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Pain – Fifth vital sign

PAIN, is now regarded as the ‘Fifth Vital Sign’. Yet, until recently, it has been a sadly neglected field of behaviour in medicine. After centuries of misconceptions and neglect, it was only in 1958, that Wall & Melzack, proposed the ‘Gate Theory’, which revolutionized the field of human pain mechanisms. More recently, Merskey & Bogduk, in 1994, for the International Association for the Study of Pain (IASP) defined pain as an “unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage”. Dr John J Bonica, considered to be the ‘father of chronic pain’, was one of the first to stress that acute and chronic pains must be differentiated. This has been substantially demonstrated by the recent and current research on pain based on neurophysiologic and chemical investigations demonstrating the plasticity of the brain and neural circuits involved in pain behaviour. Over the last 50 years, pain medicine has undergone tremendous progress and has emerged as a specialty of its own which requires a multidisciplinary as well as multimodal approach. Now over the last around 20 years, the pain specialty has increasingly become aggressive with the advent of many new interventional strategies coming up its sleeve, and a new subspecialty known as ‘Interventional Pain Management’ has established itself.