Pain Perception

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The problem of pain perception is one of the most complex and burning of contemporary issues. In ancient times doctors tried to understand the nature of pain, noted its diagnostic value and searched for ways to combat it. At that time it was thought that pain was a kind of the sixth sense, like touch, sight or hearing. However, unlike the sensory, pain is not a monomodal feeling. The word pain includes category of emotional experiences, reflecting many different unique events with different causes that are characterized by different properties of sensory and affective nature. The perception of pain was psychologically examined. It was clear that pain is a unique and completely individual experience. No one can experience another's physical pain. Except for some rare abnormal cases, everyone experiences pain, and although it's hard to describe, everyone knows what pain is.

It is now believed that pain is the physical discomfort or suffering, which people understand and realize. Both external and internal adverse incentives can be the cause of pain. Personal and emotional coloring of pain indicates the nature of the flow of relevant processes. The perception of pain is extremely subjective. Different people have a different threshold of pain sensitivity. People have a different range of endurance of pain. This reflects the personality characteristics of a person, the so-called endurance of the cortex and related correlates: self-possession, self-control in relation to the disconcerting effect of deep brain structures, which reflects the emotional stress-induced effects. The perception of pain applies to complicated experiences. It is not just a feeling, caused by a specific stimulus. Pain perception is modified depending on the intensity, duration, the emotional state and the causing effects of the past experience.

The element determining the intensity of pain is a psychological response of the individual. It causes a painful feeling of suffering and negative emotional assessment. The experience of “pure” pain, which is not mixed with the emotion, is extremely rare. That is why the perception of pain is often associated with such emotions as grief, fear, anger or aggression. Combinations of pain and compassion, pain and guilt are less common. In the clinic pain is perceived differently by patients. Sometimes it is described as sharp or cutting. These adjectives indicate not only its physical characteristics, but also a reflection of fear. Sometimes pain is described as deep or dull, and these expressions may reflect a combination with grief. Acute and sudden pain causes fear. It indicates that the relationship between acute and sudden pain and fear is stable with respect to the environment. At the beginning acute pain causes fear. It may enter into depression continuing for some time. Unrelenting pain is perceived as suffering. Chronic pain, which is not curable, leads to despair. Chronic pain causing suffering and the loss of well-being is perceived as a strong sense of hopelessness and depression.

Extremely rare, there are exceptional people, whose chronic pain is combined with compassion for others, with a desire to help them. Pain is not often seen as a sense of guilt, only under certain circumstances. During WW II in one of the fights two thirds of soldiers refused from analgesic, because their pain reduced a sense of guilt to their comrades for the fact that they had to leave the field. There is also other combination in clinical practice when guilt, resulting from long-term psychological trauma, creates a sense of pain.

There are some methods that help reduce pain. Distraction is one of them. Distraction is an excellent painkiller. Parents of children are not in vain trying to shift attention to something else when they fall or hurt. Studies show that such diversionary tactics helps reduce pain sensations in the physical layer. During the study, conducted by researchers from Germany, the volunteers were asked to perform simple tasks on memorization, applying to them the painful effects of heat. As it turned out, the participants experienced less pain when their jobs became more complex. Using CAT, the researchers retraced the changes in the brains of volunteers and found out that in those people, who were more immersed in the solution of intellectual tasks, the activity in areas of the spinal cord was lower than in those volunteers, who experienced more pain.

Results of the study suggest that the decrease of pain as a result of distraction cannot be explained only by the mental processes. The physiological mechanism is involved in this phenomenon. It reduces the number of signals passing through the spinal cord to the brain. Analgesic effect of distraction can be explained by the release of opioids in the body that play an important role in the processes associated with pain. To confirm this, the researchers conducted an experiment again, giving some volunteers medication that blocks the production of opioids. In this case, the diversion of attention to the tasks was much less effective at reducing pain.

