Overview
This lecture provides an overview of pain as both a sensory and emotional experience, covering its physiological basis, perception, types, assessment tools, and non-pharmacological management strategies.
Nature and Definition of Pain
- Pain is an unpleasant sensory and emotional experience related to actual or potential tissue damage.
- Pain involves both physical signals and emotional responses from the mind.
- Pain sensation refers to neural input from nociceptors, while pain perception is the conscious interpretation of that input.
Types and Psychology of Pain
- Nociceptors are sensory neurons activated by harmful stimuli and initiate the pain process (nociception).
- Hyperalgesia is increased sensitivity to pain after an injury due to sensitized nociceptors.
- Pain signals travel through the spinal cord to brain structures like the thalamus, hypothalamus, limbic system, and cortex.
- The hypothalamus mediates physical responses (e.g., sweating, elevated heart rate); the limbic system manages emotional responses (e.g., fear, anxiety).
Influences on Pain Perception
- Stress, focus, emotions, culture, gender, and personality all impact pain perception.
- Pain threshold is the minimum stimulus to feel pain; pain tolerance is the maximum pain one can handle—both are subjective.
- Pain history and coping strategies can affect an individual’s pain experience.
Pain Assessment Tools
- The Brief Pain Inventory (BPI) measures pain severity and its interference in daily life.
- The Sport Inventory for Pain (SIP and SIP-15) assesses pain and coping specifically in athletes.
Pain Duration and Types
- Acute pain is recent, sudden, high intensity, and localized.
- Chronic pain persists beyond normal healing (3-6 months) and can be harder to treat.
- Persistent pain meets chronic time criteria but indicates a treatable condition, common in athletes who do not rest.
Complex Regional Pain Syndrome (CRPS)
- CRPS Type 1 (Reflex Sympathetic Dystrophy) follows minor nerve injury; Type 2 (Causalgia) follows major nerve injury.
- CRPS affects the sympathetic nervous system and can worsen with ice application.
Psychological and Referral Considerations
- Chronic pain increases risk for psychological issues including suicide; mental health referrals may be necessary.
- Understanding pain during rehabilitation helps athletes set expectations and manage discomfort.
Non-Pharmacological Pain Management
- Distraction (visual, auditory), massage, and TENS are used for pain relief.
- Placebo effect occurs when pain reduction is achieved through belief in treatment's efficacy.
- Psychosocial strategies include education, stress management, muscle relaxation, and imagery.
Pain Management Planning
- Pain management plans can use dissociative (distraction) and associative (interpretation-based) strategies for athletes.
Key Terms & Definitions
- Nociceptor — sensory neuron that detects painful stimuli.
- Nociception — process of sensing and transmitting pain signals.
- Hyperalgesia — increased sensitivity to pain.
- Pain threshold — lowest intensity of a stimulus that is perceived as pain.
- Pain tolerance — maximum amount of pain a person can endure.
- Acute pain — pain of short duration and sudden onset.
- Chronic pain — pain lasting longer than the normal healing period.
- Persistent pain — prolonged pain that remains treatable.
- Complex Regional Pain Syndrome (CRPS) — chronic pain condition involving the sympathetic nervous system.
- Placebo effect — pain relief due to belief in treatment, not physiological action.
Action Items / Next Steps
- Review and distinguish between pain sensation and perception.
- Learn and apply pain assessment tools (BPI, SIP/SIP-15).
- Be alert for signs of CRPS and know when to refer athletes to mental health professionals.
- Practice non-pharmacological pain management techniques and develop individualized pain management plans for athletes.