John F. Denove
Pain: 101
Where does it hurt? Making chronic pain understandable
A dictionary defines pain as the sensations one feels when
hurt, mentally or physically. Suffering is the bearing or undergo- ing of pain, distress or injury. Some jurors see pain and suffering as a person’s attempt to get money for nothing or a shot at win- ning the lottery. The burden falls on the plaintiff’s attorney to convince the jury that although pain is subjective, it is very real for the person who is in pain. Pain takes away one’s ability to enjoy life. It is not surprising that the word pain comes from the Latin word poena, which means punishment. Humans are hard-wired to feel pain. Acute pain serves a vital
purpose. It protects us from serious injury. When we touch some- thing hot, we immediately withdraw our hand. The memory of this acute pain reminds us to avoid objects or situations that in the past caused us pain. Acute pain from injuries or illness forces us to rest, which is often essential for the body’s natural recupera- tive and disease-fighting mechanisms to ensure recovery. Although the basic concept of acute pain is easily under-
stood by jurors, the reasons one continues to have chronic pain after the injury has healed are more difficult to understand. Acute pain plays a role in protecting the individual. Chronic pain, however, serves no useful purpose. Chronic pain is not a warning signal. There is no survival value in severe, unrelenting pain that persists after an injury has healed. Chronic pain pro- motes an extended and destructive stress response that produces neuroendocrine dysregulation, fatigue, dysphoria, myalgia and
74— The Advocate Magazine JULY 2011
impaired mental and physical performance. Each and every problem caused by chronic pain further increases the severity and frequency of the pain.
The physiologic response Before one can understand the causes of chronic pain, it is
necessary to understand the physiologic response to an acute injury. A scratch demonstrates what occurs in the body after simple
trauma. The scratch produces a white line that persists for about 15 seconds. The white line occurs because small blood vessels in the skin are sensitive to stretch and react by going into spasm which prevents blood flow. Within a short time, the white line dis- appears as the spasm releases, but the skin color does not return to normal. It becomes red. This occurs because the blood vessels dilate in the scratch region to a much wider diameter than nor- mal. This remains for several minutes and is produced by chemi- cals, which leak from the damaged cells. Until repair processes have restored the cells to normal, the vasodilation will remain. If the scratch is more severe, two further reactions occur. The skin over the red line begins to swell and becomes pale. Now the ves- sels are so dilated that the fluid leaks from the blood serum through the capillary wall into spaces between the tissue cells. White blood cells invade and destroy broken cell debris. Special cells that form connective tissue begin to appear and there is
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