Lesson 9 - Pain, Aging and Death

What is Pain?

It is one of the most common reasons patients seek medical help. It is a frequent symptom associated with a wide range of diseases and health conditions.

What is the definition of pain?

Pain can be defined as an unpleasant physical and emotional sensation caused by actual or potential damage to body tissue.

What are the Types and Causes of Pain?

1. Nociceptive Pain

2. Chronic Pain and Sensitization

What is Nociceptive Pain?

• This type of pain occurs due to tissue damage—for example, from injury, inflammation, or disease.

• It is the body’s natural response to harm and often signals that something is wrong.
  

What is Chronic Pain and Sensitization?

• If pain continues for more than 3 months, it is considered chronic pain.

• Chronic pain can occur even after the original tissue damage has healed, due to changes in the nervous system that make the body more sensitive to pain—a process called sensitization.
  

• These changes are difficult to reverse, which is why chronic pain may persist long-term and become a pain disorder in itself.

Why does early treatment matter?

Because nervous system changes that lead to chronic pain are hard to undo, it is important to treat pain early—before it becomes long-lasting and more difficult to manage.

How to measure pain?

1. Self-Reports

2. Observational Evaluations

3. Physical Assessment

What is self-report?

It involves the patient describing their own pain experience. This is one of the most common and direct methods of pain assessment.

• Patients are asked to rate or describe their pain using questionnaires, checklists, or verbal descriptions.

• These tools help healthcare professionals understand the intensity, location, and nature of the pain.

What are Observational Evaluations?

When self-reports are not possible (e.g., in young children, unconscious patients, or those with communication difficulties), observational methods are used.

• Healthcare professionals observe facial expressions, body movements, and vocalizations (like moaning or crying).
  

• These signs are then used to evaluate the patient’s pain level and make clinical decisions.

What is Physical Assessment?

This method involves using physiological indicators to assess pain, such as:

• Heart rate

• Blood pressure

• Body temperature

What is a dolorimeter?

This measures a person's pain threshold (the point at which pain is felt) and pain tolerance (how much pain a person can endure).

What are painful behaviours?

According to Turk and colleagues, a person's ability to manage or understand pain is often reflected in how they behave in response to it.

What are the three main types of pain-related behaviours?

1. Facial or Auditory Expressions

2. Aberrant Posture or Movement

3. Negative Emotional Effects

What are Facial or Auditory Expressions in pain?

• Visible and audible signs of pain.

• Examples: Grimacing, grinding teeth, moaning.
  

What are Aberrant Posture or Movement in pain?

• Unusual or protective body movements.

• Examples: Limping, holding or guarding the painful area.

What are Negative Emotional Effects?

• Emotional and psychological responses to chronic pain.

• Examples: Restlessness, irritability, depression

What are avoidance of activities?

• Withdrawal from daily routines and responsibilities.

• Examples: Not going to work, staying in bed, refusing to eat.

What are some pain management techniques?

There are a variety of non-drug treatments that help relieve and manage pain by targeting both the body and mind. These methods are particularly helpful in chronic pain and for patients seeking holistic care.

• Acupuncture

• Mind-Body Techniques

• Massage Therapy

• Meditation

What is Acupuncture?

• A traditional practice where thin needles are inserted into specific points of the body.
  

• Research shows it can help relieve pain and is also used for other health complaints.

What are Mind-Body Techniques?

These therapies teach how the mind and body interact, helping to reduce stress, improve emotional balance, and alleviate pain.

What are some examples for mind-body techniques?

• Relaxation Therapy
  Helps calm the body and mind, reduce stress, and ease pain. Focus is often placed on breathing techniques.
  

• Hypnotherapy (Hipsoft)
  Used for conditions like back pain, repetitive strain injuries, and even cancer-related pain. It helps shift focus away from the pain.
  

• Guided Imagery (Guided Representation)
  This technique involves focusing on calming mental images to reduce pain, helpful for headaches, arthritis, and chronic illness pain.
  

• Biofeedback
  A method where patients learn to control unconscious physical processes (like heart rate or blood pressure) to reduce stress-related symptoms and pain.

What is Massage Therapy?

• Improves blood flow, reduces muscle tension, and lowers stress and anxiety.
  

• Particularly effective for chronic back and neck pain.

What is Meditation?

• Calms the mind and helps individuals cope with emotional and physical pain.

• Encourages mental clarity, peace, and better emotional response to discomfort.

What is aging and population aging?

Population aging refers to the gradual increase in the proportion of elderly individuals within a country’s total population. This shift occurs due to declining birth rates and increased life expectancy, and it presents both social and economic challenges for governments and communities.

What is Age Thresholds for Elderly Population?

• In developed countries, individuals aged 65 years and above are considered elderly.
  

• In developing countries, such as Sri Lanka, the elderly population is generally defined as those aged 60 years and above.

What are the Aging Trends in Sri Lanka?

• In 1964, 5.4% of Sri Lanka's population was aged 60 or older.
  

• By 2001, this figure had risen to 9.9%.
  

• Between 1981 and 2011, the elderly population doubled.
  

• By 2041, it is projected that 27.8% of Sri Lanka’s total population will be aged 60 years or above, indicating a significant demographic shift.

What is the Regional Comparison in South Asia?

• In the year 2000, Sri Lanka had the highest percentage of elderly people in South Asia, at 9.3%.
  

• By 2025, Sri Lanka is expected to be the most rapidly aging country in the region, even surpassing India in aging rate.

What are Socioeconomic Issues in Aging?

1. Increased Dependency Ratio

2. Healthcare Demands

3. Pension Costs

4. Strain on Economic Resources

What is the issue in Developed vs. Developing Countries?

• In developed countries, population aging occurred gradually alongside socioeconomic development. This allowed these nations to plan ahead and implement systems to support their elderly populations.
  

• In developing countries, however, aging is happening rapidly and without corresponding economic growth. As a result, these countries face serious challenges in addressing the needs of their elderly citizens.

What is Death?

It is defined as the permanent cessation of all biological functions that sustain a living organism. In medical terms, "brain death"—the irreversible loss of brain function—is commonly accepted as the definition of death in humans.

What are the Causes of Death?

• Aging

• Accidents

• Medical conditions (e.g., heart disease, cancer)

• Violence (e.g., killings, martial law-related deaths)

• Suicide

Additionally, sudden deaths may result from:

• Severe illness

• Unintentional injuries

• Self-harm

What are the Challenges in the HealthCare System in Long-Term Disease Management?

• Managing NCDs requires a life-cycle approach, focusing on prevention, early detection, and continuous care.
  

• The existing primary health care system needs to be restructured to better handle this rising burden.

What are the Key Initiatives in Long-Term Disease Management?

The Primary Health Care System Strengthening Project (PSSP)—funded by the World Bank—is a major initiative aimed at:

• Improving the quality and accessibility of primary health care services.
  

• Enhancing the early detection and management of NCDs.
  

• Providing care to high-risk populations.
  

• Supporting the Ministry of Health’s efforts to redesign the health care system for long-term disease control.

How Mental Health Affects Physical Health?

• People with mental health disorders (such as anxiety, depression, or chronic stress) are more likely to develop physical illnesses like heart disease, high blood pressure, diabetes, or weakened immunity.
  

• Ignoring or neglecting mental health can worsen the condition and lead to other complications, both psychological and physical.
  

• Experts believe that various mental states can manifest physically, such as through fatigue, body aches, digestive issues, or sleep disturbances, all of which affect daily functioning.

What is the perspective of WHO?

• Mental health is not just the absence of mental illness—it is a state of complete physical, mental, and social well-being.
  

• The WHO strongly emphasizes that mental health is essential for overall health, productivity, and life satisfaction.

What are ways to Support Both Mental and Physical Health?

1. Regular Exercise

2. Building Social Connections

3. Getting Enough Sleep

4. Engaging in Hobbies

5. Connecting with Nature