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What exactly is pain?

Only the very lucky manage to go through life without experiencing really serious pain. It can be a sports accident when young, or broken bones in a traffic accident, or that paralyzing, just-can’t-move moment when you think you’re having a heart attack. Whatever the cause, it’s not something you can ever forget. It’s like the world just stopped moving for a moment and everything became focused on whichever part was damaged. Then, if the luck persists, the pain goes away. It may take weeks or months. But the sense of relief as you slowly feel your life coming back together again. The sense you can move again without everything coming to a stop again. These are feelings you treasure.

Almost everything that moves anticipates or feels pain. That’s why even the smallest insect moves out of your way when you might step on it, or the fish thrashes on the end of the line as you pull it out of the water. It’s a universal sensation, common to all living things that have any type of nervous system. In the wild, it’s the essential survival message system, bringing you news that part of you is under attack and you should either fight back or get out of Dodge the fastest way possible. At our level of physical performance, it’s the same message except we head for a doctor or the Emergency Room depending on the extent of the problem. All this is wonderful except the designer forgot to instal a way of switching it off. Yes, we know already, is not enough to tell it to stop. It just keeps on making itself felt.

This makes a key distinction. If the pain is actually going to stop, the pain is called acute. The best examples are injuries and illnesses that we can cure. One the skin has grown back over the wound or the bones have knitted back together, the pain will stop. But if the pain is going to set in, this is chronic pain. It can be months or years without any real change. So a disease like arthritis will slowly damage a joint and, every time we move or put weight on it, the background pain will intensify.

The second important distinction is between nociceptive and neuropathic pain. Nociceptive pain is where the nervous system is working exactly as it was designed, i.e. it tells us exactly where the source of the problem is. That’s why you can go into a consult with a doctor and point to the area of tenderness or pain. But if the pain does not seem to be associated with a particular source of injury, it’s called neuropathic. Sometimes, this is a problem with the nervous system itself or it’s a documented form of sympathetic pain where injury in one part of the body is reflected to a different part. The key to understanding all this is that the pain is actually an electrical signal generated in the nervous system and transmitted to the brain. Ultram intercepts that message and prevents it from reaching its destination. That way Ultram works no matter what the cause of the pain and no matter which part of the body has been injured.