The Categorization Of Pain

Acute Pain

Pain may be categorized as either acute or chronic. Acute pain originates from a known stimulus that causes tissue injury. Dental pain following oral surgery is the most thoroughly studied type of acute pain and is frequently used in clinical trials as the model of acute pain. This type of pain is medicated by the inflammatory substances discussed earlier. Other common types of acute pain include menstrual pain associated with dysmenorrhea, and pain following injury.

Acute pain can be further classified as somatic, visceral or referred. Somatic pain is superficial. Coming from the surface of the body (e.g., a paper cut). Visceral pain involves one or more internal organs and is usually poorly localized and often radiates (e.g., intestinal gas pain). Referred pain is pain that exists in an area that is distant from the site of the disorder.

Chronic Pain

Chronic pain is usually defined as pain that lasts for longer than six months, and which remains after the healing of tissue injury. Chronic pain can be further broken down into malignant and nonmalignant pain. Examples of nonmalignant chronic pain include back pain, neck pain, migraine headache, and arthritis pain. Chronic pain of malignant origin is primarily pain caused by cancer, which is managed with different treatment strategies than those used to treat nonmalignant pain.

The following table compares the characteristics of acute and chronic pain.

         Characteristics of Acute and Chronic Pain

Characteristic	Acute Pain	Chronic Pain
Types	Somatic, Visceral referred	Persistent (e.g., low back pain) Or intermittent (e.g., migraine)
Source	Acute or potential tissue damage	Usually unknown
Onset/Duration	Sudden, up to 6 months	Sudden or insidious, >6 months to years
Physiologic	Elevated heart rate, Respiratory rate, blood Glucose, Decreased GI motility and receptions, an and blood flow to visceral organs, Occasional nausea	Similar to acute pain but adaptation occurs and heart rate, respiratory rate and blood pressure are normalized
Psychologic Responsea	Fear, anxiety and uneasiness	Depression, behavior modification, insomnia  and denial
Prognosis	Complete relief probable	Complete relief unlikely

Signs And Symptoms Of Arthritic Disease

Medical Encyclopedia


Among the most common symptoms of arthritis are pain, stiffness, or locking of the joints, swelling, weakness, or difficulty moving, and fatigue, often resulting in emotional swings, such as anxiety or depression. Pain is the most common of these symptoms.

The kind of joint stiffness experienced by patients can help differentiate between different arthritic conditions. In osteoarthritis, patients may experience a gelling phenomenon which is a short-lived stiffness after periods of joint inactivity. This stiffness is relieved by exercising the affected joint inactivity. This stiffness is relieved by exercising the affected joint. In contrast the stiffness of rheumatoid arthritis is prolonged.

The number and type of joints affected can also vary with different forms of arthritis. Osteoarthritis usually involves one, or only a few, joints. It is asymmetric, in that it usually does not affect the same joint on both sides of the body. Rheumatoid arthritis tends to be polyarticular, effecting three  or more joints. In addition joint involvement tends to be symmetrical.


The specific joints affected by the disease also provide an important clue. In osteoarthritis, the distal interphalangeal (DIP) joint and the joint at the base of the thumb are frequently affected, while in rheumatoid arthritis, the proximal interphalangeal (PIP) joints, metacarpophalangeal (MCP) joints, and wrist are frequently affected.

Other signs and symptoms that may be associated with arthritis include swelling, inflammation, and a reduction in the range of motion of a joint. Patients may also experience a sensation of joint instability and /opr a dry. cracking sound or sensation from within the joint.

In advance disease, there is often evidence of destruction of cartilage, bone, and soft tissues of the joint. This can lead to functional impairment, which may be very disabling to the patient.

In addition to the physical symptoms attributable to joint involvement, patients may experience fatigue and mental depression. Thus, a number of psychosocial issues are as important as the treatment of physical symptoms in patients with arthritis.

Summary Point:

• The most common symptoms of rheumatic diseases are pain, stiffness, swelling, weakness, difficulty moving joints, fatigue, and emotional swings.

• Pain is the most frequently reported symptom of arthritis. 
  

Synovial Joint

Arthritis is a general term for a group of disorders that cause inflamed. swollen, and painful joints. Joints are found wherever two or more bones or cartilage and bone meet. There are many different kinds of joints in the body. They can be categorized according to structure or function. Among the structure variations are:

>   Fibrous joints.

