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Physical Medicine Rehabilitation & Clinical Neurophysiology

Definition of Pain

Pain is defined as “an unpleasant sense that covers all prior experiences of an individual with or without any organic reason that originates from any part of the body”. Pain is essentially a sensation which enables the individual to be aware of the processes in their body. For example, a patient with appendicitis is alerted with abdominal pain. Without the pain, the patient would only become aware after the fever due to the infection of periton that is caused by the perforation of appendicitis.

Does Everyone Feel the Same Pain?

As stated in the definition, pain is a very complex sensation. It may result from an organic reason, which is any condition that harms the body (illness, trauma etc.). However, an organic reason is not the prerequisite for pain. There are also patients suffering with no possible medical explanation. Thus, pain may also result from psychological reasons. It is essentially a sensation. Each brain comprehends pain differently. For example, a patient feels no pain upon an injection while others suffer badly. It is explained with the concept of “pain threshold” in modern medicine. Meaning, there is a threshold for each person to comprehend a stimulus as “pain” and this threshold is different for everyone. It has been determined by applying a gradual pressure to the same sites in the body with a special pressure gauge (illustration) that the threshold for comprehending a sense of pressure as pain is different for each person. And this shows that pain is a personal sensation.

The History of Pain Management

It is quite understandable that pain management may be very challenging in some cases due to the complexity of pain. The history of pain management dates back to centuries ago. Herbal medicines and heat & cold applications are among the very first methods for pain management. Alpha salicylic acid (aspirin) extracted from willow bark underlies modern painkillers.  The introduction of non-steroidal anti-inflammatory drugs (NSAIDs) with remarkable studies in pharmacology is the groundbreaking advancement in pain management. This has been followed with the exploration of opioids and strong analgesics that are categorized as narcotics and sold with green/red prescription. Local anesthetics are medicines that block the sense of pain on the administration site for a certain time. Local anesthetics enable us to perform small surgical interventions, dental interventions without any pain to the patient. General anesthetics on the other hand enable us to perform surgeries without any pain by completely controlling the pain. For the last century of the history of pain management, many physical therapy methods have been developed and conventional methods are employed within the framework of modern medicine (illustrations; conventional and modern vacuum therapy). Physical therapy methods are highly utilized for pain management for the last thirty years.

Which Groups of Specialists Provide Pain Management? 


Pain is classified to determine the treatment protocols. Pain can be classified as acute pain and chronic pain based on the occurrence rate and somatic pain, psychosomatic pain and neuropathic pain based on the origin. It may be required for the patient to be treated by multiple physicians based on the origin of the pain (multi-discipline approach). A stomach ache might be relevant for an internal specialist, a general surgeon an a rheumatologist from time to time. However, the most common origin of the pain is musculoskeletal system and thus, the major group of specialists dealing with pain management is physical therapy specialists in our country. Recently, physical therapy, anesthesiologist  and neurology specialists are provided with the opportunity to become a specialist in pain management by taking an additional 2 years-of training. Pain management specialists provide some special interventions in addition to the therapies presented by physical therapy specialists.   These interventions are mainly spine-cervical vertebra injections in combination with fluoroscopy or CT.

Which Methods are Utilized in Pain Management?

Simple analgesics, anti-rheumatoid medications, opioid and narcotic analgesics (addictive drugs), antidepressants, neuropathic medications, cortisone, ozone injection, physical therapy methods (TENS, low frequency current, ultrasound etc.), special injections (spine, soft tissue, intraarticular injections, botox injections) are among the most commonly used methods in pain management.

Pain is a complex sensation and determining the source of the pain is the most important step of the treatment. Only after that, one or several of the methods above can be utilized for pain management.