What is pain?

"Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage (I.A.S.P.)."

Pain is an individual experience and so pain intensity cannot be measured objectively. Communication about your pain is important for effective pain management.

Understanding pain better:

1. Distinction between acute and chronic pain

It is important to distinguish between acute and chronic pain. This is because the approach is very different.

• ACUTE PAIN: Pain has a function as an alarm signal so that appropriate action can be taken to prevent further tissue damage. This pain reduces and stops once the tissue has healed. Examples include: pain due to tendonitis, bone fracture, peptic ulcer, cystitis.

Pain is managed with medication or other medical interventions aimed at preventing and repairing tissue damage.

• CHRONIC PAIN: This is pain that persists beyond the usual tissue recovery period (more than 3 months on average) and, in addition, has an impact on several areas of life. When pain becomes chronic, it loses its usefulness as an alarm signal and should be considered a problem in itself (pain syndrome). Examples include: nerve pain due to MS, low back pain due to osteoarthritis, prolonged tension headache.

This is why chronic pain is best treated with a multidisciplinary approach. The treatment team works with you on options to evolve the pain to a liveable and manageable level. For this, medication is combined with dosed and supervised exercise, relaxation techniques, psychological counselling, building up relaxing and social activities.

1. Types of pain

NOCICEPTIVE PAIN:

• Originates from tissue damage (inflammation) which releases substances that excite pain receptors. The pain stimulus is transmitted via nerve fibres to the brain leading to an experience of pain.
• A typical feature of this type of pain is that the patient also has periods when he has little or no pain.
• Examples include pain due to lumbago, tendonitis, peptic ulcer, tooth abscess, heart attack,... .
• Pain medication such as paracetamol or anti-inflammatories have their place here, in addition to medication or interventions to address the source of the pain.

NEUROGENE PAIN (nerve pain):

• Is caused by damage or malfunction of nerve tissue (peripheral nerve fibre, spinal cord and/or brain). 
• Typically, neurogenic pain is present regardless of load and may be accompanied by spontaneous pain attacks.
• Pain medication therefore targets the specific mechanisms of neurogenic pain (antiepileptic drugs and antidepressants).
• Examples: band-like pain thv the trunk in MS ('MS hug'), trigeminal neuralgia (facial pain), nerve compression by disc herniation, peripheral nerve inflammation in diabetes, ...

ONCOLOGICAL PAIN (pain in cancer):

• This pain occurs when the tumour grows into the tissues and or nerves. Tissue damage or pressure releases substances that excite the pain nerves. This stimulus is transmitted to the brain via the spinal cord, causing an experience of pain. Pain in cancer often consists of a combination of the previously mentioned types of pain.

Communication about pain

We invite you to discuss pain during your consultation, admission or treatment at NMSC. Of course, it is best to discuss this with your doctor, but nurses/healthcare workers and rehabilitation therapists are also trained to take the necessary steps in case of pain.

For example, during the first week of admission, the nurse will systematically ask you at least twice a day if you are in pain. If your answer is yes, the nurse will ask further questions about the location, character and intensity of the pain (scale from 0 to 10: 0=no pain and 10=worst pain).  She/he will also record this in your file and discuss it with the doctor and, if necessary, also with the therapeutic team.

The questions below may come up when the doctor/nurse or other healthcare provider explores your pain:

1. Where do you have pain?
2. How bad is this pain on a scale of 0 to 10 
3. How long have you had this pain?
4. Is there anything that provokes the pain (activity, sitting, lying down, coughing, ...) ?
5. Is there anything that reduces the pain?
6. Are you comfortable or not?
7. Would you like us to do something for your pain?

FOLDERSFOLDERS ‘Hoe omgaan met pijn?’ ‘Comment parler de la douleur?’  

Depending on the evolution, the doctor, nurse and/or therapist will continue to question your pain. After all, this information and communication is needed to help you manage your pain. To do this properly, we want to understand your pain.

When it is difficult for you/your relative to communicate about pain, pain is systematically evaluated in a non-verbal way and family members are involved in following up on pain management.

In chronic pain, it is often better not to ask about pain on a daily basis because your attention will remain too focused on the pain. In consultation with you, it is decided how further communication about your pain will take place during admission or treatment.

Working together on pain

Pain management is given an important place in promoting your quality of life. In any case, you are our most important partner in the treatment of pain.

In acute pain, the approach will mainly consist of determining the cause, starting medication or another treatment technique. Here, doctors and nurses usually play the most important role. Nevertheless, complementary techniques from e.g. physical therapy (such as physiotherapy) can contribute.

In chronic pain, the cause of the pain is known but not solvable or long-term in nature. You yourself will play a key role in the approach. The team will help you in various ways to evolve the pain to a livable level. Medication or medical interventions certainly have their place but are not the only strategy in this case. Our main focus is on tapping into resources that can help you live as active and comfortable a life as possible despite the presence of pain.

The fact that NMSC is known for its interdisciplinary approach is also an asset when it comes to tackling pain. Together, we get your pain small!

For more information, contact Ms Corinne Cuvelier or Dr An van Nunen at medischsecretariaat@mscenter.be or by phone at 02/59 78 647