Evaluation and Control of Pain in Clinical Settings

Abstract

Background: Pain is a subjective and an unpleasant sensory and emotional experience associated with actual or potential tissue damage or injury. It can also occur without actual tissue damage, even though the patient refers to it. Pain is a conscious experience, an interpretation of the nociceptive input influenced by memories, emotional, pathological, genetic, and cognitive factors. Pain promotes defensive action and future avoidance behaviour, which requires associating defensive behaviour with resultant changes in pain. Pain has been a predominant health concern for mankind since the dawn of recorded history, and pain control is one of the cardinal objectives of the practice of medicine. It is the most common symptom of disease reported to physicians; more than 80 % of all patients who present to hospitals and clinics do so because of pain. Pain affects the general health, psychological health, social and economic well-being of an individual. The annual cost of uncontrolled chronic pain in the general population is in amount of hundreds of billions of dollars. Objective: The work discussed the evaluation tools and protocols, strategies for pain control, and future therapeutic drug targets for pain and analgesia. Method: The literature search used for the narrative review employed electronic databases in the search for relevant research articles, and they included scopus, pubmed, medline, google scholar, and the directory of open access journals. Others were the use of standard textbooks and the review of references of identified journal articles. Articles on pain and analgesia were identified and reviewed for selection. The keywords used in the search were: ‘’Pain evaluation, Pain assessment, Pain control, Pharmacotherapy of pain, Pain management, Types and characteristics of pain, Aetiology/ Cause of pain, Classification of pain, Severity of pain, Measurement of pain intensity, Pain evaluation tools, and Novel therapeutic drug targets for pain’’. The exclusion criteria used, included articles not written in English and those articles that hinged the clinical management of pain on herbal and alternative medicines (e.g., acupuncture, homeopathy etc.). Result: One hundred and ninety-seven works, ranging from published journal articles to non-journal articles were identified. A total of 82 research works, monographs and textbooks were selected. The works were extracted and reviewed after screening of the titles and abstracts, and in compliance with the inclusion/ selection criteria. Conclusions: Clinical pain is a serious public health concern. Pain evaluation is a multi-strategic observational assessment of a patients’ pain experience. The tools (self-report, behavioural and physiological) for pain evaluation have been demonstrated to be clinically effective in assessing acute pain. Pain evaluation is crucial and clinically useful for an effective and successful pain management. Pharmacotherapy is a critical component in the clinical management of pain, including acute, chronic and acute-on-chronic pain.