Talk:Pain

An original Citizendium Article

My own original work as first posted on 2007-02-12. There was nothing from any other publication (other than the few references) at this stage. Christo Muller (Talk) 14:57, 16 April 2007 (CDT)

I think the idea of having a lead article "Pain" which stands independantly, yet links into all the subjects you mention is brilliant. Why don't you start writing "Pain" as an article. I am not foresighted enough to see all the links, but I do know that there are several of us active on the wiki that are flexible and collegial and can, hopefully, collaborate on such a spectrum of articles. I like to think of Citizendium as primarily focused for the user- and what I love about your "Pain1" is that it introduces the complexity of the subject in, to fall back on a cliche- a very "user friendly" manner. I do not have the focus at the moment to go through in detail, but my general impression is extremely favorable. I would be honored to help author once you start the article. Thanks for showing this to me. Nancy Nancy Sculerati MD 18:54, 9 February 2007 (CST)

Pain in infants and children

I would appreciate including this topic. I have been beside myself too many times battling the fixed idea of many people that somebody too young to verbally complain 'feels no pain'. Nancy Sculerati MD 08:00, 10 February 2007 (CST)

Now in Main article space

My own idea is that of a "cycle" of articles, integrated yet each one stand-alone, so that the reader may over time get an overview of the importance of the subject to humans. One would like all the add-ons that persons think should be there recorded somewhere. At present this is at the end of the article, but a "topic suggestion" sub-page may work better. I see the Category tags don't work, so I will just delete the lot (except CZ live, of course :-))- I do not think they help much anyway. I would rather ask at the specific workgroups (e.g. philosophy, healing arts) if there are persons with an interest in contributing. --Christo Muller 12:56, 12 February 2007 (CST)

I think you've nade a really lovely start. If I may I'd suggest that the article could benefit from a few engaging illustrative examples, in other words I'd look, for this "gateway" article, to highlighting just a few things that make this such an interesting and important (and intriguing) topic, and which might be linked to illustrations. 1) Phantom limb pain 2) The ability to overcome extreme pain in extreme circumstances (- there are many remarkable examples of this, including in citations for valor) 3) Syndome of insensitivity to pain is sad and remarkable, and could be expanded on to stress the important adaptive function of pain. 4) The gate theory of pain? Gareth Leng 07:56, 22 February 2007 (CST)

Yes, short examples and illustrations would fit in, specifically to whet the appetite (if that is appropriate to the topic:)) for the linked articles. See what I wrote to Nancy about her comment on hereditary insensitivity to pain, below. My thought would be to mention that specifically when one writes about nociception physiology, and rather remove it from this one. The problem is that we do not know whether these persons cannot feel pain, we know only that they do not have the ability to detect tissue damage. --Christo Muller (Talk) 15:33, 22 February 2007 (CST)

meanings of pain

When you talk about the few individuals who don't feel pain, it highlights a choice that I think has to be made in this article- and that is "pain" as opposed to other (painful :-)) forms of discomfort. I am aware that they are all related, but-for example, whereas somebody with Familial Dysutonomia does not feel pain, they do still experience discomfort in other ways. I'm not sure I understand the focus.I mean- nobody is born unable to feel any type of pain including emotional anguish unless they are so low functioning to be essentially brain dead. Nancy Sculerati MD 09:04, 22 February 2007 (CST)

Well, Christo, now that I have read through, I have to say that this is pretty wonderful. Nancy Sculerati MD 10:19, 22 February 2007 (CST)

Thanks Nancy. I agree with your assessment of "do not feel pain" - all the HSAN types show defects of nociception, but that does not say that that the person affected cannot "hurt in the brain" (for the moment I forget the quote about "pain mainly in the brain", there is one that is a take on "rain in Spain" somewhere). I've not seen a study of what these persons really do feel, emotion-wise, apart from not responding normally to standard noxious stimuli during clinical neurological assessment. Someone will no doubt sometime do an fMRI or SPECT study to see if their brains light up with hurt the way the rest of ours do (probably the Riley-Day kids, I'd guess). The sentence is not necessary for the article, and does introduce a subject which may be discussed more profitably in an article on nociception (possibly to illustrate the value of nociception). --Christo Muller (Talk) 15:06, 22 February 2007 (CST)

OK, got it, it is Dennis C. Turk (Psychologist), John and Emma Bonica Professor of Anesthesiology and Pain Research at the University of Washington School of Medicine in Seattle Washington: "The reign of pain is mainly in the brain". Now I have to find the original publication of that - I think it was the title of a lecture. --Christo Muller (Talk) 15:16, 22 February 2007 (CST)

