What pain during childbirth. Is there a unit for measuring pain? 45 del unit of pain

To create an objective pain scale, the researchers burned the hands of ... women giving birth.

On the day of the first launch of a man into space, it is worth thinking about how many failed experiments and tests account for one scientific and design success. Even if we are talking about cosmonautics, the accidents and triumphs of which are in full view, we know mainly about major disasters with human casualties. We know crumbs about the daily scientific turnover, and if a particular field of science does not have media adherents and cannot boast of something spectacular, then here failures and failures are generally of little interest to anyone - except for narrow specialists. Meanwhile, the history of some studies that turned out to be inconclusive and subsequently curtailed “in working order” could serve as material for an action-packed film.

In the forties of the twentieth century, a group of researchers from the famous American Cornell University began a series of works on the creation of a pain scale. The lack of an objective indicator of pain sensations still causes a lot of problems for medicine: one has to rely on purely subjective assessments like “does not hurt very much”, “hurts” and “it hurts a lot”. The goal was to develop a unit of pain that would give objective information about pain sensations, regardless of their nature. An apparatus was constructed that heated the skin on the forehead of volunteers - several medical students. As a unit of pain, scientists proposed dol (from dolor - pain). Then the experiments began: the volunteers had to listen to their own feelings and report how their intensity changes.

After a thousand measurements, a scale from 0 to 10.5 dol was created. Above this value, the person ceased to distinguish changes in pain sensations. Just imagine: the level of 8 dol left a second-degree burn on the forehead. At the same time, according to the researchers, subjective pain sensations completely obeyed arithmetic laws, that is, 8 dol equals 4 dol plus 4 dol. The experiment, as mentioned, involved medical students who sometimes remained without sleep for 30 hours - however, according to the authors of the work, general fatigue did not affect the intensity of pain.

The following experiments were even more eccentric. To compare their system of measuring pain with real sensations, the authors invited 13 pregnant women who ... burned their hands between labor pains. Several areas on the arm were heated to varying degrees immediately after the next contractions in order to find out what value of the pain scale corresponded to the sensations experienced by the women in labor. Each time, the hand was burned in several places at once in order to have time to take a measurement before the next attack of contractions, and in addition, multiple cauterizations made it possible to avoid getting used to the pain.

The results of all this were very modest. Many women experienced labor pains that apparently exceeded the 10.5-dol scale. Not to mention that pain from burns interfered with subsequent labor pains. However, the researchers concluded that the initial contractions corresponded to 2 dol , the passage of the baby's head through the birth canal is 10.5 dol or more, and three hours after birth, the pain drops to 3 dol.

All this, generally speaking, is slightly reminiscent of well-known stories about medical experiments in Nazi concentration camps. The results obtained were published in the form of a series of articles in 1940, 1947, and 1948. However, no practical benefit came out: the subjectivity of pain sensations has not gone away, as well as the inability to separate pain sensations of different nature.

In a word, even a cynical argument about the end justifying the means does not make sense here, since none of the goals has been achieved.

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 rating 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.

Many people know the expression "phantom pain." It means the subjective experience of painful sensations in the amputated limbs. That is, the limb is no longer there, and pain in it sometimes occurs, and such that it brings terrible torment. Already in this phenomenon the dual nature of pain is hidden. On the one hand, this is a physiological phenomenon caused by a certain stimulus, due to which a corresponding reaction of the central nervous system occurs. But on the other hand, the feeling of pain is very individual. Some scream from an accidental prick with a pin, while others, without changing their faces, put out a lit cigarette on their tongues.

Let us ask ourselves the question: is it possible to identify quantitative indicators of pain? With mass, everything is simple: the more, the heavier the object. With energy it’s more difficult, you have to remember the physics course and practice arithmetic. But with pain, it would seem, nothing definite. But the inquisitive minds of the men of science tried to penetrate the secrets of pain and draw up a scale of pain sensations. The basis of such research was, of course, insects, and the intention of the researchers turned out to be very simple. It is known, for example, that a bee sting causes severe pain. Indeed, what if we take this indicator as a unit, and all the values ​​\u200b\u200bthat exceed this threshold are expressed as a ratio with this coefficient.

