It is vital that radiologists understand pain. After all, it is the most common symptom that leads patients to seek medical care, and represents one of the most common indications for diagnostic and interventional radiological procedures . In addition, radiological procedures can be a source of pain to patients, particularly in the context of interventional procedures . By gaining a better understanding of the nature, assessment, and effective management of pain, radiologists and radiology personnel can do a better job of caring for patients.
Nature of Pain
Pain is an unpleasant subjective sensation, although its precise definition remains elusive. It can be caused by a variety of noxious stimuli, such as mechanical trauma, temperature extremes, and a variety of chemicals. These types of pain are usually associated with the activation of nociceptors (pain receptors) in the peripheral nervous system. Depending on the type of nociceptor involved, pain may be experienced as sharp and focal, as in the puncture of a fingertip, or dull and diffuse, as in the stretching or inflammation of the bowel .
Other types of pain are more difficult to understand. In some cases, pain may also be traced to a disorder of the nervous system itself, such as the neuropathic pain associated with long-standing diabetes . “Phantom limb” pain, pain felt in a limb or part of the body that is no longer present, is experienced by the majority of amputees, at least for a time . Psychology plays a key role in the pain experience. In many cases of chest pain, headaches, and back pain, no anatomic or pathologic cause of pain can be identified .
During the 17th century, French philosopher Rene Descartes proposed that pain represents the transmission of a disturbance from injured tissue to the brain . Today the broad outlines of the pathways along which sensations that register as pain are transmitted are relatively well worked out. From the stimulation of a sensory receptor that can generate a pain “signal,” the impulse travels to the spinal cord, crosses in the anterior commissure, ascends via the spinothalamic tract through a nucleus in the thalamus, and then travels into fibers that terminate predominately in the primary and secondary somatosensory cortex, as well as in portions of the brainstem, limbic system, and other areas of the cerebral cortex .
Yet this account does not fully explain the nature of certain types of pain, such as many cases of low back pain, chronic pain, and phantom limb pain. To further explain the complexity of pain, additional theories have built on the theory proposed by Descartes. These include gate control theory, the descending pain modulatory system, and the neuromatrix theory. These more recent theories incorporate higher brain processes in understanding the pain experience .
Although pain is by definition aversive, the inability to feel pain poses a serious problem for those afflicted with it. Congenital insensitivity to pain is associated with a dramatically increased risk of injury to organs, including the eyes, tongue, and extremities, as well as a general reduction in life expectancy . Other forms of insensitivity to pain are acquired, such as long-standing diabetes and spinal cord injury, and these too are associated with an increased risk of injury .
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Assessment of Pain
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Management
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