Pain is considered a national health problem. It has a profound impact on the quality of life and health-associated costs for all Canadians. Statistics demonstrate that the most common reason individuals seek medical care is due to pain. The cost to health care for treating chronic pain is more than HIV, cancer, and heart disease.
According to the Canadian Pain Coalition, veterinarians receive five times more training in pain than doctors and three times more training than nurses. The Coalition adds, Pain research is grossly under-funded in Canada.
Pain is a complex phenomenon. It involves many nerve cells, many types of nerve chemicals, and many different nerve cell receptors to which the nerve chemicals bind in order to continue a pain signal’s trip to the spinal cord and brain. (Besson, 1997)
“Muscle is an orphan organ. No medical specialty claims it. As a consequence, no medical specialty is concerned with promoting funded research into the muscular causes of pain, and medical students and physical therapists rarely receive adequate primary training in how to recognize and treat myofascial trigger points.” — David G.Simons, MD pioneer in myofascial pain and trigger points and aerospace physician
According to the International Association for the Study of Pain (IASP), pain is defined as: An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Note: The inability to communicate verbally does not negate the possibility that an individual is experiencing pain and is in need of appropriate pain-relieving treatment. Pain is always subjective. Each individual learns the application of the word through experiences related to injury in early life. Biologists recognize that those stimuli which cause pain are liable to damage tissue. Accordingly, pain is that experience we associate with actual or potential tissue damage. It is unquestionably a sensation in a part or parts of the body, but it is also always unpleasant and therefore also an emotional experience. Experiences which resemble pain but are not unpleasant, e.g., pricking, should not be called pain. Unpleasant abnormal experiences (dysesthesias) may also be pain but are not necessarily so because, subjectively, they may not have the usual sensory qualities of pain. Many people report pain in the absence of tissue damage or any likely pathophysiological cause; usually this happens for psychological reasons. There is usually no way to distinguish their experience from that due to tissue damage if we take the subjective report. If they regard their experience as pain, and if they report it in the same ways as pain caused by tissue damage, it should be accepted as pain. (Merskey, & Bogduk, 1994)
Fordyce WE, Cousins MJ, describe that chronic pain exceeds the combined costs more than coronary artery disease, cancer, and AIDS combined. It is aptly described as a ‘hidden epidemic’.(Fordyce, Cousins, (1996)
Costs Associate with Pain
Pain costs Canadians more than $37 billion each year in health care. Additional costs for pain-related loss of work, compensation, litigation, and liability to workers, employers, and society. Studies suggest that more than a third of Canadians will suffer from a chronic pain condition at some point in their life. Health care quality suffers when, for pain, hospitalized patients stay longer, have slower recovery times, and reduced treatment outcomes. (Strassels 2009)
“But what many people don’t understand is that pain itself can cause harmful side effects and can affect concentration and mental clarity just as profoundly as any drug,” Dr. Scott Strassels said. (Strassels 2009)
Patients with chronic or persistent pain often don’t feel believed. Since our medical community is unable to address patients’ claims of pain doctors imply that the patient should learn to live with it.
Lynch stated that patients who do not report pain and healthcare providers who fail to assess for pain are major barriers to the relief of pain. Using pain as the fifth vital sign and being knowledgeable about pain assessment and management can help nurses and other healthcare providers overcome many of the barriers to successful pain control. A successful pain control plan includes establishing the pain diagnosis, treating the cause of the pain when possible, optimizing analgesic use, implementing non-pharmacological interventions to maximize physical and psychological comfort and function, and referring the patient for invasive pain management options when indicated. (Lynch, 2001)
Citizens, who cannot afford the cost of pain treatment that would enable them to get back to work, are prevented from contributing to society. Compression massage has been able to resolve 95% of chronic and acute pain using localized palpation and increasing amounts of pressure until the tissue empty.
Doctors take their patients’ complaints of pain seriously. Pain is processed by the brain and so pain is always real. If people are in pain, they need to be treated accordingly, regardless of what the tests say.