Entomologist Justin Schmidt was the first to use such a scheme. In 1984, he proposed the "stinging Schmidt index" that was named after him. The bites of various insects were determined in the range from 0 to 4. True, the Schmidt scale is not linear, that is, index 2 does not mean that the degree of pain is exactly 2 times higher than index 1. This is the weak side of the scale. According to Schmidt, "null" refers to an insect bite that does not penetrate human skin. And index 1 is the sensation of pain from a bee sting, which is defined as "light, ephemeral." What insects follow next in this peculiar hit parade?

Index 1.2: fire ants - "acute pain, similar to a fire burn."

1.8: acacia ants - "increased pain, similar to a piercing."

2.0: hornet - "increased pain, repeated bites are fatal."

2.0: oars (paper wasps) - "pain commensurate with extinguishing a cigarette on the tongue."

3.0: red American reaper ant - "terrible pain."

4.0: wasps - tarantula hunters - "feeling of a strong current, causes blindness."

4.0+: Tropical Ant Species - "Ultimate Sting Pain Power".

The insects that deliver the most pain as a result of a bite are large tropical ants from the genus Paraponera. They are common in Central and South America and were first described by the Danish entomologist Johann Christian Fabricius in 1775. For a strong sting and very painful bites (the pain is felt all day long!) These insects even got the name "bullet ant". It would seem that with a sting index of 4+, you need to run headlong from these predators, but among the Maui Indian tribe, bullet ants are used in the rite of initiation of the transition to adulthood. Ants are caught, put to sleep with a special herbal infusion, and then placed in a glove in the amount of several dozen. A boy who claims to become a full-fledged member of the tribe puts this glove on his hand and waits for the ants to wake up, after which he must endure their numerous bites for at least five minutes without changing his face! Temporary paralysis and blackening of the fingers along with unbearable daily pain are guaranteed!

6 years after the introduction of the pain index from insect bites into biological science, Schmidt improved his scale. In 1990, the scientist classified the stings of almost 80 species of bees, wasps and ants, describing in more detail the sensations from their stings.

However, it is worth recognizing that the pain from insect bites, being a good marker of pain in humans, still does not cover the entire spectrum of such an amazing phenomenon as pain. Almost half a century before J. Schmidt, scientists tried to create a scale of pain, for which they ... burned the test subjects!

In 1940, a group of doctors at Cornell University decided to create a device to measure the intensity of pain. As a unit of measurement of pain, they chose the concept of "dol", from the Latin dolor, dolores, which literally means "pain". Specialists have developed a quantitative scale of 21 points, or "dol", on which they tried to measure the degree of pain in patients.

To do this, the volunteers were exposed to heat on their foreheads for three seconds, in other words, they burned them! Moreover, since there were only four volunteers in the first experiment, they decided to let them go through a maximum of experiments, which eventually accumulated more than a hundred. Subsequently, James D. Hardy and colleagues improved this scale. They divided the 21 intervals into two sub-intervals "having a basis for marked changes in pain sensation". However, further experiments, due to clearly inhumane experiments, had to be stopped, because already at 8 dollars (albeit on a 10.5-point scale), the heating device caused a burn of the second degree to the forehead of the subject ...

Obviously, fixed indicators of the degree of pain allow you to treat it in a more adequate way. Therefore, it is not surprising that research in this area has become the prerogative of medical science. And Russian scientists play a dominant role here. So, in 2003, our compatriots G.A. Adashinskaya, E.E. Meizerov and A.A. Fadeev patented an invention in the field of medical psychology on a method for assessing pain.

The researchers proposed to test the patient on seven scales: 1) frequency, 2) duration, 3) intensity, 4) sensory perception of pain, 5) emotional attitude to pain, 6) level of neuroticism and 7) level of adaptability. The neurotization level scale takes into account the main behavioral factors - anxiety, emotional lability, aggression, depression, psychogeny, hypochondria, which makes it possible to increase the reliability of pain assessment.

