Pain is often regarded as the fifth vital sign in regards to healthcare because it is accepted now in healthcare that pain, like other vital signs, is an objective sensation rather than subjective.
As a result it is necessary to assess pain.
Most pain assessments are done with in the form of a scale. The scale is explained to the patient and they give a score.
A rating is taken before administering any medication and after the specified time frame to rate the efficacy of treatment.
Patients rate pain on a scale from 0-10.
0 being no pain and 10 being the worst pain imaginable.
A scale with corresponding faces depicting various levels of pain is shown to the patient and they select one.
Patients whom cannot verbalize/comprehend pain scales are assessed with different types of scales.
Used for neonates/infants:
The scores are added together to achieve a 0-10 pain score.
TYPE OR CATEGORY OF PAIN
NOCICEPTIVE PAIN
This is the typical pain that we have all experienced. It is the signal of tissue irritation, impending injury, or actual injury.
Nociceptors in the affected area are activated and then transmit signals via the peripheral nerves and the spinal cord to the brain. Complex spinal reflexes (withdrawal) may be activated, followed by perception, cognitive and affective responses, and possibly voluntary action.
The pain is typically perceived as related to the specific stimulus (hot, sharp, etc.) or with an aching or throbbing quality. Visceral pain is a subtype of nociceptive pain. It tends to be paroxysmal and poorly localized, as opposed to somatic pain which is more constant and well localized.
Nociceptive pain is usually time limited--arthritis is a notable exception--and tends to respond well to treatment with opioids.
NEUROPATHIC PAIN
Neuropathic pain is the result of a malfunction somewhere in the nervous system. The site of the nervous system injury or malfunction can be either in the peripheral or in the central nervous system.
The pain is often triggered by an injury, but this injury may not clearly involve the nervous system, and the pain may persist for months or years beyond the apparent healing of any damaged tissues.
In this setting, pain signals no longer represent ongoing or impending injury. The pain frequently has burning, lancinating, or electric shock qualities.
Persistent allodynia--pain resulting from a nonpainful stimulus, such as light touch--is also a common characteristic of neuropathic pain. Neuropathic pain is frequently chronic, and tends to have a less robust response to treatment with opioids.
PSYCHOGENIC PAIN
The use of this category should be reserved for those rare situations where it is clear that no somatic disorder is present. It is universal that psychological factors play a role in the perception and complaint of pain.
These psychological factors may lead to an exaggerated or histrionic presentation of the pain problem, but even in these circumstances, it is rare that the psychological factors represent the exclusive etiology of the patient's pain.
MIXED CATEGORY PAIN
In some conditions the pain appears to be caused by a complex mixture of nociceptive and neuropathic factors.
An initial nervous system dysfunction or injury may trigger the neural release of inflammatory mediators and subsequent neurogenic inflammation.
Example: Migraine headaches probably represent a mixture of neuropathic and nociceptive pain.
Myofascial pain is probably secondary to nociceptive input from the muscles, but the abnormal muscle activity may be the result of neuropathic conditions.
Chronic pain, including chronic myofascial pain, may cause the development of ongoing representations of pain within the central nervous system which are independent of signals from the periphery. This is called the centralization or encephalization of pain.
UPPER EXTREMITIES
Cervical spondylosis or disc protrusion can produce cord compression (upper motor neuron signs) or root compression (lower motor neuron signs).
C5-6 disc protrusions are the most common cervical disc problems; they can compress the C6 root and also produce C7 upper motor signs.
LOWER EXTREMITIES
It is important to note that lumbar disc lesions can only cause root (lower motor neuron) syndromes.
Hyperreflexia is a sign of disease or injury at a higher level, in the spinal cord or brain. 95% of lumbar disc lesions involve L5 or S1.