The Perception of Pain

By | December 2, 2011

For some patients an ingrown toenail is an annoyance, while for others it is a disability.

There is an old saying in the chronic pain community that if you relieve 90% of a patient’s pain the 10% is 100% of what is left. For these patients any pain is unacceptable. In my opinion they probably represent the opposite of the patients we discussed in yesterday’s blog, in that they are unable to suppress any sensation of pain. All afferent impulses impinge on their consciousness. We have had some success treating these patients with a combination of tricyclic antidepressants and SNRIs. Together these drugs seem to lessen the conscious perception or the patient’s preoccupation with pain. On close questioning the patients will usually report that at some level the pain is still there. It just doesn’t seem to bother them as much.

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