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By Dr. Patrick D. Wall, Mervyn Jones (auth.)

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Extra info for Defeating Pain: The War Against a Silent Epidemic

Sample text

During this time, you may have feIt a slight buming along the scratch, and you also observe a prickly feeling if you run your fingers lightly across the scratch. The reason for these sensations is that the nerves have been sensitized by chemicals released by the damaged tissue. You have now produced the four classical signs of inflammation: 1. Redness, caused by dilation of the blood vessels. 2. Heat, caused in the first place by a flow of warm blood brought by the dilated blood vessels. If the damage is extensive and prolonged, the brain will respond to it by producing a fever, with flushing, high temperature, and sweating.

One recorded example is that of a linoleum layer who cut his finger with a sharp blade, so that about an inch of fingertip remained attached only by a narrow flap of skin. Astonished that he was feeling no pain, he washed and bandaged his finger and drove in his car to the hospital. On the way, he feIt hot throbbing sensations, and by the time he entered the emergency dinic, he was in pain. But at the time when he was still pain-free, he was fully aware of what had happened and his injury-detecting sensory fibers were sending their messages at maximum intensity.

Five percent of the patients never required analgesia during the whole recovery period. The pain has a time course not only in intensity, but in 46 Chapter 2 nature and quality, moving from acute to more long term. Since operations-like many injuries-go deep, there is a variety of pains, each with its mIes and distinct natural history. For example, women who have had a cesarean section report at least three separate recognizable pains. First, there is the incision, with its stitches, as an obvious source.

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