The Complexities of Measuring and Defining Pain

health insurance in personal injury claimsMy personal injury law firm has represented a great many people over the years who have been injured in motorcycle accidents and automobile accidents.  One somewhat difficult aspect of the profession is determining, and measuring, how much pain any one individual suffers as a result of injuries caused by trauma.

The Complexities of Measuring and Defining Pain

Pain is difficult to define.  Aristotle considered pain as the equivalent of unpleasantness and opposite to pleasure. Spinoza regarded pain as a focal form of sorrow which he considered one of the three primary emotions. He thought of pain as an emotion opposite to pleasurable excitement and “related to a man when one of his parts is affected more than.the others; melancholy, on the other hand, when all parts are equally affected. ” Keele has summarized the history of man’s ideas of the anatomical and physiological basis of pain.  In current scientific usage ”pain” carries the Spinozistic notion that the unpleasant feeling is specifically localized to some place or places in the body.

SPECIFIC RECEPTORS AND PATHWAYS
One finding of points on the skin particularly sensitive to painful stimuli and of other spots which could be struck painlessly with a fine needle was followed by efforts to locate a specific end organ or receptor of pain in the skin. However, agreement on the existence of such specific receptors does not exist nor is there any generally accepted proof of the existence of specific sensory fibers in peripheral nerves for the conduction of pain impulses. It has been shown that large myelinated (covered with a sheath of a white, fatty substance called myelin) fibers conduct impulses more rapidly. On the other hand, these fibers can readily be blocked by compression (as with the application of an inflated blood pressure cuff to a limb.).

Conversely, small mye­linated and unmyelinated nerve fibers are more sensitive to pharmacological blocking agents. These fibers appear to be the pathway for painful impulses. They enter the spinal cord in the lateral division of the dorsal root and synapse (connect or join) with cells whose axons (processes) ascend in the opposite side of the spinal cord in the spino-thalamic tract.

lt should be emphasized that a number of clinical observations have shown that there is individual variation in the number of spinal segments required for the “cross-over ” of the fibers, that some or rarely most of the fibers may remain uncrossed in the spinal cord, that there is variation in the representation of a particular area of the body in the pain pathway in the anterior quadrant of the spinal cord and that the pain fibers are more diffusely distributed in the anterior quadrant of the spinal cord than the standard textbook diagrams would indicate.

CEREBRAL CORTEX
It has been known for a long time that stimulation of the cerebral cortex could produce pain in a localized area of the body and there have been reported instances of relief of pain by resection of a localized area of cortex. However, a complete loss of pain sensation in a circumscribed area of the body or limbs has never been reported after resection of an area of sensory cortex. ,
That there are centers in both thalamus and cerebral cortex for recognition and localization of pain is clear.

SUBJECTIVE AND PERSONAL EXPERIENCE
It is important to recognize that pain as we know and observe it is a peculiarly subjective and personal experience. The pain experienced by A is not and never can be the pain of B. The physician, the spouse, the friend or acquaintance of the sufferer can observe the effects of pain on the patient but can never experience his pain. The only pain of which we can have first hand knowledge is our own.

The same person who suffered acutely from the extraction of a tooth in a dental chair, even with tho aid of local anesthetic, may have a tooth knocked out of his jaw in an athletic contest and suffer little immediate discomfort. The individual who faints at the sight of a hypodermic needle and syringe in a physician’s office may suffer a severe laceration of a limb under other circumstances without being aware of the injury until minutes later.

TYPES OF PAINFUL TISSUE STIMULATION
The exact mechanism of pain production by injury varies with the tissue involved. While many types of stimuli may be painful (if adequate) to the skin and superficial structures, deeper structures may be painful only with certain types of stimulation as previously pointed out.

Muscle spasm is generally painful.  Distension of a viscus is painful, but muscle, the abdominal viscera and tissue of the central nervous system (brain and spinal cord ) may be cut, burned, handled or treated with chemicals without pain or discomfort.

MEASUREMENT OF PAIN
The measurement of pain is a matter of considerable importance to both physician and attorney, and it is important for both to realize that since pain is a subjective experience there is no objective method of measurement. It is true the effects of pain on the individual can be observed but a very superficial attempt to compare the effects of a specific stimulus of different individuals will convince the observer that not only does the pain threshold vary from subject to subject and also in the same subject.

Hello. I’m Ed Smith, an Elk Grove Personal Injury Attorney with the most informative accident and personal injury information website available – www.autoaccident.com.

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