How many people can endure pain. High and low threshold of pain sensitivity in women or men - what is measured and what it depends on. The most complete assessment of pain - the McGill questionnaire

06.11.2019

Pain is a very unpleasant sensation, signaling that there is a problem with the body, that a person must get rid of its source. Every year, $50 billion is spent on the development of new pain medications. Acute pain disappears quickly after the cause is identified and eliminated. Chronic pain can last for years, negatively affecting the quality of life. We offer a rating of the most unbearable pain that a person can experience.

Since the Achilles tendon is the strongest and longest in the body, when it is torn or injured, a person experiences very sharp and severe pain. It is located from the middle of the calf down to the very heels, the length of the tendon is 15 cm. It allows you to walk, jump, run. When a tendon is injured or torn, which is not uncommon in athletes, a person experiences pain similar to a bullet wound. A rupture requires surgery, and damage requires long-term rehabilitation.

Unfortunately, many people who are attacked in the wild by large animals such as lions, tigers and bears do not survive and cannot describe what the pain they experienced was like. These large and strong animals strike, bite and scratch during the attack. During the attacks, limbs are torn off from the victim, large pieces of flesh are torn out - the beast simply tears apart the body of the victim.

13. The birth of a child

Only a woman can describe the pain at the birth of a child. Today, several brave male volunteers have agreed to undergo the experiment. Electrodes were attached to their bodies to simulate contractions and labor. It is not known whether the pain was as severe as it happens during real childbirth, but the men really suffered. They described it in such a way that their muscles twisted from the inside, their stomach ached, the bones of the pelvis moved apart so that it seemed that the internal organs wanted to crawl out.

Stones in the kidneys or in the bladder are formed from deposits of calcium salts, uric acid and cysteine. Scientists call the phenomenon of stone formation "nephrolithiasis". People who have kidney stones experience sharp spontaneous pains that radiate to the side, lower back and right shoulder. In addition to unbearable pain, the temperature may rise, blood is found in the urine and feces, and vomiting appears. Stones either come out on their own or are removed by a surgeon during surgery. Most stones are 3 mm in diameter, which is enough for the stone to block the flow of urine from the kidneys. The largest stone that was removed from a patient was 15 cm in diameter.

Many periodically have a headache, but paroxysmal pains appear as a result of neurological disorders. The pain is localized in one place in the head, mainly in the eye area. Since there are several such attacks during 6-12 weeks, they are called cluster ones. Those people who have experienced cluster headaches say that their sensations are similar to having a red-hot poker inserted into the eye. Cluster headaches are unbearably severe, people even have suicidal thoughts in order to stop them.

Naturally, many will say that a third-degree burn is more painful, since it causes damage to several layers of the skin, but since the nerve endings burn out, the pain is actually not so strong. But a second degree burn causes very severe pain. They can cause shock, they are so strong.

Seizures, which are known medically as "titanus" or tetanus, cause unbearably severe pain. Titanus is a bacterial infection caused by Clostridium tetani. When it enters the body, it releases a poison that causes painful muscle cramps, especially in the maxillofacial muscles. You can become infected by stepping on a rusty nail and getting hurt, and if a person has not been vaccinated against tetanus.

8 Wart Bite

The warthog is a type of fish found in coastal regions of the Pacific and Indian Oceans that has neurotoxin glands. The wart, or stone fish, can mimic under the bottom stones, which means that when walking along the shore, a person can step on it. The fish instantly stings a person with its spike with neurotoxin, the person experiences sharp and unbearably severe pain. If the dose of neurotoxin was very large, then within two hours the victim dies. Edema forms at the site of the bite, and the toxin spreads very quickly throughout the body. The person is delirious, he is sick, paralysis sets in, and convulsions begin. If a fish bite fell on the chest or abdomen, then it is almost impossible to save a person.

An abscess can be localized anywhere in the human body, but if it occurs in the area of the tooth, then the pain is unbearable. Caries allows bacteria to enter the tooth and cause inflammation and swelling. The infection spreads further, covers the bone around the tooth, causing complications. In addition to severe pain, the patient experiences fever, swelling of adjacent tissues, etc. Fortunately, antibiotics can help, but without the help of a surgeon who must open the abscess, you can not do it.

