Pain, Inflammation & Fever

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Pain is how our bodies let us know that there is something wrong. It is the natural defence mechanism that our bodies have to let us know that something harmful has occurred, either internally or externally through disease, illness or injury.

Pain happens in order to make people take action to help protect the body against further damage just like shivering and sweating are our natural temperature regulating responses to cold and heat.

Pain is caused by the stimulation of nerve endings called nociceptors, which transmit signals along the spinal cord to the brain.

Most types of pain are well managed with analgesics (painkillers).
Medicines used to treat pain do not kill pain, they simply mask it for short periods of time until the problem is resolved.

Pain will usually go on its own but if for whatever reason it did not after a few days or it kept re-occurring, it should not be ignored.
Pain happens for a reason and it could be a sign of something more serious happening in our bodies.

Anybody that suffers from pain that is severe or prevents movement, has pain that starts suddenly or it does not get better with over the counter (OTC) analgesics; Or pain that continues to come back after using medicines or the pain is accompanied by other symptoms such as bleeding , fainting, shortness of breath or loss of weight, should seek medical advice as soon as possible.

People have different pain thresholds, so some can withstand more pain than others.

The response in a person’s body to pain is affected by their general well-being so when feeling run down and with little energy, the pain threshold is normally lower than usual.

Pain happens in four different stages. These are as follow:

1) Tissue damage at the site of injury triggers pain receptors.
2) Pain receptors then send a nerve signal to the brain.
3) At this point, the subconscious part of the brain interprets this signal as something unpleasant.
4) In the last stage of this process, the conscious part of the brain then analyses and recognises this unpleasant sensation as pain at the site of injury and determines its seriousness.

There are lots of different types of pain caused by lots of different conditions (e.g. period pain, dental pain, headaches, including sinusitis, migraine and tension pain; indigestion, including stomach ache; muscular pain, including back pain, strains and sprains, bursitis and bruising; joint pain, including osteoarthritis and rheumatoid arthritis… etc).

Pain is usually caused by damage to a particular part of the body or by different physical disturbances.
Pain can be felt at the site of damage or close to the source in which the sensation of the pain will vary.
Pain can be “acute” or “chronic”.

- Acute: Is pain short lived that usually presents itself as sharp and confined to one specific area.
- Chronic: Is pain suffered for a long time (always present), and is felt on a larger area of the body. It normally presents itself as a dull, throbbing or deep pain.

Acute pain signals are carried out to the brain much faster than the dull, aching pain signals. This is why sharp acute pain is often followed by a dull, throbbing pain than can be persistent even after the stimulus has gone.

TYPES OF PAIN:

- Superficial: This type of pain, is pain that arises from the surface of the body. It normally feels like a sharp pain, and its source is usually easily identified. Some people refer to the pain as piercing, stabbing, stinging or burning.

- Deep: This type of pain is normally felt in bone joints, muscles and tendons. Some people tend to describe the pain as dull or aching, and it is much less localised.

- Visceral: This type of pain is also dull and aching, even though it tends to feel more deep. This pain, however, normally relates to internal organs, such as the stomach, liver, etc. People often find it difficult to identify the exact location of the pain.

- Referred: This type of pain can sometimes be felt on the surface of the body even though it is actually due to damage from an internal organ (e.g. heart conditions, in which the pain is felt across the chest and down the left arm).

For the most part, rather than treating the condition, you will be treating the pain in order to reduce the symptoms. Of course the opposite is also true in some cases when treating the condition will resolve the pain instead.

Anyone that suffers from pain that lasts for longer than 10 days should seek medical advise.

INFLAMMATION:

Once the pain messages have reached the brain, the body responds very quickly. In order to try to minimise the damage to the part of the body where the pain is, a chemical called histamine is released from cells in the skin. This provokes local blood capillaries to dilate and the blood to pool around the damaged tissue. The result of this is, reddening and swelling to the damaged area, making it feel tender and hot to the touch. This is the first stage of inflammation.

Inflammatory mediators, such as 5-hydroxytryptamine (5-HT), substance P (also released from mast cells) and kinins (formed in the damaged tissues), then strengthens these effects.

Not long after this reaction in the body (within the hour and throughout several days), the formation of chemicals called prostaglandins, which have an important role to play in pain and inflammation, occurs. This provokes a prolonged feeling of pain and the stimulation of nociceptors.
Prostaglandins are made by two different types of enzymes called Cyclo-Oxygenase-1 (COX-1) and Cyclo-Oxygenase-2 (COX-2).

COX-1 enzymes mediate the synthesis of prostaglandins involved in “housekeeping” functions in the body, such as: gastro protection, renal perfusion and platelet aggregation.

COX-2 enzymes are the ones responsible for increasing the pain signals that are being sent to the brain. They mediate the production of prostaglandins involved in pain and inflammation. They cause gastric irritation.

In the later stages of inflammation and in chronic states, prostaglandins maintain the capillary dilatation and permeability, therefore sensitising the nociceptors.

Prostaglandins are not stored within the tissues, but are synthesised from phospholipids in the cell membrane during the inflammatory process.
This is refereed as the “Arachidonic Acid Cascade”
.
Prostaglandins E-1 (PGE-1) and prostaglandins F-2 (PGF-2) are the most important ones in mediating inflammation.
PGE-2 causes fever by acting on the hypothalamus in the brain.

Other prostaglandins have homeostatic roles, such as: mediating gastric motility and secretion, affecting blood pressure and mediating contraction of the uterus at term.

FEVER:

Prostaglandins are also believe to be involved in causing fever in people. In this case, they are produced by white blood cells when the body is fighting an infection , and then they are carried to the part of the brain that controls body temperature (the hypothalamus). This is when fever occurs.

NEWS:

- Music helps with chronic pain:

It is believed that listening to music can help alleviate chronic pain and (its associated depression, according to a paper in the Journal of Advanced Nursing).

US researchers studied 60 patients who had suffered years of chronic pain. For one week, 40 of the patients listened to music on a headset for an hour a day and the remainder did not.

At the end of the week, those who had listened to music reported that their pain had fallen by up to 21% and their depression by up to 25%. These patients also reported that they felt less disabled by their condition and said they had more power over their pain.

“We already know that listening to music promotes a number of positive health benefits”, says the study’s co-author, Professor Marion Good. “This research adds to the growing body of evidence that music has an important role to play in modern healthcare”.

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