurring for a short, immediate period. Chronic things are longer-term; they are conditions that the person has had for quite a while and will continue to have. However, when it comes to pain, acute pain can be different than chronic pain not just in duration but in how the doctor and nurses will help you manage the pain.

What is acute pain?

Acute pain is caused by soft tissue damage, infection or inflammation and may be brought on by an injury, surgery, or disease. Most of the time, acute pain can be treated by addressing its cause and then using pain medication.

So acute pain goes away?

Yes, most of the time acute pain will go away as you heal. Doctors and nurses help you manage acute pain by providing temporary pain relief while addressing the cause of the pain.

What is chronic pain?

Chronic pain was once defined as pain that lasted six months or longer. Today, it is more likely to be described as pain that lasts a long time. Chronic pain may be related to a disease, condition, or old injury. In some cases, you can have chronic pain from an old injury that has healed (but the pain persists). In some cases, your doctor may not be able to determine the cause of your chronic pain. It is in many ways different from acute pain.

If the doctor can’t find a cause for my chronic pain, will he believe me? Or does that prove that my pain is psychosomatic?

If you are in chronic pain and your physician is unable to find the cause of it, you should get a referral to see a pain specialist. Pain specialists are doctors who are experts in treating people with chronic pain. They are very familiar with the fact that some chronic pain seems to have no obvious explanation.

How is chronic pain different from acute pain?

Your doctor may not be able to treat the root cause of your chronic pain. In some cases, your doctor may not even know the root cause of your chronic pain, so treatment to make the condition go away is not an option. Furthermore, there can be a psychological component to chronic pain that is rare with acute pain. If you have chronic pain, you know that it can be discouraging. There is evidence that this psychological component can make chronic pain more difficult to bear than the same amount of pain in an acute situation.

Do doctors treat chronic pain differently than acute pain?

When dealing with acute pain, doctors always address its root cause, but that can be difficult or impossible in cases of chronic pain. In fact, our current understanding is that chronic pain is like the "disease of pain" and cannot be treated like acute pain.

How many people suffer from chronic pain?

It has been estimated in the medical journal Pain that about 33% of U.S. citizens have chronic pain. (Source: Magni C. et al. Pain 1993; 53: 163-6.) Clearly, millions of people around the world have chronic pain.

Are there doctors who specialize in treating pain?

Yes, there are pain management specialists but considering the millions of people in chronic pain, there are not very many physicians with specialized training in this area. In fact, pain management is not commonly taught in most medical schools, although most physicians across all specialties treat people with chronic pain.

Who should treat people with chronic pain?

If you or a loved one is in chronic pain, you would be well advised to seek out a consultation with a pain management specialist. Your physician may be able to refer you or you can consult with your healthcare provider. Pain management experts are aware of the latest research into pain treatment and may be able to offer you the benefits of current research into pain.

How can medical science treat pain?

Most pain is treated with combination therapy, that is, more than one treatment. Drugs, both over-the-counter and prescription, are a first line of treatment. Physical therapy or massage can be used. Sometimes people find relief in so-called alternative therapies, such as acupuncture. If these things do not work or do not work well enough, there are a couple of implantable devices that may be tried.

What is an implantable device?

An implantable device is a small, battery-powered device that is implanted inside the body and used to help treat pain. There are different types of them, but they work in that they interfere with the way your body perceives pain.

How do we perceive pain?

The body contains special receptor cells that sense pain. The signals are delivered to the spinal cord and from there go to the brain. The brain then translates this signal into a perception, namely pain. Drugs and devices all try to block pain.

How do some drugs and devices block pain?

There is a theory of pain called “gate control.” Think of the pain signals all converging to your spinal cord. Now think of the spinal cord as a one-lane highway straight to the brain. The “gate control” theory says that the entrance to the spinal cord’s one-lane highway is a gate. Only one signal can get through the gate at a time. If two signals arrive at the same time, one gets in, the other gets blocked. If you can interfere with the signals getting onto the highway, you won’t experience pain.

Give me an example of this “gate theory.”

Let’s say you bump your knee and it hurts. Have you ever noticed that if you rub it, it does not hurt as much? That’s because when you rub it, you are also creating signals that travel through the body to the spinal cord and from there to the brain. The “rubbing” signals are blocking some of the pain signals.