The other method that will help a person reduce pain is hypnosis. In the state of hypnosis the sensitivity to pain (analgesia), touch and temperature stimuli is decreased. These defensive adaptations undoubtedly exclude the cortical element. A person, who is under hypnosis, does not react to gestures or facial expressions on injections. It is important to note that during hypnosis pain is perceived, (it is recorded by CAT). However, the patient does not feel it. Thus, under the hypnotic analgesia and anesthesia the functional dissociation is noted. The information on pain exposure remains, but its emotional component disappears. This is a special kind of dreamlike state of a man and the higher animals. At the heart of hypnosis is the process of braking including the cerebral cortex of the brain. Braking has a fractional character, spreading to different parts of the brain at different depths, and capturing different parts of the brain. Between inhibited areas lie active areas of the cortex and subcortical structures. These sites like “watch points” provide, in particular, the ability of communication of a patient a doctor and the ability of therapeutic effects of a word in isolation of other stimuli from the external and internal world of a patient immersed in a hypnotic state. On the basis of some studies it may be assumed that one of the main mechanisms of the hypnotic analgesia is the deactivation of anterior regions of the left hemisphere of the brain, which occurs at the time of the pain impulses influenced by the information coming from the motivational-affective subcortical centers and centers of the selective attention. Control of pain is due to ignoring the information about pain as insignificant to the organism. Hypnosis can change the perception of pain by focusing on different senses. It transfers pain to other areas of the body. Hypnosis can be distracted from pain by concentrating on a foreign object.

Hypnosis that develops during sleep is itself a healing factor. It regulates metabolic functions of internal organs, the cardiovascular and other systems with the help of the brain. Hypnosis can be used as a separate type of treatment or serve as part of the therapeutic complex (along with medication, physiotherapy, diet and other therapeutic methods).

Expectation plays a very important role in pain perception. Suppose a person has severe pain. In this situation, fear of physical activity, as a result of which he/she awaits the onset of pain, may motivate avoidance of physical activity. Non-appearance of pain is a powerful reinforcement to further reduce of the physical activity. Thus, the development of conditioned reflex is initiated, which follows the process of operant learning. As a result, for the emergence of avoidance behavior nociceptive stimuli and the corresponding reactions are no longer needed. In acute pain the limit of the physical activity is even useful, because a person avoids pain and speed the healing process. However, in the course of time fear of the expectation of pain during the physical activity can develop.

This fear acts as a conditioned stimulus, activating the sympathetic nervous system. The mechanism may persist after the subsidence of the original unconditioned stimulus (trauma). The activation of the sympathetic nervous system and increased muscle tone can be seen as an unconditioned reflex, which leads to even greater pain. Pain associated with prolonged muscle tension occurs in the absence of injury. This is also due to the unconditioned stimulus. Although fear causes the inherent link between pain and relevant stimuli, eventually anticipation of pain is associated with physical activity in general, leading to evasion of adaptive behavior even in the absence of nociceptive stimuli and related activation of the sympathetic nervous system. In acute pain, many activities that are neutral or pleasant in other situations can cause or exacerbate pain. They are perceived as repulsive. A person begins to avoid them. Over time more and more actions are seen as the cause of the pain, causing fear and making the patient evade these actions. This can include a simple physical activity, work, leisure and sexual activity.

Adaptation to the sensation of pain is much less than in other types of sensations, and in those cases, when pain stops to be observed, it is usually due to distraction and shifting attention. The process of physiological adaptation for pain goes through several stages. Firstly, the phenomenon of compensation is dominated (dysfunction). Then a stage of incomplete adaptation and a stage of relatively stable accommodation begin. Training, the overall reactivity of the organism and its original functional state is important for the physiological adaptations. People must learn to take a blow and come to terms with the idea that it would be painful. The most important thing is to move the sensation of pain in the subconscious. People have to prepared, because a person is afraid of what he/she does not know.

A level of emotional state and intelligence of a person are of paramount importance in the knowledge. The intensity of pain entirely depends on the personal characteristics of the person, his/her mental attitude, physical condition and age. Each person perceives and expresses pain very individually.

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