Pain; algema. Boerhaave, and most ether authors on this subject, assign a stretching of the nerves as the only immediate cause of pain: but this is a partial view of the subject, since compression, irritation, and many other causes, concur. See the articles Cerebrum, Nervi, and Sympathia.
Many kinds of pain are described by authors; as a gravitative pain, or a sense of weight on the part affected, as the liver; a pulsative pain, which always succeeds some remarkable inflammation in the containing parts, and is a symptom of suppuration; a tensive or a distending pain, excited by the distention of some nervous, muscular, or membranous part, from a fluid, or flatulence; an acute pain, when attended with quick and lively sensations; a dull pain, when attended with numbness.
The mediate and more remote causes of pain are generally obvious, and the cure will consist generally in removing them; for though, in many instances, the chief complaint is very distant from the seat of these causes, yet their removal is the most effectual method of relief. For these methods we must refer to the particular articles.
When pain is owing to inflammation, the pulse is quicker than in a natural state, generally full, hard, and tense; the pain is equal, throbbing, and unremitting. If a spasm is the cause, the pulse is rarely affected; at intervals the pain abates, and then returns with a considerable degree of aggravation; gentle motion sometimes abates the pain; but in inflammatory pains no such relief is ever experienced.
The pains so frequently attendant on child-bed women, called after pains, from their occurring after delivery, arc often occasioned by coagulated blood, which excites the action of the uterus to discharge it. Care should be taken not to confound them with the pains attending puerperal fevers, or the colic. After pains come by fits, and soon go off, but return at different intervals, usually longer each day, and after two or three generally cease. Notwithstanding these pains, the lochia flow properly; but the violence of the pain is generally followed by the discharge of clots of coagulated blood. This is not the case in colic; and puerperal fever is attended with shivering and tumefaction, with soreness on the abdomen.
As these pains arc spasmodic, opiates, with frequent draughts of warm caudle, camomile tea, etc. are only necessary. See Puerperalis febris.
under the denomination painful diseases, because pain is the characteristic symptom and constant concomitant of such complaints, as gout, rheumatism, and colic, and these all arise either from irritation spasm, or distention; but most commonly from the first often inducing the two last.
When pains arise on taking cold during the use of mercury, which is not unfrequently the case, a continuance or a repetition of the mercurial course is the only cure. See the third volume of the London Medical Observations and Inquiries, p. 244.
Dolor faciei crucians. We have adopted this little change from Dr. Fothergill's appellation of the tic doloureux. In fact, it is a pure unmixed pain, from a nervous affection only; and, when we consider the subject of nosology, we shall find, in this, and some other diseases, a strong inducement to form an order or class of Dolores.
It is an affection of a branch of the fifth pair of nerves, which passes through the infra orbital foramen to the cheeks. The pain is most excruciating, not constant, but not regularly intermittent, or ushered in by a febrile paroxysm. Opiates scarcely lull its violence, and the only remedy is the division of the nerves. It has been said that the pain returns after the operation; but we have no evidence that nervous sensation is communicated through the medium which unites the end of the wounded nerves, though some sensation is referred to the part, from an affection of the trunk, or superior branches. If there was the slightest suspicion of this kind, a portion of the divided nerve might be cut off, so that the extremities would be no longer in contact. A more common cause of the failure of the operation is, that the trunk of the nerve, when it escapes from the foramen, is not divided; but some principal branch has been mistaken for it. Dr. Fothergill, in a late treatise on the subject, has collected all that has been said on the Tic doloureux, q. V. The name is derived from the pungent stroke with which the pain attacks, resembling the bite of an insect.