A Focus On: Pain

A Focus On: Pain

“Matthew …[drew] a picture that acknowledged his own vulnerability: ‘A bad monster that scared everybody. He hurts people with his big nails’ ... He now reported pain quite emphatically.”


Figure 8.8. ‘Bad monster’, by Matthew, 25 March. Reproduced from The psychological impact of life-limiting conditions on the child. Jan Aldridge and Barbara M. Sourkes. In: Oxford Textbook of Palliative Care for Children (2 ed.). Goldman A, Hain R, and Liben S (Eds). © OUP 2012. DOI: 10.1093/med/9780199595105.001.0001


Pain is a unique, deeply personal experience that is accompanied by a wide range of emotions such as fear and anxiety.  The latter distinguishes pain from the physiological process of “nociception” and reflexive measures, which is what researchers typically study in preclinical models of pain.  In a 2011 Institute of Medicine Report on chronic pain, it was estimated that almost one in three adults in the United States lives with chronic daily pain.  Despite being more common than heart disease, diabetes and cancer combined, there are still major gaps in our knowledge with regard to diagnosis and treatment.  The socioeconomic costs of pain are staggering, with a majority stemming from losses in work productivity. 


Although acute pain can be a protective mechanism to guard against ongoing tissue damage, chronic pain is better thought of as a disease, rather than symptom.  When considering pain as a disease, the goals of treatment shift from elimination of pain to appropriate management and restoration of physical function and quality of life.  In view of the fact that pain is always subjective, as well as the difficulty in identifying which of the plethora of pain mechanisms is responsible in any given patient, treatment outcomes are often sub-optimal.  


Most of the textbooks and literature in this area have targeted pain specialists, although most patients with pain are treated in primary care settings.  As such, it is paramount that all medical providers understand the essentials of pain therapy – including how to listen to and communicate with their patients about pain – and know when a referral to a pain specialist is needed.  There is a proliferation of recent scholarly and academic work on closing the gaps in knowledge and improving patient outcomes. Articles and chapters focus on a wide array of common pain conditions and broader pain concepts.  With September being Pain Awareness Month, we encourage clinicians to explore the many recent advances across the specialty that may help better explain the unique physical and emotional toll of chronic pain, and aid healthcare providers in managing one of societies greatest problems.


Further reading

1. British Journal Anaesthesia, Postgraduate Educational Issue, Managing Pain: Recent Advances and New Challenges. July 2013.

2. Brummett CM, Cohen SP.  Managing Pain: Essentials of Diagnosis and Treatment.  Oxford University Press 2013.

Chad M. Brummett, MD., Assistant Professor, Department of Anesthesiology, University of Michigan, Ann Arbor, USA, and Steven P. Cohen, M.D., Professor, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, USA/Professor of Anesthesiology, Walter Reed National Military Medical Center, Colonel, US Army Reserve.

Oxford Medicine Online publish a wealth of content relevant to pain and pain management. Oxford University Press also have a wealth of relevant information in other web services such as Oxford Scholarship Online and in our journals. Our coverage takes in many perspectives, from the student to the specialist.

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