The Pain Clinic in the 21st century.jpg

The Pain Clinic in the 21st century

By Dr Miguel Pereira [email protected]

Dr Miguel Pereira is responsible for the Anesthesiology Department of the Hospital Particular do Algarve Group (HPALG) and has a Post-Graduation in Pain Medicine.

Pain is defined by the International Association for the Study of Pain (IASP) as a “multifaceted disagreeable experience involving a sensorial and emotional component associated to an injury”. It is known as the fifth vital sign.  

The treatment of pain is of the utmost importance, considering the increase in the rate of our normal life span, resulting in an increase of chronic illnesses such as osteoarthritis or cancer.

How is pain classified?

Pain is acute when its duration is less than six months or if it is associated to surgery, trauma or acute illness. It is due to a known cause, it’s in a specific region of the body and is easily identified or temporary in duration.

Pain is chronic when it persists for longer than one to six months after an acute episode, without time limit and sometimes due to an unknown cause. 

What are the various types of pain?

Nociceptive Pain – It is somatic when associated to trauma, burn or ischemia. It is localised and described as a sharp or stabbing pain.

Viscera Pain– It is known as a visceral pain when it is a nagging, deep, undefined, internal pain. This type of pain is often described by patients suffering from gastrointestinal dysfunction or cancer.

Neuropathic Pain – When there is an alteration in the function or structure of the nervous system. It is a central pain such as that suffered by patients after a stroke / neurologic illness or peripheral illness such as trigeminal cephalagias, diabetic neuropathy, postherpetic neuralgia or back pain. Patients describe this type of pain as a burning sensation, electric shock, pins and needles or painful to the touch (allodynia).

Psychological Pain – A psychological trauma which may result in physical pain – who hasn’t felt this at some stage in life?

How is pain diagnosed?

The rating and evaluation of pain is reached in The Pain Clinic by a doctor specialising in pain control. The patient undergoes a medical examination and the specialist will make note of medical history and study previous test results.

By utilising an appropriate scale, a pain level is then reached.

How to treat pain?

In 2001, a national plan was initiated in Portugal, with the creation of Pain Clinics throughout the country.

In addition to the various types of pain already described, there are infinite subjects and types of treatment for the relief of pain, such as myofacial, fibromyalgia or headaches. 

Treatment is based on the analgesic scale of the International Health Organisation with the use of various drugs and various techniques, some more invasive than others.

In HPALG hospitals, teamwork between the various specialists is fundamental, as referral to The Pain Clinic in the early stages of a disease may save the patient unnecessary pain. 

In the 21st Century, quality of life is fundamental as is dying with dignity.