Peritoneal tissue lines not only the inside of the peritoneum, but also the organs of the small pelvis. When it becomes inflamed, terrible pains begin. Peritonitis occurs as a result of inflammation of the appendix, with perforation of the gastrointestinal tract, with injuries of the peritoneum, after operations, as a complication. A person has very strong and acute pain, the temperature rises, vomiting begins. If a person is not helped, then death will occur.

Torsion of the testicles in men and the ovaries in women causes a sharp, sharp pain. When the spermatic cord becomes twisted in men, blood rushes to the testicles, causing severe pain. Urgent surgical intervention is required. Ovarian torsion most often occurs in women over 30 years of age. When twisted, the artery is clamped and acute pain appears. Only urgent surgery can help.

A fracture of the penis causes one of the most severe and inhuman pains. It can occur during intercourse. With careless actions, the cavernous bodies, the albuginea and in some cases the urethra are torn, and the man hears a characteristic crunch and experiences terrible pain. Over time, the penis will swell and turn blue. In such cases, surgical intervention is necessary.

Derkum's disease is characterized by the appearance of painful tumors throughout the body. In 85%, this disease occurs in women, as women are more prone to obesity. However, recently this disease has begun to occur in men and not in obese women. Tumors cause very severe pain, similar to the pain of a burn. The habitual processes of dressing or taking a shower cause unbearable attacks. The cause of the disease has not yet been identified, and treatment is symptomatic.

With inflammation of the trigeminal nerve, the pain is similar to the fact that lightning passed through the body. Most often, inflammation occurs in men: 1 case per 20,000 people. The pain can last from a few seconds to several hours. Therapy for trigeminal neuritis is to relieve symptoms and prevent complications.

1. Bullet ant bite

A volunteer, Gemish Blake, voluntarily sticks his hand into a mitten full of ants and a bullet - in a few seconds, the hand is bitten up to 100 times. This is one of the famous initiation rites of the Brazilian tribes, and Blake decided to test how painful it was. According to the pain index according to the Schmidt scale, developed by Dr. Justin O. Schmidt, the bullet ant sting pain index is 4.0+ (maximum). This pain is similar to that experienced when burned with coals or when a long rusty nail penetrates the heel. No less in other parts of the world.

An analysis of brain activity during pain will help create a device for an objective assessment of the severity of pain.

There is a thermometer to measure the temperature, but to answer the question “how badly does it hurt?” Doctors still have to rely on the subjective assessments of patients: “very”, “not very”, etc. In addition, if you have to treat an infant, then you won’t ask him where and how it hurts (not to mention when a person is generally unconscious).

Pain, like any other, is reflected in brain activity, which can be seen with a tomograph. Of course, researchers couldn't help but think of using one of the various tomographic methods to create an objective pain gauge. However, the brain is a complex system; it simultaneously processes a lot of information related to current sensations, memory, etc. Therefore, the primary task here was to find exactly those changes in its activity that correspond to pain sensations.

One such attempt was made a few years ago by neuroscientists at Stanford: they used an algorithm that predicts the nature of sensations without knowing anything about what caused them. With the help of such a “blind” method, visual activity was previously assessed, as well as brain function when performing a task. It turned out that it is also possible to distinguish pain from non-pain with 80 percent accuracy. True, questions immediately arose: will this method work for any kind of pain, how does a person’s emotions affect it, etc.

On the other hand, there are areas in the brain that respond in a special way to pain - the thalamus, the somatosensory cortex, and the anterior cingulate cortex. Maybe you don’t need to take all brain activity, but focus only on such zones? Over time, however, it turned out that they react not only to real pain, but also to thoughts about it and even to social conflicts. However, two years ago, researchers at the University of Colorado at Boulder published a paper claiming they had succeeded in separating social pain from physical pain. Moreover, they even managed to determine with a very high accuracy the moment of transition between a simply strong sensation (when a person held a moderately hot cup in his hand) and pain (when the cup became very hot).

In a new paper published in Nature Neuroscience, Oxford neuroscientists discuss another area of the brain that could be a good pain gauge: the superior parietal insular cortex. In Irene Tracy's experiment ( Irene Tracey) and her colleagues involved 17 volunteers who applied a cream with the substance capsaicin contained in hot peppers to the skin of their legs. Capsaicin burned the leg, while the researchers monitored brain activity. When the pain subsided, a container of hot water was applied to this place on the skin to “refresh” the sensations. Then, after a few minutes, the hot water was replaced with cold water to soothe the pain. In general, the entire experiment lasted several hours. When scanning the brain, a method was used that made it possible to evaluate its activity over a sufficiently long time - this way it was possible to compare changes in pain sensations and compare them with how they were described by the participants in the experiment themselves.

The authors of the work conclude that only the upper parietal part of the insula can serve as an adequate indicator of pain - due to the fact that the experience lasted long enough, it was possible to check how much the activity of the brain zone depends on some fleeting experiences.

The insula has long been known to be related to pain, but we needed to make sure we could trust its testimony. Of course, it remains to be seen how she feels other pain, especially that which comes from the internal organs. It is easier to assess the activity of any one area of the brain than several or even the entire brain. Although, perhaps in the end, the pain meter will turn out to be some kind of algorithm with which it will be possible to process the readings of several brain regions that respond with the greatest specificity to physical pain.

Pain is always an unpleasant sensation. But its intensity can be different: it depends on what disease has developed, and what pain threshold a person has.

So that the doctor can understand exactly how it hurts - unbearably or more or less moderately - the so-called pain scales were invented. With their help, you can not only describe your pain at the moment, but also say what has changed with the appointment of treatment.

Visual analogue scale

This is the scale most often used by anesthesiologists and oncologists. It is an opportunity to assess the intensity of pain - without any prompts.

The visual analog scale is a 10 cm long line drawn on a blank sheet of paper - without cells. 0 cm is “no pain”, the rightmost point (10 cm) is “the most unbearable pain, which is about to lead to death.” The line can be either horizontal or vertical.

The patient should put a dot where he feels his pain is located. The doctor takes a ruler and looks at what mark the patient's point is:

0-1 cm - the pain is extremely weak;
from 2 to 4 cm - weak;
from 4 to 6 cm - moderate;
from 6 to 8 cm - very strong;
8-10 points - unbearable.

When evaluating pain, the doctor not only looks at this point, but also at the whole behavior of a person. If a person can be distracted with questions, if he calmly walked through the office to the exit, perhaps he exaggerates the degree of pain. Therefore, he can be asked to re-evaluate his pain - on the same scale. And if this is a woman, then ask to compare with the pain during childbirth (it is estimated at 8 points for each woman). If she says: “What are you, giving birth was twice as painful,” then it is worth estimating her pain at 4-5 points.

Modified visual analog scale

The essence of pain assessment is the same as in the previous case. The only difference between this scale is in the color marking, against which the line is drawn. The color goes in a gradient: from green, which starts from 0, to 4 cm it changes to yellow, and to 8 cm it changes to red.

Verbal rank scale

It is very reminiscent of a visual analogue scale: also a 10 cm long line that can be drawn in front of the patient yourself. But there is a difference: every 2 cm there is an inscription:

at 0 cm - no pain;
2 cm - mild pain;
at around 4 cm - moderate pain;
6 cm - strong;
8 cm - very strong;
at the end point - unbearable pain.

In this case, it is already easier for a person to navigate, and he puts an end to it, based on which epithet he most associates with his own state.

The positive side of this method of pain assessment is that it can be used to assess both acute and chronic pain syndrome. In addition, the scale can be applied to children, ranging from elementary school students, as well as people with elementary degrees.

Scale of pain "in faces" (facial)

This scale can be used to measure the intensity of pain in people with advanced dementia. It consists of 7 drawings of faces with emotions, each of which schematically conveys the strength of the pain syndrome. They are arranged in order of increasing pain.

Why exactly the drawings, and even such primitive ones? Because it is easier to read emotion from such drawings and harder to misinterpret than from a work of art or a photograph.

Before a person points out a face that displays the appropriate degree of pain, he needs to explain the picture. The doctor says: “Look, nothing hurts in the first person, then people who feel pain are shown - every time more and more. The most right person is terribly tormented by pain. Show me how much pain you feel." After that, the person points or circles the desired face.

