Archive for February, 2009

Is Pain a Disease or a Symptom?

by Ylisabyth (Libby) Bradshaw, D.O., M.S.,FACEP, Academic Director of the Pain Research, Education and Policy program at Tufts University School of Medicine
Does it matter whether pain is a disease or a symptom?
For people living and suffering with pain, such a question may seem irrelevant. Perhaps like splitting hairs.
“Just make the pain better.”
“I don’t care what category you put it in!”
“Don’t just talk about it. Do something! Anything to relieve this agony.”
Why would it matter whether and how medical professionals want to categorize pain?
Symptoms are defined as subjective experience; diseases are defined in objective terms, with specified causes, or associated signs and symptoms.
People with pain certainly have a personal, internal experience of pain. And, aside from asking a person to describe and rank the intensity of their own pain, there’s no medical test for determining the type of pain or its severity.
The predominant medical view for centuries has been that pain is a symptom, and viewed as an entirely subjective experience by an individual. Physiologically, pain has been seen as simply the transmission through nerves of information about damage or potential damage to parts of the body.
After all, when pain is caused by something inside the body – a ruptured disk, nerve disease, or compression from an expanding tumor – it seems that something is irritating or pressing on a nerve, which is then communicated, allowing us to feel pain. Pain is a classic symptom, it would seem.
And pain could hardly be expected to be a disease when it’s caused by forces from outside the body – a fall, an automobile crash, or even surgery; it seems completely straightforward – and easy to understand when nerves are compressed, crushed, or cut – pain is the symptom.
Yet, accumulating evidence in neuroscience says pain is more complicated. No matter what initiates pain – from traumatic forces to specific neurological disorders – if conditions continue, and the pain signal is maintained, specific bodily changes occur.
Measurable now in research labs, such characteristic, physiological alterations, arising from actively transmitting information about pain, can unfortunately become sustained biochemical changes. Ordinarily, our bodies reverse this process when the initial circumstances causing pain are relieved. Yet, too often these changes become irreversible, and permanent, resulting in chronic pain.
Two imperfect examples from our material world – Once cement is mixed and sets up, it becomes a new substance. Once glue is used, it can bind to a substance, and be impossible to remove. The science of pain is still discovering answers, and resolving uncertainties. OK, our brains and nerves are not comparable to cement, glue, or jello. Yet it is clear, signals about definite or potential tissue injury turn on many biochemical processes that transmit information about pain through our nerves. Over time, these can become irreversible changes. Pain, then, is beyond being merely a symptom.
Please join this initial discussion on the Pain Research, Education and Policy blog at Tufts University School of Medicine, and include your thoughts regarding, “Is pain a symptom or a disease?”
If pain is more than a symptom, does that make it a disease?
Common definitions of “disease” include impaired functioning*. From your knowledge and experience, how do pain conditions have impaired functioning?
We look forward to interesting exchanges from students, faculty, practitioners, alumni and members of the general public committed to improving the conditions treatment and prevention of individuals across all ages with acute and chronic pain problems.
* Disease -
“a condition of the living animal …[or one of its parts] that impairs normal functioning and is typically manifested by distinguishing signs and symptoms” MeriamWebster
“an impairment of the normal state of the living animal … or one of its parts that interrupts or modifies the performance of the vital functions, [and] is typically manifested by distinguishing signs and symptoms…”
Medline

10 comments February 22nd, 2009

PREP Gathering of Students, Alumni and Faculty

The PREP program’s small classes and collaborative learning experiences lead to wonderful , long lasting connections between students, faculty and alumni. PREP students, faculty, staff and alumni joined together at a local Boston restaurant on February 13, 2009 to celebrate three new PREP graduates, Anne Colyn, Jess Gerber, and Marie Belle Francia, and wish them well on their new career adventures.
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MS-PREP 2008 graduates Marie Belle Francia, Anne Colyn, and PREP academic director Libby Bradshaw
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MS-PREP 2008 graduate Jess Gerber, PREP student Gretchen Kindstedt, MS-PREP 2008 graduate Anne Colyn
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PREP student Sherry Brink, MS-PREP 2008 graduate Marie Belle Francia, former PREP program director Jeanne Connolly, PREP student Cindy Rodman

1 comment February 14th, 2009

What is PREP?

PREP stands for Pain Research, Education and Policy. We are a unique Master’s degree program drawing students from diverse fields with a common interest in creating new models for addressing and treating pain in our society. Our curriculum is based on the premise that the experience of pain and its control are influenced by factors ranging from molecules to social, cultural, and economic forces. The co-founders of this program were an anesthesiologist/internist and a sociologist, a diversity that reflects the interdisciplinary collaborative perspective of our curriculum. Our students acquire the requisite tools to understand and engage in pain research, education, and advocacy positions. We hope you will visit this blog often to see the exciting and innovative work the PREP program’s students, alumni and faculty are doing in the workd of pain research, education and policy. Visit our program website for more information.

1 comment February 14th, 2009


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