How do pain medications work?

Different drugs act in different ways. Some may block “reception” of pain signals. In other words, pain still occurs but the signals don’t get received, so the brain never gets the message. In very simplistic terms, that is how opioid drugs work.

What is an opioid drug?

Those are a special category of drugs used by physicians to treat pain. They include a lot of drugs we might call narcotics, including morphine. They are very powerful medications and should be used only under close medical supervision.

Can I get addicted to opioids?

Yes, they are addictive. However, medical research indicates that people who take opioids or narcotic drugs for pain management are not as likely to get addicted as people who take the same drugs recreationally. This is a good topic to discuss with your doctor.

Are there other types of pain medications?

Yes, there are many types of drugs that can relieve pain. These can include drugs to reduce inflammation, block pain signals, or help relieve the cause of the pain. They may be taken by mouth, by injection, by intravenous (IV) line, or by using an implantable pump. That’s one of the devices that can be used to help you manage chronic pain.

What devices can be used to manage chronic pain?

There are two main types of devices. The first is called a neurostimulator. That is a device that uses very low-voltage pulses to stimulate the area around the base of the spinal cord. A neurostimulator blocks pain signals by flooding the one-lane highway to the brain with painless, harmless electrical signals. The other device is an implantable pump. It’s sometimes called an intrathecal pump.

What is an implantable intrathecal pump?

An implantable pump is a small device that is implanted in the body. It contains a little reservoir that holds pain medication. The pump has a catheter or thin tube that goes from the device to the intrathecal area, which is at the lower spine. The pump then sends very small amounts of pain medication directly to the base of the spine.

How does that help?

If you take pain medication any other way, you have to take pain medication into your whole body. For instance, if you get a shot of morphine, your entire body gets the morphine. By sending the drug specifically and exactly to the intrathecal area, you can get the same or better pain relief with much smaller amounts of the drug.

How much less drug will a person with an intrathecal pump need compared to a person taking drugs by injection or by mouth?

That depends! However, it is not unusual for a person with an intrathecal pump to get pain relief with one-hundredth the amount of the drug that would be required if taken another way. Sometimes, even less than that is required. The advantage is that you get the same pain relief with very little drugs. Plus, the pump delivers the drug constantly and at the right doses, so you don’t have to worry about giving yourself shots or taking pills.

How does a person get an implantable pump?

Implantable pumps are only right for certain people. That is why you need to see a qualified pain management specialist. If this looks like a good way for you to get medication, a pump can be implanted in a surgical procedure. Although no surgery that you have to have is ever “routine,” this kind of surgery is not particularly complex and usually does not take a long time. However, every patient is different so you should discuss the details of your surgery with your physician

What happens when the pump runs out of medicine?

The pump holds a certain amount of medicine that usually lasts a fairly long time. However, it will need to be refilled periodically. No surgery is required. The doctor injects a syringe needle through your skin and directly into the pump. He or she can then refill the pump.

That sounds great. What are the risks?

Any time you have surgery, you are taking a risk. Your healthcare team will do everything possible to minimize your risks, but no procedure is ever risk free. You will also need to see your healthcare team regularly for check-ups and to refill your pump. The pump is battery operated and the battery lasts a very long time (years). However, it will eventually run down. When that happens, the entire unit will need to be replaced. This requires another surgery but it may be faster and “more routine” than the original surgery.

Do all people experience pain?

Actually, there is a very rare condition in which some people are born insensitive to pain. This condition can be dangerous since injuries can occur of which the person is unaware.

How can I know if I actually have chronic pain?

If you think you have pain, you have pain. Discuss it with your primary care physician and, if need be, seek out a pain management specialist. There are so many new treatment options today that putting up with pain may be unnecessary suffering for some people.

Can pain specialists help me?

Pain management specialists have more knowledge and better drugs and medical equipment than ever before in history. Some people will literally experience complete relief from their pain. Many more will experience some degree of relief. Even if a pain specialist cannot help you as much as you would like today, medical science is advancing so rapidly that more relief could well be on the way. If your life has been limited by chronic pain, you owe it to yourself to contact your physician.

What are some organizations that study pain where I might find out more information?

Some excellent websites can be found by Googling these specialty societies: