Pain

Pain

Pain is your body telling you that you have hurt it. This is a good thing, important when you are injured. It can also help diagnose problems with your body. Sometimes pain continues long after it's necessary. Amputees report phantom pain in the legs or arms they no longer have. There are different kinds of pain, and describing the type is useful in diagnosis: recurring, constant, steady, knife-like, radiating, sharp, dull. Medicines that dull pain are analgesics. Those that kill all feeling are anesthetics.

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    A , Fitness, answered

    Third-degree pain comes on in the middle of activity, say two miles into a brisk three-mile walk. At this stage, pain may interfere with activity. There's more "point tenderness" than with first- or second-degree pain, and after a workout, you may see some swelling at the site; this is a sign that some tissue -- muscle, tendon, or bone -- is not coping well with the load you've put on it. 

    Action: Third-degree pain is clearly an indication that it's time to cut back, take some time off, or find an alternative activity; rest and recovery are very important at this point. 

    Apply ice to the point of tenderness to reduce swelling that may increase the discomfort. Elevation and compression also help reduce swelling and stiffness. Think of the mnemonic RICE -- rest, ice, compression, elevation. Once the initial swelling and tenderness have eased, apply heat or gentle massage to speed healing. 

    Stubborn third-degree pain may point to a biomechanical or equipment problem that needs to be corrected before you go further. If you repeatedly feel third-degree pain in your knees during or after walking, for example, it may be time to consult a sports medicine specialist, physical therapist, or other movement specialist who can analyze your gait, shoes, and other factors.

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    A , Fitness, answered

    Fourth-degree pain comes on at the beginning of the workout and doesn't go away; it may also be pain that has lingered from exercise the day before, through the night, and into today's activities. It is sharp and increasingly localized, with holdover swelling and tenderness from the day before, and impedes motion and performance. At this stage, you've moved beyond the normal pain of exertion into the realm of overuse syndrome.

    Action: Rest is imperative. Stop doing whatever causes the pain, but don't quit being active. This is important. You want to stay active, but without causing additional irritation to the tissues that have been injured. If you have pain in your knee from running, for example, perhaps you can swim. If you have pain in a shoulder from tennis, perhaps cycling or brisk walking will be a good substitute. This is called "relative rest;" you're resting what needs to be rested while staying active. 

    While you rest, explore what may be causing the pain and ways of correcting the cause(s). At this point, you may want to get advice from a sports medicine specialist. Apply RICE (rest, ice, compression, and elevation) and analgesics, then heat and a gentle massage. Physical therapy may be appropriate.

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    The symptoms of pain are difficult to describe because each person experiences pain differently. However, people with neuropathic pain typically experience a burning or tingling sensation or sensitivity to cold or touch. Nociceptive pain, which is the most common type of pain, gives an achy, sharp, or throbbing sensation. Hospital emergency departments often use a pain chart to help patients quickly identify their level of pain, from no pain at all through worst pain possible.

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    Acute pain can be caused by a wide variety of conditions, some of which are inherently dangerous. If you bring up your pain with a doctor, they will want as much information as possible to see if they should try to diagnose some other ailment. The first thing they will want to know is the location of the pain. They will want a basic report of severity: how much does it hurt? They will ask about the depth of the pain: deep or surface? The quality: burning or aching? If the pain comes and goes, they will want to know when and how long, and whether or not there is some specific proximate cause.

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    A Geriatric Medicine, answered on behalf of
    A study published online in the Journal of the American Geriatrics Society evaluated pain severity and distribution in relation to sleep difficulties among 765 people age 64 and older. Pain severity was measured using the Brief Pain Inventory (BPI) Pain Severity Subscale, and grouped according to no pain, single site, two or more sites, and widespread pain (upper and lower extremities and back pain).