The scientists note: “Measuring pain seems to be a complex set of problems. The individual perception of pain is influenced by demographic factors, gender, age, ethnic characteristics, as well as the emotional and physical state of the patient. For the qualitative and quantitative assessment of pain, psychological methods are increasingly being used, taking into account the factor of the subjective self-assessment of pain by the patient, as well as the doctor's analysis of the behavioral and affective components of pain.

In the proposed method, the patient describes his pain sensations on a scale from 0 to 6 according to several factors: the frequency of pain (absent, once every few days, almost daily, daily, almost hourly, the pain is almost constant, constant), the duration of pain attacks, etc. The subject also expresses his feelings verbally (so-called "descriptors") and even chooses colors according to the degree of pain.

Research scientists have shown that most patients with severe pain choose black, red or gray. With unbearable pain, the tendency to prefer black is greatly enhanced. At the same time, in the group with psychogenic pains, the yellow color is “leading”. For color testing, the same eight colors are used as in the well-known Luscher test: 1 - blue, 2 - green, 3 - red, 4 - yellow, 5 - purple, 6 - brown, 7 - black, 8 (0) - grey.

It is also interesting to note that a comparative statistical analysis of pain sensations revealed a significant difference in the perception of pain by men and women. Moreover, both on a scale of sensory perceptions, and on an emotional-affective attitude to pain. In addition, scientists have proposed measuring "tools" to identify the dependence of the degree of pain on the time of day, sleep, food intake, weather, general condition, exposure to harmful conditions, as well as the "posture-movement" factor!

With a combination of objective and subjective factors in the phenomenon of pain in identifying the degree of pain sensations, it is impossible, of course, to do without a verbal description of patients. Medical science has amassed an impressive vocabulary of relevant descriptors indicating the intensity of pain. Here is an example of scaled pain sensations: 0 - no pain, 1 - pressing, 2 - sore, 3 - gnawing, 4 - bursting, 5 - breaking, 6 - tightening, 7 - squeezing, 8 - holding down, 9 - scraping, 10 - scraping , 11 - scratching, 12 - shearing, 13 - pulling, 14 - pulling, 15 - aching, 16 - pulsating, 17 - drilling, 18 - boring, 19 - stabbing, 20 - tingling, 21 - dagger, 22 - piercing, 23 - tearing, 24 - tearing, 25 - cutting, 26 - chopping, 27 - whipping, 28 - sawing, 29 - pinching, 30 - biting, 31 - shooting, 32 - burning, 33 - burning, 34 - braining, 35 - migrating , 36 - paroxysmal, 37 - superficial, 38 - deep, 39 - wavy, 40 - beating, 41 - monotonous, 42 - dull, 43 - twisting, 44 - numb, 45 - chilling, 46 - itchy.

Agree, this scale is at the intersection of medicine and literature, so the above definitions can be a note to writers. Even more interesting are the descriptors that reflect the emotional attitude to pain: 0 - no pain, 1 - indifferent, 2 - insignificant, 3 - not disturbing, 4 - distracting, 5 - interfering, 6 - disturbing, 7 - annoying, 8 - annoying, 9 - annoying, 10 - depressing, 11 - disgusted, 12 - painful, 13 - frightening, 14 - tormenting, 15 - tormenting, 16 - exhausting, 17 - harassing, 18 - awesome, 19 - painful, 20 - torturing, 21 - exhausting, 22 - terrible, 23 - terrible, 24 - severe, 25 - indefinite fear.

Content

The tolerance of traumatic factors is determined by the functioning of the central nervous system. The pain threshold depends on the level of irritability of the nerve endings and feelings arising from unpleasant influences. This indicator is transmitted at the genetic level, but it can be changed by learning what parameters determine it. Although women experience the most excruciating pain for a person during childbirth, men in life are distinguished by a higher degree of tolerance and adaptation.

What is pain threshold

The degree of perception of traumatic effects on the body is related to the level of excitation of the nervous system. The subjective reaction of the body to severe pain determines its threshold for a person. The ability to endure unpleasant sensations is laid down in the genes, so this characteristic is individual for each. The strength of pain that a person is able to withstand is still determined by the source of irritation, emotional mood and hormonal levels. In a state of passion or during childbirth, sensitivity is reduced due to the instinct of self-preservation and the influence of the endocrine system.

