In this article
Before going on to understand how to identify and manage pain it is important to understand what pain is and what may cause it in individuals. Understanding different types of pain will enable you to better know how to manage and aid an individual under your care who is experiencing pain.
One of the key functions of the nervous system is to detect sensations from both the external and internal environment and to transmit these to the brain.
The nervous system consists of the:
- Spinal cord.
This is the system that interprets and causes pain. Pain occurs when nerves that exist all over the body send messages to the spine and on to the brain. The brain interprets the signals and causes the sensation of pain; the individual then perceives and experiences pain.
Nerves can detect both internal and external pain usually caused by tissue damage or death. External stimuli such as a hot stove or internal stimuli such as a heart attack or abdominal distress can cause pain in the same way.
Short-lived or new pain, also known as acute pain, is a helpful indicator of injury or illness and serves a purpose in avoiding danger or harm.
Persistent pain, also known as chronic pain, continues past its initial helpful stages. This pain instead becomes a burden on the individual’s life.
What is pain to the individual?
Pain might be described as an unpleasant sensation that can range from mild, localised discomfort to agony.
Pain could be described in many ways including:
McCaffrey in 1968 stated pain is, “Whatever the experiencing person says it is, existing whenever the experiencing person says it does”. This ideal has been widely used by many healthcare frameworks and guidelines. Therefore, in a care setting pain is whatever the individual says they are experiencing and it exists whenever they say they are experiencing it.
Even if the pain has an unclear source, the pain is still valid and still should be treated as such.
There are several different types of pain an individual may experience, and everyone may describe them slightly differently.
During this article, we will focus on types of:
- Acute pain.
- Chronic pain.
- Malignant pain.
- Neuropathic pain.
- Palliative pain.
What are the causes of pain?
Pain may occur for many different reasons:
- Injury from accidents or activities.
- Acute illness.
- Chronic ongoing illness.
- Chronic pain.
Pain can be a short-term issue that can be managed well with medications for a short period. Once the underlying issue is treated the pain will often subside. For example, injuries will usually eventually heal and the pain will subside as a result.
Pain, however, can be a more long-term issue; chronic pain can not only be caused by ongoing illnesses but may also be categorised as an ongoing illness in itself.
What is acute pain?
The British Pain Society describes acute pain as alarms telling us something is wrong. Acute pain is short-term pain that often comes on suddenly and indicates a specific cause. Acute pain will often resolve when the underlying issue is resolved.
Acute pain can often be managed well at the time of the illness and injury and should subside as soon as or soon after the initial injury or illness is treated.
Worsening pain post-treatment or intervention could be a sign of a developing issue such as dislocation of a new joint or infection of a healing wound.
Types of acute pain – injury
An injury may cause acute pain. Sporting activities may cause pulled muscles or torn ligaments. Injuries from accidents may cause pain from things like broken bones, burns or bruising.
Acute pain may be the result of something very visible such as:
- A broken bone.
- A wound.
- A burn.
New pain as a result of these kinds of injuries is expected when they occur. Pain can at times be a useful indicator, in less visible pain sources, of how severe an injury may be or if it has improved after treatment.
Developing pain from past injuries can be a sign of worsening issues such as infection.
For example, if an individual breaks a bone the initial level of pain will indicate that the injury is more severe than a pulled muscle or bruise. Once treated and rested for the recommended time the pain will subside.
Types of acute pain – post surgical
Surgical or dental interventions often result in pain for the individual. Often pain is part of the recovery process and is managed for the short time it is present.
Ongoing pain or developing pain from a surgical site can be a sign of a complication or infection. And pain levels should therefore be monitored to see if they persist for longer than expected or become less manageable than expected.
Often an individual will have a detailed post-surgical plan to improve their healing outcome and manage pain.
This may include:
- Prescribed medications.
- Specialist physiotherapy.
- Equipment to help with daily living.
- Wound care instructions.
As the individual recovers from the surgery and heals, it is expected that their pain will subside.
Types of acute pain – acute illness
Spontaneous acute pain is often a sign of a new illness; this can range from minor to very serious. Pain is a good alarm for these issues, as the type and position of the pain can be a useful indicator as to what the illness may be. For example, worsening pain that comes in waves and affects the right lower abdomen may indicate appendicitis.
Once the underlying illness is treated the pain will often subside.
The site and type of acute pain can often be used to try to diagnose developing or new illnesses.
When assessing the need for further escalation of acute pain it is important to understand:
- What type of pain the individual says they have.
- How long have they had it for.
- When it started.
- Where on the body it is occurring.
Types of acute pain – underlying conditions
Acute pain can be an indication of worsening ongoing conditions. For example, an individual with angina may get acute chest pain when doing something strenuous. When they take their prescribed treatments and rest, the pain should subside. Worsening pain or pain not managed by the prescribed medication may indicate a worsening of the condition that should be escalated and assessed by a physician.
Acute pain may be caused by a flare-up of an existing issue. Individuals with eczema, for example, may suffer a flare-up on a part of their skin causing inflammation and pain at the site.