>   Cartilaginous joints, and

>    Synovial joints

Joints can also be classified according to their ability to provide movement immovable joints are called synarthroses, slightly movable joints are called amphiarthroses, and freely movable joints are called diarthroses. Diarthroses are the most common joints in the body and they are the primary type of joint found in the extremities. Diarthrodial joints are often referred to as synovial joints because they contain a synovial membrane and synovial fluid. Arthritis occurs primarily in freely movable, synovial joints.

Fibrous joints, such as those that are found between the separate bony plates that make up the skull are fastened tightly together by a thin layer of fibrous connective tissue. In general, these joints allow little, if any movement and are therefore synarthroses.

The bones of cartilaginous joints are connected by cartilage. One example is the joint are connected by cartilage. One example is the joint between the public bones of the pelvic girdle. These joints allow limited movement, and are, therefore, amphiarthrotic.

The synovial, or diarthrotic, joint is of greatest interest in the study of arthritis. These joints are freely movable, and are much more complex than fibrous and cartilaginous joints.

Among the joints most commonly affected by osteoarthritis and rheumatoid arthritis are the joints in the fingers, toes, hips knees, wrists, and ankles. The proximal and distal interphalangeal joints of the fingers are hinge joints, while the metacarpophalangeal joints are modified hinge joints or condyloid joints. Hinge joints permit movements in different planes.

The hip and shoulder joints are ball and socket joints. This type of joint consists of a bone with a globular or slightly egg-shaped head that articulates with the cup-shaped cavity of another bone. This arrangement permits movement in a wide variety of planes, and includes movement around a central point or axis.

The knee joint is the largest and most complex of the synovial joints. It includes the upper leg bone the lower leg bone (the tibia), and the kneecap (patella). Although the knee is sometimes considered a modified hinge joint, the connection between the femur and tibia more closely resembles a condyloid joint, while the atriculation of the femur and patella is a gliding joint. In addition, this joint contains two crescent-shaped, fibro-cartilaginous menisci that project into the space between the femur and tibia. The menisci contribute to the stability of the joint and help distribute the body weight that is applied to it. The knee also contains bursae that act as cushions and facilitate the movement of tendons over bony surfaces.

Musculoskeletal - Rheumatic Disorders

Musculoskeletal disorders are among the most important causes of chronic pain and disability throughout of the world. Osteoarthritis, which is one of the most common of these disorders, is the single greatest cause of human locomotor problems. Although nonsteroidal anti-inflammatory drugs (NSAIDs) have been used for many years of treat these conditions, they are associated with number of potentially serious side effects.

RHEUMATIC DISORDERS IN PERSPEVTIVE

There are more than 100 distinct conditions that can be categorized as rheumatic or musculosketal. Some of these conditions involve multiple body systems while others affect primarily musculoskeletal tissues. Overall, these disorders are more prevalent, and a more frequent cause of disability, than either heart dieased or cancer. No age or racial group is spared, and clinical manifestations are diverse.

Arthritis and musculoskeletal diseases are among the most common reasons for physician office visits, as well as visits to surgeons, family doctors and specialists. These diseases are time-consuming to evaluate and manage. The economic impact of these diseases is associated with indirect physician visits, physical therapy, and drugs.

Osteoarthritis, also known as degenerative joint disease, is the most common form of joint disorder. Osteoarthritis of the knee and hip is the leading cause of chronic disability in developed countries. In some people, evidence for osteoarthritic changes may be present by the second or third decade (usually without associated symptoms) By age 40, almost everyone has evidence of some osteoarthritic changes in weight-bearing joints, although most people remain asymptomatic.

Interestingly, historic evidence for the existence of osteoarthritis has been found in nearly all vertebrate animals, including ancient fish, dinosaurs, birds, bears, whales, and dolphins. This suggests that osteoarthritis has an evolutionary origin. In man, the primary joints affected by osteoarthritis (joints in the knees, hips, spine, fingers and feet) suggest that this condition is a response to the special demands of the upright posture and prehensile grip.

Nonsteriodal anti-inflammatory drugs (NSAIDs) are a primary class of therapy prescribed for the symptomatic relief of the pain and swelling associated with arthritic disorders. They are the single largest group of medication used worldwide, with annual sales in excess of $US 2 billion. 

   Despite of the fact that NASIDs are the most widely used drugs for the treatment of arthritis, side effects may occur with these agents, and some of these reactions constitute a serious drawback to their use.