Low pain threshold

Serious danger - shock. The low threshold of pain sensitivity, together with the inability to tolerate discomfort, makes any traumatic manipulation unbearable. You should always warn the doctor about your threshold so as not to get psychologically traumatized. At low rates, it is not recommended to pierce ears, make tattoos, painful cosmetic procedures with injections without using various methods of anesthesia: special creams that are applied to the skin, sprays.

High pain threshold

With this type of sensitivity, it is much easier to endure stressful situations for the body. Having a high pain threshold does not mean that you can put yourself to the test. It is believed that the degree of susceptibility depends on the psychotype of a person. Those who do not experience fear of physical influences at all, as a rule, are active, extreme, and have leadership qualities.

Pain threshold in women and men

The degree of perception of feelings depends on gender. Evolutionarily determined the role of a man - a hunter, defender, conqueror, who had to endure suffering and endure blows in fights. The male sex hormone, testosterone, has an analgesic effect. In this regard, men have a constant high threshold of sensitivity.

Women have a more vulnerable nervous system due to a larger number of receptors; there is less testosterone in their blood. In addition, historically, the fair sex was little exposed to negative stimuli from the outside world. This results in a low pain threshold. The sensitivity of a woman directly depends on the period of the menstrual cycle and changes in the time of day. So, in the morning and during periods of menstruation, increased vulnerability is observed.

What does it depend on

In addition to gender, a number of internal and external factors influence the pain threshold. Knowing them, you can control your feelings and sensations. If you have to undergo medical or cosmetic procedures that cause discomfort, you can prepare your body for stress. It is important to keep in mind that the pain threshold can change over time and circumstances. What factors affect this:

• experienced nervous shocks, degree of fatigue;
• the presence of inflammatory processes in the body;
• diseases of the nervous system, the degree of its training;
• genetic predisposition;
• saturation of the body with useful substances and vitamins;
• individual physiological characteristics;
• the amount of vitamin B necessary for the normal functioning of the nervous system;
• psychological mood, psychosomatic characteristics, emotions.

Pain types

There are four types of people according to the tolerance of unpleasant sensations. The first type has a low sensitivity threshold. Such people acutely perceive minor physical, psychological pain. The second type differs from the first in a wide tolerance range. This means that they perceive pain hard, but they are able to endure suffering. The third type is characterized by a high degree of tolerance and a short interval: with an increase in unpleasant sensations, they immediately give up. The fourth variety tolerates pain calmly and has a strong reserve of patience.

The fourth type just needs to tune in morally to unpleasant sensations, and medical manipulations will be perceived calmly. It will be possible to avoid pain shock during medical procedures if you determine in advance the type to which the patient belongs and select the appropriate anesthesia (aerosol or injection). In addition, for the fourth type, it is important to develop a sense of empathy. It may seem to children related to him that since they are not hurt, then others do not suffer.

How is a person's pain measured?

In the middle of the last century, scientists set out to develop an objective scale of unpleasant sensations. As a result of a series of 100 experiments, a quantitative estimate from 0 to 10.5 dollars was created. The name of the unit of measure comes from the Latin name for pain "dolor". During labor, a woman experiences sensations in intensity equal to 10.5 dollars. For comparison: during the experiments in which the scale was developed, with pain of 8 dollars on the forehead of the study participants, a second-degree burn from the action of high temperature remained.

How to know your pain threshold

On an outpatient basis, the degree of sensitivity is determined using a special apparatus - an algesimeter. There are 4 types of unpleasant sensations: nociception (a physical sensation in which nerve receptors begin to transmit signals to the brain), pain, suffering. This device allows you to identify the onset of the action of the stimulus, as well as the interval between the first stage and the last. According to the reaction to the impact and the stages from nociception to a state close to shock, the pain type of personality is determined.

Test

The algesimeter fixes the minimum and maximum pain threshold. During the evaluation, the area between the toes and hands, where the skin is most delicate, is exposed to heat or electricity. The minimum threshold implies the pain that already causes discomfort, and the maximum - the one within which it can be tolerated. Based on the results, the therapist draws conclusions about the person's tolerance.