Once treated the pain and inflammation should stop but the pre-existing condition has the potential to flare up again. This is not an indication of a worsening condition but one that can on occasion cause more prevalent symptoms.
Individuals with an underlying health concern may experience acute pain as a result of their condition. Diabetics, for example, may develop a painful ulcer from a small wound or trauma if untreated.
What is chronic pain?
Chronic pain is defined by the National Institute of Health and Care Excellence (NICE) as:
- Pain that persists for more than 3 months.
- An unpleasant sensory and emotional experience associated with actual or potential tissue damage.
- Pain which has a long-term effect on an individual’s social and psychological wellbeing.
Chronic pain affects between 3 to 5 in every 10 people.
The most common types of chronic pain are:
- Back pain.
- Joint pain.
NICE categorised chronic pain into two main types in 2021; these are:
- Primary – Where the cause of the chronic pain is unclear.
- Secondary – When the chronic pain is caused by an underlying issue.
Types of chronic pain – chronic secondary pain
Chronic secondary pain is long-term pain that has an identifiable cause.
The cause may be:
- The effects of a long-term illness such as arthritis or cancer.
- A previous injury such as whiplash which causes ongoing neck or back pain.
- A previous surgery – Surgery can cause Chronic Post-surgical Pain.
- A degenerative illness such as spondylosis of the spine.
Types of chronic pain – chronic primary pain
Chronic primary pain is categorised by NICE as pain in one or more areas of the body which is independent of an identifiable cause either psychological or biological. It can cause a significant emotional or functional disturbance.
Examples of chronic primary pain include:
- Chronic primary headache.
- Complex regional pain syndrome.
Primary and secondary pain can co-exist and one individual may feel pain that can be explained but can also experience pain with an unclear cause.
Whether the cause of the chronic pain is known or unclear, the pain is still valid. As McCaffrey said, the pain is as the experiencer says it is. So chronic pain with no clear cause is still real and therefore valid.
What is the impact of chronic pain?
Chronic pain, either primary or secondary, will have a broad impact on the individual’s life. People will often find that chronic pain has an impact on them psychologically and socially. It will also often mean an individual may not be able to maintain employment.
Management of chronic pain will often include strategies to improve all areas of the individual’s life such as their psychological and physical wellbeing. Holistic management can often improve the quality of life for the individual and reduce the impact of the pain.
The individual should be involved in their care and should be encouraged to be involved in making a care and support plan.
What is malignant pain?
Malignant pain is pain caused by the individual having some kind of malignancy (cancer).
Pain in those with cancer can be caused by:
- Pressure from the tumour pressing on bones, nerves or organs of the body.
- Chemicals from the tumour or the treatments causing nerve changes.
- Some chemotherapy drugs which can cause burning or shooting sensations.
- Radiotherapy which can cause skin irritation and redness.
Cancer patients may also experience pain from the region the cancer is in if there is a wound present or sometimes on movement.
What are the types of malignant pain?
Types of pain those who have cancer may experience are:
- Nerve pain, known as neuropathic pain. Often feels like a burning, shooting or tingling pain.
- Bone pain, also known as somatic pain. Often will feel dull, throbbing or achy.
- Soft tissue pain, is often more general pain caused potentially by damage nearby. This can be sharp, cramping, achy or throbbing in nature.
- Phantom pain, can occur if an individual has had a part of their body removed. The individual will complain of feeling pain in the part of the body which is no longer there.
- Referred pain occurs when another organ causes pain in a different part of the body.
The pain will vary depending on the type of cancer an individual has and at what stage it is.
What is neuropathic pain?
Neuropathic pain may result from an injury or illness that damages the nerves of an individual. Damage to nerves in the body or the central nervous system, brain or spinal cord, continue to cause pain after the initial injury occurs.
Neuropathic pain can occur more commonly in those with long-term conditions such as:
- 20-40% of people with diabetes.
- 30% of individuals with cancer.
- Those with multiple sclerosis.
- Those who have had vascular events such as strokes.
The pain is often described as stabbing or burning; it can often also feel like pins and needles. The pain can be made worse when touched even with light objects like clothes or bedsheets. The pain will often disturb sleep and limit day-to-day activities.
What are the effects of neuropathic pain?
Managing neuropathic pain is difficult as the pain can be so prevalent in an individual’s life.
The effect of the pain on the individual’s life is often managed with several different interventions such as:
- Antidepressant medication.
- Transcutaneous electrical nerve stimulation (TENS).
- Relaxation techniques.
- Psychological support.
What is palliative pain?
Symptom management is a very important part of end-of-life care. Pain management in particular is often very important to the individual requiring palliative care and their family members.
Palliative pain may be:
- Disease-related – This could include malignant pain but is not limited to cancer patients. Many other illnesses can cause pain in their last stages.
- Treatment-related – Opioid treatment, for example, can cause discomfort through constipation.
- Debility – Those who are reaching the final stages of life often are weaker and more prone to pressure damage and issues such as oral thrush.
- Unrelated illnesses – The individual may have a history of arthritis or spondylosis which will continue to cause pain in the final stages of life.
Palliative pain whether new or worsening should be discussed openly and escalated to ensure a high quality of life for the individual in their end stages.