SeriesSuffering: the contributions of persistent pain
Section snippets
Basic definitions: pain and suffering
The standard definition for pain is that it is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”.1 Viewed from an evolutionary perspective, pain is perceived threat or damage to one's biological integrity and has sensory and emotional features. The sensory awareness of tissue trauma represents information crucial for adaptation and survival. The emotional experience of tissue trauma represents the biological
How pain causes suffering
Many physicians think of pain as a purely subjective, private experience; this view is correct but incomplete. Tissue trauma generates noxious signals, and figure 1 shows how excitation of nociceptors15 and sometimes neuropathic conditions16 can generate nociceptive afferent volleys. Peripheral and central mechanisms can exacerbate noxious signalling through sensitisation. Tissue trauma may cause nociception, neuropathy with abnormal neural firing patterns, or both. Inflammation and repetitive
Implications for care
Our concept of suffering resonates with the lay use of the term-the perception of damage to the self and grief over a loss in self-esteem. Although unrelieved pain can create an overwhelming degree of personal discomfort, its contribution to suffering is more insidious. At a physiological level, chronic pain is a stressor that promotes an extended and destructive stress response that involves neuroendocrine dysregulation, fatigue, dysphoria, myalgia, and impaired mental and physical
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