Page 56 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

Defining Pain 29

they transmit pain signals (via the peripheral nerves as well as
the spinal cord) to the brain. This form of pain may be classi-
fied according to the mode of noxious stimulation (e.g. “ther-
mal”, “mechanical” or “chemical”). Examples include sprains,
bone fractures, burns, bumps, bruises, inflammation (from an
infection or arthritic disorder), obstructions, and myofascial
pain (which may indicate abnormal muscle stresses). The pain
is typically well localized, constant, and often with an aching
or throbbing quality. Visceral pain is the subtype of nocicep-
tive pain that involves the internal organs. It tends to be epi-
sodic and poorly localized.
In contrast, neuropathic pain is the pain associated with
the nervous system and is the result of an injury or malfunc-
tion in the peripheral or central nervous system (Treede
et al. 2008 ):
Pain caused by a lesion or disease of the somatosensory nervous
system (ISAP 2012 )
Peripheral neuropathic pain is often described as “burn-
ing”, “tingling”, “electrical”, “stabbing”, or “pins and nee-
dles” (Paice 2003 ). Among the many causes of peripheral
neuropathy, diabetes is the most common, but can also be
caused by chronic alcohol use, exposure to other toxins
(including many chemotherapies), vitamin deficiencies, and a
large variety of other conditions. Persistent allodynia, pain
resulting from a nonpainful stimulus such as a light touch, is
also a common characteristic of neuropathic pain. The pain
may persist for months or years beyond the apparent healing
of any damaged tissues. In this setting, pain signals no longer
represent an alarm about ongoing or impending injury,
instead the alarm system itself is malfunctioning.
Finally, Phantom pain is pain felt in a part of the body that
has been lost or from which the brain no longer receives sig-
nals. It is a type of neuropathic pain and is common in those
with amputations (Kooijman et al. 2000 ).
It has been suggested that the pain that patients experience
can be an issue for all irrespective of type of wound
(see Table 2.1 ); whether chronic or acute (White 2008 ;