A Conceptual Model of Pain
by James Woessner, MD, PhD
 Pain, as a concept and symptom, is discussed and described throughout
professional and lay medical literature. “Pain” is the reason for initial
contact with any physician for the vast majority of medical problems, e.g. abdominal pain,
chest pain, limb pain, low back pain, etc. Understanding pain mechanisms, however, is
often hampered by the complex neural interconnections involved in pain. Any one, or
combination, of the following mechanisms can contribute to pain: neural “sensor”
stimulation, neural “wire” misfiring, and “perceptron” dysfunction.
The general public often righteously complains about the lack of recognition and help
for their pain and discomfort — aside from direct treatment of the underlying medical
pathology. On the other hand, many physicians feel helpless, in the face of the onslaught
of public indignation, to help with pain that is not supported by “standard”
laboratory and/or radiological evidence, or even by “physiologically” consistent
behavior; someone just can’t hurt overall!
Medical doctors depend on knowledge of the pathophysiology or at least a diagnosis to
decide on treatment. Thus, to maximize success, physicians need to understand how pain is
perceived. Certainly, knowing where and what the problem is, increases the likelihood of a
positive outcome. Present categories of pain mentioned in medical literature are helpful,
but these concepts are not organized to provide the practicing physician with handles that
can help the physician more effectively treat those patients presenting with pain —
particularly chronic pain.
While the Joint Commission now recognizes and mandates pain as the “fifth vital
sign,” the present focus of Pain Medicine is “cover-up” rather than
“cure.” Even with an abundance of detailed Pain Medicine literature, there
appears to be a limited understanding of the basic mechanisms of pain, even within the
research world. Obviously, without a reasonably detailed diagnosis reflecting the
underlying pathophysiology of a given pain, treatment is no more than “hit and
miss.”
Please refer to the Sep/Oct 2002 issue for the complete text. In the event you need to order a back issue, please click here.
— Sep/Oct 2002
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