Podcast 607: Is Pain the Enemy?

Contributor: Don Stader, MD

Educational Pearls:

• Pain is ubiquitous in the emergency department but it is not the enemy - suffering is
• Nociception is the ability to feel noxious stimuli which usually causes a reaction, like pulling a limb away when you feel something painful. Nociception is really a brainstem reflex.
• Pain is nociception plus cognition, meaning we process the noxious stimuli in our frontal cortex but it is not necessarily suffering. 
• Pain can be associated with euphoria, such as with distance running
• Suffering, unlike pain, is associated with emotional distress
• Nociception is a brainstem reflex, pain involves the brainstem and the frontal cortex, while suffering involves the brainstem, frontal cortex, and the limbic system attaching an emotional response
• Providers should educate patients' expectations on pain as a part of the physiologic process and emphasize the focus on alleviating suffering

References

Sneddon LU. Comparative Physiology of Nociception and Pain. Physiology (Bethesda). 2018 Jan 1;33(1):63-73. doi: 10.1152/physiol.00022.2017. PMID: 2921289

Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD