Approach to the management of nonmalignant pain

Pain is a universal, subjective, unpleasant sensation. It results from a noxious stimulus that causes the body to perceive existing or potential damage to its organs. The biochemical mechanism of pain is based on peripheral nociceptors that preferentially receive noxious stimuli and thereafter cause the primary afferent nociceptor fibers to release endogenous chemicals such as bradykinin, histamine, prostaglandins, serotonin, norepinephrine, and substance P. Additionally, substance P may stimulate prostaglandin and collagenase production, thus providing an explanation for the effectiveness of anti-inflammatory drugs in relieving pain. The interpretation of pain is highly individualized and embodies the entire personality. Thus, no two patients with pain can be treated in the same way. Pain is assessed through medical history, physical examination, and a variety of pain scales. General principles in managing pain call for the physician to (1) respect pain; (2) recognize the psychologic components of pain; and (3) treat the underlying disorder in a timely fashion. Modern management of pain evokes a multidisciplinary approach that includes patient education, pharmacologic intervention, physical medicine, minimally invasive procedures, psychologic counseling, behavioral modification and, in some instances, surgery or a variety of other nonpharmacologic modalities.