How to raise your pain threshold

To reduce sensitivity, you can influence those factors that determine the threshold of unpleasant sensations. For example, before a traumatic procedure, it is recommended to get enough sleep, not to drink alcohol and drugs. Tune in to a positive outcome, to the desired result. Regular physical activity and sex increase stamina, harden, stimulate the production of endorphins, which inhibit discomfort. There are a few more home remedies to temporarily increase your pain threshold:

• meditation, yoga classes, relaxing massage;
• adherence to a diet, the use of foods rich in vitamin B, which promote the secretion of serotonin;
• distraction of receptors through the use of ginger, red pepper, mustard, horseradish, chili peppers.

How to downgrade

It is impossible to completely change the sensitivity, because it is laid at the level of genetics. There are techniques that only temporarily change the pain threshold. A high threshold of sensitivity causes delight in many, it helps to endure intense unpleasant effects, but this also indicates low sensitivity. In sex, seafood, massages, essential oils, ice cubes will help enhance sensations.

How important is it to know your pain threshold?

Awareness of personal tolerance for discomfort will help you decide whether to do cosmetic procedures that cause injury. This helps to determine whether anesthesia is needed in this case, what kind of it to apply. Knowing the absolute threshold of pain, you can train nociceptors - zones of nerve endings that respond to unpleasant sensations. Those who walk barefoot on broken glass are doing sensitivity work, adapting to traumatic external factors.

Video

Attention! The information provided in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment, based on the individual characteristics of a particular patient.

Pain measurement – algesimetry (Greek: algesis, sensation of pain + metreo to measure, determine). There are the following types algesimetry :

experimental

1. subjective

   1. pain threshold

      by intensity of pain

      pain tolerance threshold

objective

clinical

multidimensional

AT experimental algesimetry Both subjective and objective tests are used. Pain can be induced by thermal, electrical, mechanical, or chemical stimuli. Experimental algesimetry is a rapidly expanding area of ​​research that can provide fundamental information about the nature of pain.

Subjective algesimetry. For experimental study of the relationship between noxious stimulus and pain in people apply classical psychophysical methods.

AT subjective algesimetry measures:

pain threshold, those. the lowest intensity of the stimulus that causes a sensation of pain;

pain intensity, expressed verbally or by some other signal;

pain tolerance threshold- the intensity of stimulation at which the subject asks to stop it.

Objective algesimetry. As applied to humans, objective algesimetry consists mainly in measuring motor and autonomic responses to pain and recording cortical evoked potentials (the term "objective" simply means that variables recorded by the observer are measured, and not the "subjective" responses of the subject).

Often several methods are used simultaneously (for example, recording evoked potentials while tracking pupil diameter as an indicator of sympathetic tone), and subjective tests can be combined with objective ones. (multidimensional algesimetry).

Clinical algesimetry. One approach to clinical algesimetry is based on the use of methods of relative assessments (subjective);

H For example, the patient is asked at different times to reflect their painful sensations on a simple analog scale - from the absence of pain to its intolerance.

In another method, he is presented with lists of questions such as the widely used McGill Pain Questionnaire.

Finally, clinical pain can also be correlated in intensity with experimental pain. For example, when defining tourniquet pain ratio the patient compares his sensations with experimentally induced (by applying a tourniquet) ischemic muscle pain.

Adaptation to pain

In addition to the intensity of pain, from a clinical point of view, it is important whether a person adapts to it. Subjective experience seems to indicate lack of adaptation(headache and toothache can last for hours). When pain from prolonged exposure to hot is measured experimentally(Fig. 10.3), adaptation to it is also not found. The pain threshold even decreases slightly over time, and this shows that prolonged thermal stimulation causes sensitization nociceptors in the affected area. (On the other hand, in everyday life one usually observes addictive to multiple nociceptive stimuli.)

Theories of pain

Pain specificities

Pattern (pattern theory)

1. intensity

   distribution

Gate control (spinal processing of nociceptive information).