Dealing With Pain

Managing pain

BMJ 2003; 326 doi: (Published 12 June 2003) Cite this as: BMJ 2003;326:1320
  1. Eileen Mann (, nurse consultant pain management1
  1. 1 Poole Hospital NHS Trust and IHCS Bournemouth University, Poole BH21 2JB

    Managing pain effectively is one of the biggest challenges in medicine, and one of the areas of clinical practice where a good doctor-patient relationship can, potentially, help improve the end result. But it takes time to get this right—and requires help from other healthcare professionals, argues a nurse consultant in pain management


    Scientists are beginning to understand how and why we feel acute pain, and the complex interplay of neurones and messenger molecules that leads to its perception. However, researchers are only just starting to explain the contribution of emotional affect, cognitive function, and how the human response to feelings such as anger, frustration, depression, anxiety, fatigue, and hopelessness can impact on the perception of pain.

    Our improved understanding of acute pain has led to an explanation of how and why the majority of analgesics work and why conventional approaches such as analgesic medications are often so effective. But it has also led to chronic pain emerging as a distinct phenomenon on its own.1 Although it may share nociception, which describes the tissue irritation that accompanies acute pain, other factors may be associated with pain that does not go away, such as abnormal nerve activity and alteration within the central nervous system. Increased suffering also adds a dimension, and changes in behaviour mean that chronic pain affects the person as a whole and is not just confined to a part of the body.2

    Given the myriad of influences on pain perception, it becomes clear that applying a traditional biomedical model that just looks for an organic cause of pain may fail some sufferers as it does not routinely take into …

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