Classifying Pain

According to the International Association for the Study of Pain (IASP), pain can be described as the “unpleasant sensory and emotional experience associated with actual and potential tissue damage, or as described in terms of such damage or both”.  Pain is subjective and there are many ways to classify pain.  Other definition separate the actual sensation and the tissue damage because there can be the sensation of pain without demonstrable tissue damage.  Pain is both physical and emotional in most cases.
 
Pain is classified according to its location, duration, intensity, frequency and underlying cause.  Knowing these classifications helps healthcare professionals better diagnose pain and manage it to the benefit of the patient.
 
There are some problems with identifying and treating pain adequately.  For example:
  1. There is pain where the cause is known but the treatment is inadequate, such as with peripheral nerve disorders, cord disorders and deep tissue disorders.
  2. There is pain where the cause is not known but the treatment is effective, such as with tension headaches and trigeminal neuralgia.
  3. There is pain where the cause is unknown and the treatment is poor or inadequate, such as is seen in migraine headaches, back pain, and nonspecific pelvic or abdominal pain.
Because of these issues, simple and more complex way have been identified to classify pain according to various parameters.
 
Ways to Classify Pain
 
Pain can be classified by location.  There can be headache pain, abdominal pain, pelvic pain, extremity pain, facial pain and other more specific areas of pain that have different kinds of etiologies and different types of treatment plans.  Locations of pain can also be described using terms such as musculoskeletal pain, vascular pain, and nerve pain.
 
Pain can be classified according to duration.  This includes acute pain, subacute pain, and chronic pain.  Acute pain is defined as pain lasting less than 30 days, while chronic pain is said to last more than 6 months.  We need acute pain to help us know that something is wrong so that doctors can search for a cause and resolve the problem.  Without acute pain, we would suffer or die from burns, cuts and other injuries that need our attention.  Acute pain is protective, while chronic pain is not protective.  Chronic pain interferes with our day to day productivity and keeps us living a daily nightmare that does not go away.  Patients who learn to cope with chronic pain can become productive, while those who cannot cope with chronic pain remain disabled by it.
 
Acute pain resolves itself whenever the underlying process is discovered and treated.  Failing to adequately treat acute pain can interfere with the healing process as well as interfere with sleep, emotions, oxygen levels, and immune function.  Doctors often fail to adequately treat acute pain, especially post-operative pain, leading to unnecessary complications.
 
Chronic pain is confusing and often leads to pain-dominated depression and debilitation.  Chronic pain needs to be treated differently from acute pain and results sometimes in worsening of the condition.  Chronic pain needs to be treated using rehabilitative models, especially if it is non-cancer pain.  Chronic pain needs assessment and treatment by a multidisciplinary team that can address the complexities of chronic pain.
 
If there are legalities and settlements as part of chronic pain, there is less of an impetus to adequately manage the pain, furthering its complexities.  Few chronic pain patients get better before they receive an adequate settlement for their pain and suffering.  There is secondary gain in having the pain while the legal process is going on. 
 
In sub-acute pain, there is a good chance of a full recovery if the pain is lasting less than 100 days.  If the pain persists beyond 100 days, some of the patients will spontaneously get better with some residual difficulties.  Others go on to have chronic pain from which few resolve spontaneously.
 
Classifications of Pain by Etiology
 
Pain can be classified as to causative factors.   This includes dividing pain into cancer pain and non-cancer pain.  Chronic cancer pain causes a great deal of anxiety and brings many patients to seek help in a pain clinic.  Non-cancer pain is usually musculoskeletal or myofascial in origin and it often takes things like trigger point injections and rehabilitation therapy to help this type of pain.
Cancer pain usually means that the person should be treated with as much pain medication as it takes to satisfy the patient’s pain without regard to the potential for addiction.  Cancer pain is further subdivided into visceral, somatic and neuropathic pain.  Opioid medication is given liberally to somatic and visceral pain, while neuropathic pain is often treated with anticonvulsants and antidepressants.  Opioid medications are also recommended and are useful in cancer pain.  Patients who are actively dying should be given as much pain medication as takes care of the pain, regardless of the potential for abuse and toxicity.
 
Classifying Pain by Intensity
 
Pain is sometimes classified by intensity.  This is difficult because pain varies in intensity over time and is perhaps the most subjective way to classify pain.  It is better to identify what effect the pain has on activities of daily living, such as the ability to take in pleasure, to do things, to sleep, and to eat.  The intensity of pain does not always reflect the person’s suffering, which is more a factor of the anxiety and depression associated with the pain.

Furthermore, someone who classifies pain as a level 10 at one state of their life, may run out of levels when even more severe pain reframes their prior conceptions of pain.
Pain is as much of a mental thing as it is a physical thing and there are often co-existing psychiatric disorders with the ongoing pain.  There is, in fact, a mental disorder referred to as “pain disorder” in which patients have pain in one or more areas that causes significant distress in their lives or impairment in social functioning. 

Psychological factors play into the experience of pain, but it is not due to factitious disorders or malingering.  Both acute and chronic pain can be associated with psychological disorders.
 
Psychosomatic pain is every bit as real as somatic pain.  People will endure varying amounts of psychosomatic pain and factors such as depression, motivation and anxiety will determine the degree to which the person tolerates this type of pain.
Pain classifications help healthcare providers use the best practices for dealing with the various kinds of pain.  By classifying the pain, doctors and pain clinic staff can best identify the proper treatment protocols to use in managing the different types of pain.

As an experienced Injury Lawyer in Sacramento, I have helped thousands of people who have suffered from severe and chronic pain. If you have severe pain as a result of an accident, call me, Ed Smith, anytime at 916-921-6400 or 800-404-5400 elsewhere.
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