Modified face scale

It consists of 6 faces, each of which depicts an emotion corresponding to the description of pain on a verbal rank scale. It is also used to assess the intensity of pain in dementia and is also conducted after a short introduction.

The scale used for bedridden and speechless patients

Resuscitators use the CPOT scale, which allows them to assess the degree of pain without talking to the patient. They take into account 4 parameters:

Tension of the muscles of the hands.
Facial expression.
Attempts to speak or resistance to breathing apparatus.
motor reactions.

Each parameter is evaluated from 0 to 2 points, after which the points are summed up.

The interpretation is this:

0-2 points - no pain;

3-4 points - mild pain;

5-6 points - moderate pain;

7-8 points - severe pain;

9-10 - very severe pain.

The most complete assessment of pain - the McGill questionnaire

Thanks to this questionnaire (questionnaire), it is possible to evaluate three main systems for the formation and conduction of pain:

nerve fibers that conduct directly pain sensations;
structures that are in both the spinal cord and the brain: the reticular formation and the limbic system;
departments in the cerebral cortex that deal with the assessment and already the final interpretation of pain.

Therefore, the questionnaire is conditionally divided into 4 groups:

to determine the sensory characteristics of pain;
to assess which pain affects the emotional components;
to evaluate how pain is assessed by the brain;
a group of words that are aimed at evaluating all criteria at once.

Physically, the questionnaire looks like 20 columns, each of which contains from 1 to 5 epithets, arranged in order - in accordance with the intensity of pain. The person needs to circle as many of them as will help him accurately describe his feelings.

The pain index is assessed by how many words were used to describe pain for each of the 4 parameters. It is also important which sequence numbers were used to evaluate each aspect. And, finally, the serial numbers of the selected epithets are summed up, their arithmetic mean value is calculated.

What are pain scales for?

Not all doctors use pain scales. They are mainly used by anesthesiologists, resuscitators, therapists and oncologists. Sometimes they are faced by doctors and other specialties when it comes to chronic patients.

Depending on how the pain is assessed, an anesthetic will be prescribed:

With mild pain, this is a non-narcotic pain reliever: Ibuprofen, Analgin, Diclofenac, Paracetamol.
With moderate - 2 non-narcotic analgesics with slightly different points of application, or a combination of a weak narcotic drug and a non-narcotic analgesic.
Severe pain requires the appointment of strong narcotic and non-narcotic analgesics. Often it is necessary to resort to additional methods: blockades of the nerve pathways, alcoholization (introduction of ethanol) into the nerve endings, which are the cause of chronic severe pain.

Any of these drugs has a lot of side effects. Therefore, it is in the interests of the patient to assess his own pain as objectively as possible, and if it changes, report it to the doctor. Now, if the doctor does not react in any way, then he needs to be changed to another specialist.

Everyone has experienced pain many times in their lives. It could be related to illness, injury, or the birth process. Not everyone can tolerate pain. But it depends entirely on the intensity of unpleasant sensations and on the emotional state of the person at the moment.

It is believed that there are several types of pain that are most unpleasant for a person: toothache, kidney pain and pain during childbirth. Recently, many inquisitive people are asking the question: "Is there a unit for measuring pain?". Various scientists undertake to investigate the nature of the phenomenon of pain. It is also known that the human body has a pain threshold. Our body protects us in times of danger. From pain shock, you can faint. This happens at a time when it is no longer possible to endure. Many argue that the unit of measurement for pain is "div" or "dol". There are also statements on the topic of how much pain a person can endure.

Pain during childbirth

Since the creation of the world, women have given birth to children. There are various rumors about the torment that women in labor had to endure before the baby was born. But one thing is indisputable - every pregnant woman is afraid of this pain to varying degrees. Gynecologists have their own opinion on this. They argue that during childbirth, the body naturally releases a hormone into the bloodstream that has an analgesic effect during contractions and attempts. Also, it is proved that the emotional state of the woman in labor plays a huge role in this process. With a panic fear of pain, the brain mentally intensifies it, despite the fact that it still doesn’t hurt so much. You can use different methods that make the process of childbirth not so painful. The most effective is proper breathing. It will help you relax as much as possible in this situation. It is also said that during childbirth, a unit of pain is much greater than that which a person can endure. Is this a myth or true? So far, there is no evidence that a common unit of measurement for pain actually exists. After all, one woman in labor will be very hurt, and the other will tell that she gave birth without labor and pain. Such cases are not uncommon.

