Is Pain a Disease or a Symptom?

February 22, 2009

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

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10 Comments Add your own

  • 1.    Sherry Brink  |  March 25th, 2009 at 6:32 PM

    With my 30+ years of nursing behind me I still think of pain as a symptom. I believe science has not always come up with the answer as to what the disease or cause of the pain is. As we become more educated on the intricacies of the brain and the neuro system the causes may become more clear to us. These are exciting times as neuro imaging becomes more exact providing clues that were was unseen. i look forward to the unravelings of this complicated system and improve the lives of those living with pain.

  • 2.    Sharon Sorensen  |  April 5th, 2009 at 12:29 AM

    Good Question. Unfortunately I have found- from being in chronic pain myself- Practitioners tend toward the limited view- one or the other. As the years have gone by and my pain has sustained, yet changed, I have realized that, for myself- I have the symptomatology of both a mechanical presentation- so classic- combined with an area of my spine where the nerves are diseased- i.e. a disordered or incorrectly functioning organ due to past and chronic damage. Medical Support for me has been limited.
    Differential diagnosis is a lost art in the medical community.

  • 3.    Denver  |  September 21st, 2009 at 6:28 PM

    Most people who have been diagnosed with chronic depression and anxiety have probably been prescribed modern anti-depression and anxiety medications such as Prozac, Celexa, Zoloft, Paxil and other SSRI related medications which seem to be the favorite choice of every modern doctor of the 21st century, this indicates findrxonline in his article about depression.
    Unfortunately these new anti-anxiety and depression medications do not come without side effects and only a small percentage of its users reports that these medications do indeed balance their moods to the point where they can say they truly feel comfortable over longer periods of time.

  • 4.    Side effects of steroids  |  April 29th, 2010 at 8:09 AM

    Pain is always a consequence, ie symptom, a sign that there is something wrong in a person’s body and soul

  • 5.    Robt Kirkendall  |  July 20th, 2010 at 10:22 PM

    A symptom that you could possibly have very poor blood flow in your legs is tinting of the skin. If you discover a blue, purple or pale region on your leg, then this may be a proof that the bloodstream is not moving as well as it really should to the spot.

  • 6.    Donna Lopez  |  October 1st, 2010 at 1:32 PM

    Pain is multimodal and is electrical, chemical and thermal as well often invisible…as felt in the mind and spirit of every sentient being. As we approach the threshold of treating pain, we must as clinicians or professionals recognize that pain, like our own complex bodies/minds/souls, has many dimensions. Our bodies need proper nutrition and the macro and micro nutrients (vitamin D…B vitamins…high qualtiy healing proteins…antioxidants…alkalinizing greens and seaweeds, etc.) need to be analyzed based on each individual human body requirements in dis-ease (we need more information on the impact of acidity in pain patients and how to reengineer the body to create a better physiologic pH that might assist in diminishing inflammation); herbs can assist where pain is exacerbated by cold or heat or by qi or blood stagnation known to Asian and Ayurvedic medicine; exercise is vital because it promotes homeostasis/brings forth enkephalons, endorphins, and other modulatory mechanisms in pain; proper breathing creates a more optimal setting for oxygenation of body cells; lasers used knowledgeably can create more rapid healing following surgery and trauma and much research is needed for this important modality; cognitive behavioral therapy might stem negative thoughts and replace these thoughts with more positive, healing ones; patient providers need to recognize what Hippocrites warned his students to be mindful of: the home and community environment and present stressors…is there an adolescent in the house…is the patient a “sandwich generation” caring both for a child and an aging parent…emotional health of the patient’s close contacts that can impact the patient’s sense of helplessness. Are we, as healers or policy makers, truly motivated to take on the monumental complexity to heal this disease called pain which will affect each and every one of us during our all too brief lifespans.

  • 7.    Pamela Ressler  |  October 10th, 2010 at 12:39 PM

    Thanks for your thoughtful comments, Donna. You ask an important question in your last sentance, “Are we, as healers or policy makers, truly motivated to take on the monumental complexity to heal this disease called pain….” I think the work being done at Tufts in the PREP program is the first step in addressing this complex issue.

  • 8.    Ryan @ Vitamin D Benefits  |  October 25th, 2010 at 2:21 PM

    By an added consumption of Vitamin D, pain can be relieved to a great extent, researches pronounce. At least 8 out of every 10 people experience pain in one form or the other in their span of life. The symptoms and causes of pain however, differ from person to person. A deficiency of Vitamin D is a cause for many forms of pain, the most common among which is muscle pain. You may feel that this deficit of vitamin D is rare. In that case, you will be surprised to know that in a recent study concentrating on the six regions of the world, namely Africa, Europe, Asia, North America, Middle East and Oceania, the results have revealed that vitamin D concentrations lower than 75 nmol/L were rather common.

  • 9.    kara  |  January 17th, 2011 at 7:28 PM

    There is nothing worse than chronic pain. To those who suffer it can be a both shourt term and longterm disease. Whatever its source it often requires treatments alongside the primary ailment. Sounds like a disease to me. scholarships for moms

  • 10.    carroll, ann m.d.  |  January 29th, 2011 at 8:25 PM

    i had traumatic compression fracture t-8, 5 months ago.
    then (new) trauma damage to t-10 disc, 1 mo ago.

    pain in past month is overwhelming, present 85% of waking hours, causes limited excursion of breathing, and appetite diminuished such as to cause weight loss of 2 lbs/week.

    feels as if pain has ‘high-jacked’ the brain, and autonomic function.

    true, thoracic n. 10 serves intercostal muscles (hence deep breathing causes pain); also, t-10 may innervate sympathetic & parasymp. vertebral ganglia (autonomic function, including appetite).

    however, i’m concerned this near-constant pain is changing my CNS/PNS irreversibly.

    what does the data show? i’m familiar with UCSF’s Gallo Center’s discovery that untreated severe spinal pain causes permanent anatomic pathology of the spinal anterior horn cells – even when original cause of the pain is healed.

    anyone there at Tufts/PREP with new data on CNS damage due to severe pain?

    thanks in advance

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