Introduction

The International Association for the Study of Pain (IASP) defined pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

Acute Pain (The following are features of acute pain)

• Pain that last less than 30 days.

• Begins suddenly and is usually sharp in quality.

• Serves as a warning of disease or a threat to the body.

• Ranges from mild and last just a moment, to moderate pain and severe debilitating pain.

• Disappears when the underlying cause of pain has been treated or has healed. Unrelieved acute pain, however, might lead to chronic pain and poor quality of life.

• Is usually caused by activation of somatic or visceral nociceptors (pain receptors) in response to tissue damage.

Pain may be divided into

• “nociceptive” (caused by activation of nociceptors or pain receptors),

• “neuropathic” (caused by damage to or malfunction of the nervous system). This usually causes chronic pain.

• In mixed type it is a mixture of the above 2 main types of pain.

Some common acute nociceptive pains are as follows:

1. Arthritic pain i.e., osteoarthritis, gouty or rheumatoid arthritis

2. Musculoskeletal pain from osteoporosis, spondylosis, sprain and strains etc

3. Ischemic disorders i.e. angina and claudication

4. Cancer pain

5. Post-surgery, post-trauma of falls with injuries i.e. soft tissue for example lacerations, contusions, bruises and  fractures of various sort

6. Pain from ulcers and diseases of the viscera

7. Burns, cuts and injuries

8. Dental pain

9. Others

Sign and Symptoms

Nociceptive pain may be divided into

• “superficial somatic” and

• “deep” pain which can be “deep somatic” or “visceral pain”

Superficial somatic pain is initiated by activation of nociceptors in the skin or superficial tissues. For example the arthritic pain of osteoarthritis, gouty or rheumatoid will have pain on movement of joints involved together with swelling and warmness.

Deep somatic pain is initiated by stimulation of pain receptors in ligaments, tendons, bones, blood vessels, fasciae and muscles, and is dull, aching, poorly-localized pain.

Visceral pain originates in the viscera organs which are often very difficult to locate. Also several visceral regions produce “referred” pain when injured, where the sensation is located in an area distant from the original site of pathology or injury. Chest pain originating from the heart which is labelled as “angina” May be referred to the neck.

Complication

Delay of appropriate treatment in acute pain prolongs misery and leads to irreversible pathologies. The complicating problems are as follows:

1. Functional Impairment : the elderly may need help for their daily activities as a lot of them have impaired ambulation as a result of pain.

2. Delirium : There are incidences of older patients becoming delirious and restless when they are in pain and this is especially so in those who are cognitively-impaired.

3. Increased healthcare utilisation cost .

Acute pain if not treated will eventually lead to chronic pain and this causes psycological pain. Psychologicall pain causes suffering and undue misery! Mood  gets changed and the person becomes more irritable. Sleep disturbance is a real issue. Some patients get isolated with decreased socialization and eventually become depressed.

Treatment

• Acute pain will stop when an injury heals or when an underlying problem is treated successfully.

• Successful treatment is highly dependent on successful resolution of the causes of pain. Without proper treatment the pain can affect the daily activities and subsequently the quality of life of the elderly person.