The arguments of scientists

You do not need to be a scientist to understand that each person has a different pain threshold due to the individuality of the organism. This is also proved by the fact that some people treat their teeth without anesthesia, and the majority cannot endure even a minute of such a test. Women experience critical days in different ways. Some can tolerate without difficulty, while others require painkillers. The unit of measurement of pain is a controversial concept. For each person, pain is different in intensity. Therefore, there can be no reference number, just like pain assessment scales. And, therefore, this fact contradicts the definition of units of measurement. Therefore, some scientists argue that the unit of measurement of pain is a myth. Perhaps the great minds of our time will reflect on this issue and create a scale of pain. But this requires great mental and financial costs, numerous studies and inventions. It is possible that soon a device will be made that uses such an indicator as a unit of pain measurement.

Pain is a natural reaction of the body to irritants that bring discomfort and threaten aggression. Nature has endowed every creation with pain. It is due to the fact that we can experience pain that we save our body, our body from the destructive effects of the external environment. When we raise our hand to the fire, we pull it away, when we cut our finger, we also try to get rid of the object that injured the hand. All these actions are natural, since they are aimed at maintaining the integrity of the body and its normal functioning. The pain that a person encounters has a different strength, so an interesting question arises, is there a unit for measuring pain? And if so, what are the limits of the body. After all, there are circumstances that cause a person to die - not so much on the nature of the lesion, but on how strongly the lesion affected the body. Pain is not only a local reaction, it is primarily a response of leading systems - cardiovascular, nervous, hormonal, respiratory, muscular.

The unit of measurement of pain, or, more simply, the strength of painful sensations, in which a person notes the discomfort associated with getting a pain syndrome, has occupied the minds of scientists for a long time. There is even a special science - algology - the science of pain. In order to determine when a person becomes sick, a special device was invented - an algesimeter, which measures the force that must be applied to the surface of the skin in order for a person to experience pain. The action of the algesimeter, however, is highly controversial. An organism that is able to adapt to various environmental conditions, after a while, ceases to feel so much pain for a certain stimulus, if this stimulus acts with a certain periodicity. Roughly speaking, if you prick your finger a hundred times with a needle, then you may not feel the hundred and first. Therefore, it is impossible to see a perfect device in the action of an algesimeter, but it is possible to find out only approximately to what strength of pain a person is susceptible, without calculating any clear indicator.

It is also impossible to say that the unit of measurement of pain is universal. After all, no matter what numbers scientists determine it, it is individual for each person. It is enough to cite the most common question that will be constantly exaggerated in society - Judging by the expressions of some ladies, these are hellish pains that simply cannot be endured. Other interlocutors claim that they did not notice the period of contractions and childbirth at all, but felt only tolerable whining in the lower abdomen. Already this example proves that everyone has their own unit of measurement of pain. And in America there is a girl at all who does not feel pain. As doctors later found out, the genes that are responsible for this protective reaction were affected in the child, as a result of which the unit of pain was equal to zero.

Pain is a fairly manageable reaction. It is possible to manage it, and people with different pain thresholds can do it. As mentioned above, when pain occurs, it is included in the work that sends a pain signal from the site of injury to the brain. Not many people can control and process such information. Nevertheless, we know vivid examples when people withstand burning coals, pierce soft fabrics with knitting needles and hooks. And this is by no means for the sake of the show - there was simply a long-term systematic work to block pain impulses. Such secrets and mysteries are not revealed even now, but it is clear that these people are prone to nociception - an incorrect (in this case, reduced) perception of the pain syndrome.

To date, British scientists have conducted a series of experiments in which they tested people for endurance to pain and recorded impulses under certain influences. Studies have shown that there are organs in which the response to pain was the strongest. But the unit of measurement of pain - del - is still relative. Due to many factors, it is unlikely that it will be possible to accurately determine the strength of pain and correlate it with any indicators.