Unfortunately patients are sometimes told to it part of aging or to learn to live with it and or to lose weight if they have a few pound extra, this is unfair. Prejudices also exist due to gender and outward appearances. Researchers are seriously lacking tools to measure treatment effectiveness though various protocols have been developed.
Inflammation
The underlying cause of pain is soft tissue inflammation (manifesting as heat, pain, redness, and swelling). This paper will use content validity to evaluate four devices individually for their usefulness in measuring certain aspects of inflammation. The hypothesis is that a number of tools (such as algometers, galvanometers, thermography, and stethoscopes) could be used to measure aspects of inflammations independently from the skin surface.
The human body responds to an injury with inflammation, which in turn manifests as redness, swelling, heat, pain, and loss of function. Pain broadcasts the injury or damage and swelling prevents movement and further injury. The swelling is the enhanced supply of fresh blood, complete with the antibodies and the cells, needed to mend the damage and encourage healing. During this phase, the body increases blood movement (containing plasma and leukocytes) to the injured tissues.
Prompt effective treatment of acute pain is critical. Pain that becomes persistent must be managed as a chronic illness. “Prolonged inflammation or chronic inflammation is characterized by simultaneous destruction and healing of the tissue from the inflammatory process.” (From Wikipedia, the free encyclopedia)
A review of current objective tools, specifically four medical devices currently used to measure aspects of inflammation for their content validity, revealed a lack of tools that adhere to evidence based practice protocols.
Numerous authors have cited Myofascial Trigger Points (MFTPs) as the cause of local and referred pain that arises from muscle and its surrounding fascia.
Many standalone devices have been found to have sufficient content validity to justify their use. These device and measurement tools can be combined into an objective MFTPs and pain measurement system that can take measurements from the skin and sounds located in the subcutaneous fascia. Objective measures combined and with subjective pain questionnaires would improve on existing standalone methods or devices.
Biosensors, in a combined functionality devise, corroborates hand palpation results into a singular measurement device to locate the damaged tissue and graphically display the differential comparisons between pain sites and healthy tissue. The result is a singular simultaneous measurement providing differential diagnosis. Four devices merged would be able to give concurrent validation for subjective complaints.
The surface tissues provide a protective coat to stop cell injury. Inflammation is a precise reaction resulting in a milieu of chemicals to stop us from bleeding to death. To stop infection white blood cells infiltrate the area and fibres form to seal the region and create adhesions. Muscles retract from the source of damage; tissues thicken as scar tissue maturates creating a fortress. Tissues swell as white blood cells, waste begins to settle in, and fluids accumulate in the capillary. The once healthy cells become weak and vulnerable to further damage creating a pain tension cycle. Mechanical forces to these damaged area tissues causes greater or lesser amounts of pain when pressure is applied due to the release of inflammatory protective chemicals.
The release of certain pain sensitizing chemicals, the anatomical location of pain sensory nerves and how pain sensations maturate can help us find the answers as to where to measure of the sensations that create subjective pain accounts. Pain is the mechanism that warns the body of and protects it from injury. Without pain or the anticipation of pain, the source of pain could conceivable continue to do damage.
The natural response is to rub or put pressure on an injured or painful. These innate healing mechanisms allowed the development of massage. Hypothesis is that massage techniques mobilize inflammatory waste away from nociceptive tissue.
These objective measures are currently used independently by clinicians for soft tissue assessment. If combined, into a singular biosensor it could simultaneously collect digitized data, storing data on a personal computer. Data can be displayed and then entered into software program for soft tissue pain treatment outcome. This multi-modal device provides clinicians with an objective pain assessment tool to aid in accurate pain and MFTP monitoring.
One of the oldest non-invasive pain management techniques is massage. Massage developed out of an innate healing mechanism.When the body experiences pain, the natural response is to rub the area or put pressure on it. First aid instructions commonly prescribed for patients with acute soft tissue injury include rest, ice, compression and elevation or RICE, which confirms that non-invasive pain management techniques can be used to decrease pain. The medical community needs safe non-invasive means to eliminate pain and suffering.