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Pain, Suffering, and Palliative Sedation
Published in Kathleen Benton, Renzo Pegoraro, Finding Dignity at the End of Life, 2020
After more than three centuries, Descartes’s theory still enjoys great popularity and interprets pain as a sign of damage to which the body is exposed and from which it is necessary to defend itself. Various pathological conditions confirm this approach. Congenital analgesia (an insensitivity to pain) is an emblematic example. Those who are affected by this disease, fortunately very rare, die quite young, since it is impossible for them to make use of this precious warning. However, it is difficult to find a satisfactory definition of pain, since other phenomena do not correspond to this description, and indeed contradict it.1 First of all, it is not uncommon for pain to come late; not a few diseases, even serious ones, develop without warning. When pain occurs late, the deterioration of the organism can be very advanced and sometimes irreversible: there is damage without pain. On the other hand, in many circumstances, the pain does not allow the body to activate any defense reaction but only makes an impaired situation even more painful. Pain then becomes a disease in itself, particularly when protracted in a chronic form: it “further weakens the subject and makes it more ill than it would be without it,” as René Leriche (1937) says in his classic work on surgical pain (quoted in Le Breton, 2010, 11).
Nervous system
Published in David Sturgeon, Introduction to Anatomy and Physiology for Healthcare Students, 2018
Broadly speaking, pain can be divided into two categories: acute and chronic. Acute pain typically persists for a relatively short period of time, is focal to the site of injury and acts as a protective mechanism. That is to say, it signals to the brain that there is an actual or potential problem that requires some kind of protective response. Chronic pain, on the other hand, may have no identifiable cause and serves no biological function. In this sense, it exhibits the characteristics of a disease state rather than a self-limiting symptom. At one time or another, we have all thought ‘wouldn’t it be nice to have no pain at all’. However, without acute pain at least, we would be at constant risk of tissue damage and serious injury. Those who suffer from the rare genetic condition congenital analgesia experience precisely this problem and often fail to perceive and respond to injury. One particularly gruesome anecdote told by a sufferer relates to his failure to notice he was chewing his tongue whilst eating breakfast. The polar opposite of this condition is phantom limb pain, where sufferers experience pain or other sensations (e.g. itching, tingling and/or cramp) in a part of the body that has been amputated or surgically removed. We will explore why this might occur later in the chapter.
The Lived Experience of Pain
Published in Daniel S. Goldberg, The Bioethics of Pain Management, 2014
Pain is fundamental to our lived experiences as human beings. A painless existence is not conducive to human flourishing. Known as congenital analgesia, individuals who have this rare genetic disorder often suffer repeated injury, including broken bones, lacerated skin, damage to internal body tissues, and have significantly shortened life expectancy.1 The point is that in whatever manifestation, pain is a fundamental part of human life. This is in part why a phenomenological approach to thinking about pain is so important. Such an approach expressly begins by refusing to abstract the phenomenon of pain from its context in the flow of lived experiences.
MR neurography showed brachial plexus abnormalities in syringomyelia with shoulder Charcot arthropathy: a case report
Published in British Journal of Neurosurgery, 2023
Kai Chen, Lijing Deng, Hualong She, Fang Hu, Tao Li
Charcot’s arthropathy is an uncommon chronic degenerative arthropathy caused by underlying neuropathies from diabetes, leprosy, syphilis, congenital analgesia, syringomyelia or trauma. Syringomyelia causes approximately 5% of Charcot’s joints.1 The shoulder joint is a common site. Its nerves mostly arise from the brachial plexus. We describe a case of syringomyelia with right shoulder Charcot’s arthropathy in a 60year-old female. We used MR neurography to examine the bilateral brachial plexi, deformity and signal reduction of the diseased brachial plexus was seen.