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Pain

Unfortunately pain does not always show a helpful red glow. This would be useful for medical assessors working out if people are faking back pain

Ow, that hurts!

Pain is very common. It means something is hurting.

Pain is a symptom (something the patient complains of). It's different from tenderness which is a sign (something you elicit on examination. So you if train a horse to kick a patient in the spleen and the patient screams, that is eliciting the sign of tenderness. Later, if they're still alive and complain about the symptom of pain, it's a, well, symptom.

(If anybody does this, please video it and put it on YouTube.com. It's only right.)

Why does it hurt?

There are many many causes of physical pain, but unless your ex-wife runs you over in a truck, love is not one of them. It is one of the most common symptoms, and probably leads to about a jillion days off work each year.

What should I know?

The biggest department that deals with pain is Palliative care. Pain control is guided by the WHO Analgesic Ladder.:

Analgesia is based on a three steps of increasingly strong pain relief. The decision to go to the next level of pain relief is based on whether the pain persists/increases whilst under each treatment.

  • Step 1 - non-opioid: this is generally paracetamol or an NSAID (e.g. ibuprofen). Regularly rather than prn.
  • Step 2 - weak opioid: usually, this will be codeine +/- a non-opioid.
  • Step 3 - strong opioid: generally morphine +/- an opioid

Sometimes, in patients with severe pain, they don't respond to morphine, or not after a certain level. In these situations, you can use methadone or ketamine, which can often alleviate pain where other methods have failed.