Types of pain

Colicky pain is indicative of an obstructed hollow organ. It is griping in nature and fluctuates, with peaks of intensity followed by partial, complete relief before a further bout occurs. Colicky pain is always severe and makes the patient restless. The patient rolls about in agony, unable to find a comfortable position. It is usually accompanied by nausea, vomiting.

Somatic pain, e. the severe pain due to inflammation of the parietal peritoneum from localized or general peritonitis, is aggravated by movement. The patient lies still and breathes shallowly to diminish abdominal wall excursion with respiration (e.g. perforated peptic ulcer), assumes a position that releases tension on the abdominal musculature, i.e. draws the knees up, a posture often observed in patients with acute pancreatitis. The pain of acute peritonitis is also aggravated by coughing.

Burning pain signifies mucosal injury/inflammation and is typified by the heartburn of reflux oesophagitis, the burning indigestion encountered in patients with peptic ulceration and the dysuria that accompanies inflammation of the urinary bladder (cystitis).

Intermittent claudication is the term used to signify cramp-like pain in the muscles of the lower limbs (usually calf, but may involve the thighs and gluteal regions) that develops with walking and subsides with rest, after which the patient can resume walking before the pain comes on again. It is caused by peripheral occlusive vascular disease (atherosclerosis), with a resultant defective blood supply leading to the accumulation of metabolites such as lactic acid on exertion. The claudication distance (the distance the patient can walk before the onset of muscle cramps) reflects the severity of the peripheral vascular disease.

Rest pain is a much more serious type of vascular pain. The patient experiences pain in the affected limb at rest. The pain is severe, constant and interrupts sleep. Some relief is obtained by dangling the affected limb over the edge of the bed. Rest pain denotes threatened viability of the limb and requires urgent vascular treatment to prevent the development of gangrene.

Root pain is caused by irritation of the spinal dorsal roots and can be caused by compression (vertebral collapse) or direct malignant involvement. The pain radiates from the back around the body, usually on either side, in the distribution of the respective dermatomes. It is often accompanied by both sensory changes (paraesthesiae) and motor changes (muscle weakness/paralysis, bladder dysfunction). Pain due to inflammation, partial injury, neoplastic involvement of nerves, nerve roots is known as It is always severe, often intractable and requires special measures that may include neurosurgical intervention.

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