Neuropathic Pain - What It Is and Why It Defies Description
Author's opening note: This particular topic is too large to contain in one single article. Thus the next two or three articles will discuss the topic of Pain, Pain Clinics, and Diagnoses.
INTRODUCTION
One of the greatest barriers to the early detection of the presence of any of the Neuropathies is the inability of the patient to describe the symptoms and pain experienced according to some agreed to standard terminology. On the other hand, the medical practitioner often has no means to properly profile the symptoms that the patient is experiencing. This lack of effective communication always works against the patient, in that a proper diagnosis is delayed when time is of the essence. Most neurological diseases respond more effectively to treatment begun in the early stages of the disease, than if delayed.
PAIN - A DEFINITION (or two, or three)
The text in this section was inspired by and paraphrased from a presentation titled The Meaning and Management of Pain by Dr. John Blashke.
The Neurological definition of pain is the sensing of noxious, tissue-damaging stimuli by nerve ending receptors, which are called nociceptors. A nociceptor contains twenty to thirty nerve fibers that are covered with a myelin sheath. These stimuli activate the nerve fibers, which convert the stimuli into nerve pulses, which are then sent to the brain. This pain sensing and transmission process is called nociception.
A precise "working" definition of pain is difficult to state succinctly. The official definition for the International Association for the Study of Pain is "Pain is an unpleasant emotional and sensory experience which is associated with actual or potential tissue damage or described in terms of such damage." The problem is this definition is somewhat vague. Substitute the word vertigo for pain and it makes as much sense. Or substitute the word nausea. The problem is, if one tries to describe pain in a specific sense, one encounters the problem of proper denotation.
Most pain clinics become involved with behavioral modification. Dealing with patients, who are disabled with chronic pain, who cannot work and function, requires changing of their behavior. This becomes the aim of many of these clinics. These behaviorists thus favor yet another definition for pain: "Pain is a process by which an afferent sensory event is perceived which then influences the behavior of the patient."
Patients that have benign chronic pain syndrome or catastrophic intractable pain syndrome by definition have no objective nociceptive basis for their complaints, nor can you demonstrate true psychological abnormalities. Yet they are disabled with chronic catastrophic pain. Thus, another definition for pain - to describe these patients is: "Pain is anything a patient says it is."
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