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The Truth About Pain

It's been said that the sensation of pain is one memory our brains forget. But it is very real to us at the time, especially when we are children. As parents we develop concerns and questions about pain, particularly what it means when our children are in pain. We asked Richard Helffrich, MD, a pediatric anesthesiologist, to answer some frequently asked questions about pain.

  • What is pain?
    The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage." By definition, then, pain is a personal experience. Therefore, if patients say they are in pain - they are in pain.
  • Why do we have pain?
    Look at pain as the body's signal that it has been injured or that something else is wrong. The pain of a twisted ankle lets you know that there has been damage to a muscle or bone, for example. It's a warning that tells you not to walk on it. The pain of sunburn keeps you out of the sun and from further damaging yourself. If we didn't have the ability to sense pain at the right time, we could harm or injure our bodies.

Is Pain Good?

  • Is pain good?
    Yes and no. Some pain can serve as a useful warning, alerting us to pay attention to a problem. But pain can also interfere with the body's functioning. Severe, long-lasting pain can keep us from doing some of the things we want - or need - to do.
  • Does pain always mean that some part of the body is physically damaged?
    It certainly means we should consider that possibility. But we also need to remember that pain has many components besides tissue damage, including emotions such as fear and anxiety. Sometimes, in order to treat pain, we have to pay attention to these psychological factors as well.
  • Do infants and young children feel pain?
    Yes. The neural pathways associated with the transmission of painful stimuli are fully intact at birth. These pathways are also fully functional in a premature infant. Conscious memory formation, however, does not develop until approximately 2 years of age. 

Chronic and Acute Pain

  • I've heard there are two kinds of pain: acute and chronic. What is the difference between them?
    Acute pain is usually immediate and of a short duration (less than 2 weeks). This kind of pain - whether from an injury, short-term illness, or surgical/medical procedure - can be helped by both pharmacologic (medicinal) and nonpharmacologic methods, such as hypnosis. Acute pain is a normal response to injury, but if it is untreated it can cause significant emotional and physical disruption.

    Chronic pain is pain that persists, usually beyond 3 months. It may be relatively constant, as is the case with cancer-related pain, or it may come and go, as with recurrent abdominal pain. Although chronic pain can represent a serious illness, the underlying cause is not always evident. Chronic pain should not be considered a normal state. No one should have to live in pain.

How Is Pain Relieved or Controlled?

  • How is pain relieved or controlled?
    As a parent, you've no doubt treated your children's everyday aches and pains with combinations of emotional support, analgesics (pain relievers) such as acetaminophen and ibuprofen, and hot or cold packs. For a hospitalized child, a greater variety of medications are used in addition to these measures:
    • Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are used for the treatment of fever and pain. These medications are administered as needed or on a scheduled basis, such as every 4 or 6 hours, in an attempt to maintain constant comfort.
      Newer NSAIDs such as rofecoxib may soon be formally approved for children.
    • Opiates - drugs like codeine and morphine that contain or are derived from opium - are considered low-grade narcotics. They are frequently used for postoperative pain and can be safely given to children. There is virtually no risk of addiction with short-term use.
    • Treatments such as massage therapy, hypnosis, or acupuncture are sometimes used to manage pain. Always ask your child's doctor before trying any type of alternative medicine (also known as complementary or integrative medicine).

    Local anesthetics can be administered in a laceration or surgical incision. They can also be given in the epidural space in the spinal column where nerves exit. This is the same technique used to reduce pain for pregnant women during labor and delivery. Continuous infusions of local anesthetics and/or opiates can be used in children after major surgery.

    Patient-controlled analgesia (PCA) is another system of pain control. It allows a patient to treat his own pain by self-administering pain medication intravenously as needed (this occurs safely under the direction of doctors and nurses who control the total dose of the drug that can be delivered within a given time frame). Some situations where PCA might be used include the following:

    • post-operation recovery (PCA might be given for 1 or 2 days)
    • cancer pain
    • severe flare-ups of inflammatory or autoimmune diseases
    • severe sickle cell crises
    • burn pain

    With these medications and approaches, pain control for children is very achievable.

How Do Pain Medications Work?

  • How do pain medications work?
    Acetaminophen and NSAIDs decrease the production of substances that allow nerve endings to transmit "painful" impulses back to the spinal cord and onto the brain centers.

    Opiates affect receptors located in the spinal cord and brain. These receptors are also present at the site of injury. When opiates are present in the brain, euphoria and sedation can be produced. These drugs alter the mind's perception of painful stimuli. At the level of the spinal cord, opiates deaden painful impulses transmitted from the peripheral nerves.

    Local anesthetics block nerve impulses. Depending on the type and concentration of anesthetic, painful impulses can be stopped while a patient is still conscious and able to move.

  • What can happen if pain is not treated?
    Unrelieved or poorly controlled postoperative pain is associated with an increase in postoperative illness in children and adults. In contrast, critically ill patients requiring intensive-care unit admission may have their stays shortened with aggressive pain management. Children who require frequent hospitalizations experience marked anxiety and fear about painful medical procedures. Distraction, a soothing atmosphere, and the administration of analgesic and/or sedative medication helps to decrease these fears.