In my practice (I am no longer active) we were a center for "Riley Day kids", 300 were followed, I operated (for various raeasons) on about a dozen, got to know others in consultation (some were adults). Just an aside, I guess. Nancy Oh, now I remember, I'd say most were emotionally fine. When they get upset- either physically off or worried or even a little scared, a blood pressure of 400/200 is what happens, along with reflexive breathholding to cyanosis with seizures. And then, it's ok. That's a routine office visit with ear cleaning. But it's not like there is no fear or psychic pain. Lots of smart good, "normal" people have that. Nancy Sculerati MD 15:26, 22 February 2007 (CST)

Not sure what you have in mind here? "At the same time, however, what is learned about the manifestations and treatment of pain in animals can also be used to help fellow living creatures who suffer pain - the very same species which are used for these experiments" - most experiments are on rats or mice?Gareth Leng 16:30, 22 February 2007 (CST)

Poor wording from my side, I was thinking of the cats and pigs we worked with, but as you say, these days most of the biochemical work goes rat. Maybe just scrap that lot. Not many rat-owners go to the vet and ask for painkillers for their rat... Maybe one can rephrase to state simply that veterinary practice benefits from this work. I think one should review the ethics of pain research in animals in a separate article. The real issue is that one does not use animals as just random experiments for uncertain human benefit, and one does not do it from the old point of view that animals don't feel pain. It bothers me that we have no other way of determining the facts. --Christo Muller (Talk) 20:20, 22 February 2007 (CST)

On CNS pain - think you need to be careful, the meninges of course are full of nociceptors and can give rise to excuciating pain, and migraine needs perhaps some explanation.16:33, 22 February 2007 (CST)

The classic view of cerebral cortex being insensitive is valid, but whether the reader will understand the difference between that and the meninges is moot. So that does need to be pointed out. As well as the fact that stimulating spinal and higher nociceptor pathways would give rise to the sensation of pain, but that this would be interpreted as coming from elsewhere. These ideas can be developed in a headache article, and I think the work on migraine is sufficient to justify an article by itself. --Christo Muller (Talk) 20:20, 22 February 2007 (CST)

I wonder whether the issue of emotional vs physical pain needs some reflection here. This article might be suited to some embellishment from art - The Scream perhaps? Should there be a section on analgesics - perhaps alluding to the history of opiate use - again scope for illustrations.

Gareth Leng 16:52, 22 February 2007 (CST)

Thanks for the input Gareth, it seems now that N is back we are all sparking again:) I've actually asked the philosophy group if there is anyone there interested in the problem of pain, but we need input from psychology and from art and religion. The Pain really is a phenomenal painting, I see it as a combination of dream terror and pain more than just pain - something beyond hurting. For an illustration I would love to use the paintings of Frida Kahlo, if one can - I do not know the copyright status. Essentially, I feel authors should feel free to add their view, and then one can synthesise and condense that for a unique article. This draft I wrote as a single sitting, with the idea of making a framework, but the more I think about it, the more I think I've left out. For example, nothing about the general principles of treatment, as you say. But its now 04:16 where I live, so I'll think more later this morning. --Christo Muller (Talk) 20:20, 22 February 2007 (CST)

Christo, great work! Very interesting and quite a thorough primer for the host of articles that should be able to link to this. A couple things did trigger some thoughts for me as well. I'm not sure if its in the list below, but we could expand on the referred pain patterns such as viscerosomatic - perhaps use something like left arm pain in myocardial ischemia. Also we could connect deramatomal pain with the neuropathic pains and could probably get some charts for that. Of course, the links go on and on with spinal cord injury, paresthesias, causalgias, etc. This could really lead to a lifetime of articles:) BTW, in the US there is a big issue that became more in the headlines in the latter 20th century related to treatment of pain in the last years of life - came to light with euthanasia and right to die issues (I noticed your lead sentence - from birth to loss of a loved one). It seems that advances in treating these pains has become more important. I think you have touched on issues of chronic pain syndromes that begin to affect quality of life. There is the use of antidepressants for some of these, etc. Also massage, etc for the gate theory. Okay, I'm rambling. Which direction were you wanting to go with it or are you happy with where it is right now? Matt Innis (Talk) 22:14, 25 February 2007 (CST)

Formatting

Is this ok that the article's sections use level 1 headers?Robert Badgett 15:01, 22 October 2007 (CDT)

Organization

I am having trouble following the organization. Is it ok to group:
3 Nociceptive pain
4 Neuropathic pain
5 Central pain
...into a larger category, perhaps 'Classification' or 'Mechanisms'? Perhaps psychogenic pain should be moved to this section as well. Robert Badgett 11:20, 30 October 2007 (CDT)

As a physiologist I guess I would have gone for an organisation that separates a)the anatomy and physiology of nociceptive pathways and b) perception of pain.

This is approximately how it is organised, but the headings don't make this clear, e.g. the categories "neuropathic pain" and "nociceptive pain" are not equivalent. I think a minor reorganisation would help. I'd suggest that the heading Nociceptive Pain" really precedes a section on the physiology of pain, whereas the other sections are about pathological states of pain.??Gareth Leng 12:01, 30 October 2007 (CDT)