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Pain is an unpleasant sensory and emotional experience usually arising from actual or potential tissue damage. Acute pain can be a difficult medical problem to diagnose and treat. It may be caused by many events or circumstances. Symptoms can last hours, days, or weeks and are commonly associated with tissue injury, inflammation,
a surgical procedure, childbirth, or a brief disease process. Other types of pain may be classified as chronic (pain of long duration), neuropathic (pain resulting from damage to nerves), psychogenic (pain not due to visible signs of disease or injury), or cancer-related (effects of a malignant disease on the body). The January 2, 2008,
issue of JAMA includes an article that identifies trends in the prescription of medicines to treat acute pain in US emergency departments.
Diagnosing the cause of pain
Your doctor will ask you about your symptoms and the history of your illness, injury, or surgery. You may be asked to fill out a questionnaire to assess the intensity and location of your pain.
The Wong-Baker FACES Pain Rating Scale (below) may help young patients rate pain intensity.
Ongoing depression, anxiety, and substance abuse need to be identified. Additional diagnostic tests may include
Imaging studies (x-ray, CT, MRI, nuclear scans, ultrasound)
Dye-injection studies such as a diskogram to identify painful disks in the spine or myelogram to identify areas of spinal nerve compression
Electromyography and nerve conduction studies to identify nerve abnormalities
Treatment of pain
Diagnosing and treating the cause of pain is an essential aspect of treatment. Initial treatment may include some of the following:
Resting the affected part of the body
Application of heat or ice
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, or naproxen; or acetaminophen
Bioelectric therapy (using local electrical stimulation to moderate pain)
medications (such as codeine or morphine)
Muscle relaxant medications
A secondary tier of treatments may include
Nerve blocks (use of local anesthetics to block nerve activity)
Trigger point injections to treat muscle spasms
Steroid injections to reduce tissue inflammation
For more information
American Pain Foundationhttp://www.painfoundation.org
American Board of Pain Medicinehttp://www.abpm.org
American Society of Anesthesiologistshttp://www.asahq.org
To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA's Web site at http://www.jama.com. Many are available in English and Spanish. A previous Patient Page on acute abdominal pain was published in the October 11, 2006,
issue; one on opioid abuse was published in the September 15, 2004,
issue; and one on pain management in the November 12, 2003, issue.
Faces scale from Hockenbery MJ, Wilson D, Winkelstein ML. Wong's Essentials of Pediatric Nursing. 7th ed. St Louis, MO: Mosby; 2005:1259.
Used with permission. Copyright: Mosby.
Sources: American Pain Foundation, American Board of Pain Medicine,
American Society of Anesthesiologists
The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients.
To purchase bulk reprints, call 203/259-8724.
Zeller JL, Burke AE, Glass RM. Acute Pain Treatment. JAMA. 2008;299(1):128. doi:10.1001/jama.299.1.128
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