Pain Defined

Pain may be defined as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage" (Merskey, 1986). Pain is always subjective. "Pain is whatever the experiencing person says it is, existing whenever he (or she) says it does" (McCaffery, 1979).

Patients may experience acute, chronic, or cancer pain..

1. Acute pain follows injury to the body and generally disappears as healing takes place. There is identifiable pathology that accounts for the pain. It may arise from operative procedures or from tissue trauma associated with an inflammatory process, for examples. It may be associated with objective physical signs such as increased heart rate, hypertension, and pallor (autonomic nervous system activity), making patients "look" like they are in pain.

2. Chronic non-malignant pain is pain that lasts for an extended period of time. There may or may not be known active pathology to account for the suffering that the individual is experiencing. Chronic pain, in contrast to acute pain, is rarely accompanied by signs of autonomic nervous system activity.

3. Cancer pain may be acute, chronic, or intermittent. It usually has a definable cause, which is usually related to tumor recurrence or treatment.

The prevalence of pain is high. It is estimated that over 75 million Americans suffer with pain. Approximately 50 million Americans have chronic pain and 25 million have acute pain. These numbers make it easy to understand that pain is one of the most common reasons that people seek medical attention.

Pain causes suffering. Unrelieved, it can destroy the quality of life. Persistent pain can impair sleep and appetite, leading to fatigue and nutritional decline. It can delay healing, cause increased stress and anxiety, alter immune function, lead to depression and destroy the will to live. Additionally, current unrelieved acute pain can cause chronic pain at a later date.

The good news is that we have the knowledge and skills to effectively manage most pain. So what is the problem? Why is unrelieved pain still so prevalent?

Knowledge is important. Clinicians as well as patients need to be made knowledgeable about methods of relieving pain. But knowledge alone rarely changes practice. Efforts must go beyond education alone if pain treatment is to improve. Pain needs to be made visible so it will not go unnoticed by clinicians.