British medical bulletin
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Acute visceral pain is dull, aching, ill-defined, badly localized and often referred to remote areas of the body. These properties indicate that the representation of internal organs within the CNS is very imprecise. ⋯ The number of nociceptive afferent fibres in viscera is very small but these few nociceptive afferents can excite many second order neurones in the spinal cord which in turn generate extensive divergence within the CNS, sometimes involving supraspinal loops. Such a divergent input activates several systems--sensory, motor and autonomic--and thus triggers the general reactions that are characteristic of visceral nociception: a diffuse and referred pain, and prolonged autonomic and motor activity.
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Psychological factors are contributory to the genesis and maintenance of many chronic pain syndromes. Treatment can be delivered either as one component of multimodal therapy or as the sole approach in a pain management programme. ⋯ Relaxation training is also of benefit. The documented success of these techniques in various settings suggests that psychological treatment should be considered a necessary component of any multidisciplinary clinic offering therapies to chronic pain sufferers.
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Interest in the management and study of pain in children has increased in recent years. A range of techniques appropriate to children with different developmental levels is now available for the assessment of various aspects of childhood pain. A management plan can be developed depending on the cause of pain and choosing from a range of therapeutic techniques. ⋯ Suitable drugs are now available but inexperience and myths may still result in reluctance to use appropriate strong analgesics in children. Postoperative pain control and the analgesic needs of neonates have been particularly neglected areas. Management can be dramatically improved by increasing staff sensitivity and the use of an integrated programme of drugs, physical techniques and psychological approaches.