    Three aspects of sleep difficulty were measured using items from the Center for Epidemiologic Studies Depression Scale, Revised (trouble getting to sleep, sleep more than usual, and restless sleep). Prevalence of trouble getting to sleep according to BPI severity was 17.8%, 19.7%, 32%, and 37%, respectively, for the lowest to highest pain severity quartiles. Sleeping more than usual and restless sleep had similar relationships to BPI severity. Overall, chronic pain was strongly associated with trouble sleeping. If pain is keeping you awake at night, consult your doctor.
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    A , Nutrition & Dietetics, answered
    Physical pain hurts, but did you know that it’s also one of the biggest triggers for overeating and making poor eating choices? That’s right, when we're in pain (think of anything higher than a 5 on a scale of 1 to 10, with 1 being feeling great and 10 being agony), we reach out for foods that will “make us feel better” emotionally (sugar, comfort foods, extra servings). What’s worse is that this actually contributes to more physical pain.
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    Pain is painful. Because there is no test that can determine how much pain you have, it’s important to communicate openly with your doctor about the level of pain with different activities and the type of pain you feel such as dull, aching, pinching, or throbbing. For instance, does your pain worsen when you walk? Do you feel more or less pain with normal activities of daily living, such as dressing, cooking, and household chores? Does the pain affect your sleep? Does the pain hinder you at work or at social engagements? Let your doctor know when you have no pain or little pain and when your pain is the worst pain imaginable. Talking openly about your pain will enable your doctor to adjust any medications you are taking, as well as see if your prosthesis needs adjusting.
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    A , Internal Medicine, answered
    Is there a way to quantify pain?

    There might be a way to quantify physical pain. Watch this video with Robin Miller, MD,  as she discusses the results of a study measuring brain waives and how this information could be used to create better pain treatment.


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    A , Fitness, answered

    Second-degree pain, which tends to come on immediately after a workout, is longer lasting than first-degree pain, the normal aches we might feel during a workout. Second-degree pain is more localized, say in an arm or leg -- with more discreet tenderness -- rather than more diffuse, as in the case of first-degree pain. This type of pain is an indication that you are pushing up against some physical limit, that perhaps it's time to just "coast" without increasing the amount of work, simply maintaining until your body becomes accustomed to the new level of effort. Second-degree pain may also be the first hint of muscle strength imbalances or biomechanical problems, aggravated by increased workload, that presage an overuse injury. The key sign at this point is increasing localization of the pain.  

    Action: You might want to cut back on your training, or at least go into a "holding pattern" without increasing your activity level or changing your routine. Wait a few days to see what becomes of the tenderness. Make sure your shoes aren't excessively worn, and check other equipment for wear or other factors that may be affecting your biomechanics. You may have to begin exploring the possibility of biomechanical problems that need to be addressed. Rest, gentle massage, heat, and over-the-counter analgesics are all appropriate.

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    A , Emergency Medicine, answered
    The pain scale is a system for determining your level of pain and whether or not it is being well controlled. There are different types of pain scales but the most commonly used one has a numerical rating scale.

    Here’s how it works. The nurse will ask you: “On a scale of 1 to 10, with 10 being the worst pain and 1 being the least, how would you rate your pain right now?” There is no right or wrong answer so say whatever you feel. However, this is not the time to try to get more attention by exaggerating your pain level because it could land you in the operating room! Minimizing it might get you there, too, so be honest and straightforward. Understand, too, that pain may not be treated until a working diagnosis of your complaint is made by the emergency medicine doctor.

    If the nurse gives you pain medication for a pain level you rated as 7, she’s going to check you later on to see how well the pain medication worked by asking you to rate your pain again. If the level is the same or hasn’t changed much, this indicates to your nurse that additional pain medication may be needed. If you rate your pain as 1 and say you feel much better, she knows the pain medication worked. But that’s not the end of it.

    You’ll be asked regularly to report your pain level number. Again, this is done for your comfort and safety and to decide the best care so please cooperate. The nurse will be documenting the times and your responses. This helps to determine if your condition is changing and how much pain medication you may need and how often. It also helps to identify when a type of pain medication isn’t working and when another one should be ordered.

    Children, elderly or anyone who may be confused may be asked to express their pain level using visual aids. This type of scale provides a visual description of pain for those who are unable to verbally communicate their discomfort. By acknowledging or pointing to the image that best matches how they feel, the patient provides the nurse with a good sense of how much pain they’re experiencing.
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