Page 75 - BBC Focus - August 2017
P. 75
IN A NUTSHELL
NATURE’S
1 ALARM Enhanced colour
X-ray of opium
Pain is essential for survival,
poppy pods
alerting us that something is
wrong and that we’ve
possibly damaged ourselves.
with underpinning problems that we my 10. Questionnaires can be used
It prompts us into action and
can work on and try to fix. instead of number scales, and
is a great teacher – we learn
A key problem in chronic pain is sometimes just smiley or sad faces,
to avoid things that hurt.
VJCV #ŤCPF % HKDTGU ECP UYKVEJ QP such as with children. Pain levels of
permanently when damaged, sending babies, comatose or anaesthetised
ALL IN constant pain signals to the sufferer’s individuals, or dementia patients may
2THE BRAIN brain. Second, it’s been shown that be more difficult to judge, and it’s
the pathway from nociceptor to brain tough to know what they’re really
Pain emerges from brain can get ‘sensitised’ so that the signals feeling. Looking at body measures,
activity, but there isn’t a are amplified. This makes the like heart or breathing rate, can help.
simple one-to-one mapping situation worse, causing even the Some studies suggest that women are
between the amount of tissue touch of clothing or bedsheets to more sensitive to pain than men, but
damage and the pain we become painful. Imagine that, but perhaps women cope better – we all
experience. It’s a highly worse, going on for years alongside know about man flu! Brain imaging is
subjective phenomenon, and additional constant pain. helping us to understand pain better,
our emotions, attention, but it should not be used as a
expectations, and context can How can we know how much surrogate for what the person reports.
all influence the incoming pain someone is in? The International Association for the
signals to strengthen or It’s important to signal when we’re in Study of Pain defines pain as “an
weaken the pain. pain because this drives empathy and unpleasant sensory and emotional
compassion in others, as well as experience associated with actual or
PROBLEM PAIN eliciting help. Generally, we use potential tissue damage, or described
behavioural observations and in terms of such damage”. In short, if
3One in five adults
language to work out if someone is the person says they are in pain, then
experiences pain that persists
suffering. People grimace, writhe or they are, no matter what caused it.
beyond three to four months
cry out in agony. But it’s hard
from the original injury – the
BELOW: to measure pain, as it’s such a How do we treat pain?
definition of chronic pain. Our
A patient subjective experience. Painkillers provide relief from pain.
understanding of the biology with If language is available, then rating The two oldest are aspirin, which is
behind this is vastly multiple
sclerosis has scales can help to capture features of derived from willow bark, and
improving, so there could be their skin the pain such as intensity and morphine, which comes from opium
new therapies on the horizon. sensitivity unpleasantness (0 = no pain, 10 = poppies. These days, aspirin is largely
checked by a
neurologist excruciating). But I doubt your 10 is replaced by ibuprofen if there is
inflammation, or paracetamol if there
is no inflammation. Morphine is an
opioid and variants of it are still
widely used, but can have associated
problems like tolerance and
addiction. Other painkillers include
different types of anti-inflammatory
style drugs, antidepressants, and
anticonvulsants. There are many
additional treatments for pain,
including cognitive behavioural
therapy, physiotherapy and surgery,
and the most effective therapies
combine all of these treatments. With
new drugs coming through the
PHOTOS: SCIENCE PHOTO LIBRARY X2, GETTY Prof Irene Tracey is head of the Nuy ffield
pipeline, and our understanding of
pain constantly improving, we can
hope for a future where no one will
have to suffer unnecessary pain.
Department of Clinical Neurosciences at the
University of Oxford.
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