Definition of colicky pain
Reading File
Finding Sources
Reading File
Reading File
Colicky Pain - Definition
Colic (colicky pain) is a type of pain that occurs when the muscular wall of a hollow tube attempts to force its contents through an obstruction or narrowing. It arises from the smooth muscle of any hollow viscus (bowel, ureter, bile duct, etc.) contracting forcefully against resistance.
Key Features (from S. Das - Manual on Clinical Surgery)
- Sudden onset and sudden offset - the pain appears abruptly and disappears just as suddenly (unlike a gradual crescendo-decrescendo)
- Griping in nature - a squeezing, cramping quality
- Intermittent and wave-like - it comes in paroxysms that correspond to peristaltic contractions
- Associated symptoms - often accompanied by vomiting and sweating
- Duration of each episode - the gripping pain of intestinal colic typically lasts less than a minute per episode
- Application of local pressure may relieve it (biliary, ureteric, or intestinal colic)
Mechanism (from Harrison's Principles of Internal Medicine, 22nd Ed.)
Intraluminal obstruction of a hollow viscus classically produces intermittent or colicky pain that is not as well localized as the pain of parietal peritoneal irritation. As the viscus progressively dilates and loses muscular tone, the colicky character of the pain may actually diminish and be replaced by a more steady, constant pain.
Four Common Types in Surgical Practice
| Type | Origin |
|---|---|
| Ureteric colic | Ureter (e.g. renal stone) |
| Biliary colic | Gallbladder/bile duct |
| Intestinal colic | Small or large bowel obstruction |
| Appendicular colic | Early appendicitis (central, diffuse, intermittent - later becomes constant RIF pain) |
Note on "Biliary Colic": Harrison's points out that this term is technically a misnomer - sudden distension of the biliary tree actually produces a steady rather than truly colicky pain. The term persists by convention despite the pain not fitting the strict wave-like pattern.
- S. Das: A Manual on Clinical Surgery, 13th Ed., p. 17
- Harrison's Principles of Internal Medicine, 22nd Ed., p. 154
Different types of pain
Finding Sources
Finding Sources
Reading File
Reading File
Reading File
Reading File
Reading File
Here is a comprehensive overview of the different types of pain, drawn from multiple authoritative textbooks.
Definition of Pain
Pain is defined as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage."
- Harriet Lane Handbook, 23rd Ed.
Classification I: By Mechanism (Pathophysiological)
This is the most clinically important classification.
1. Nociceptive Pain
Caused by activation of nociceptors (pain receptors) in response to tissue injury or inflammation. It serves a protective/adaptive function.
Subdivided into:
| Subtype | Origin | Character | Examples |
|---|---|---|---|
| Somatic | Skin, bones, joints, muscles, ligaments | Sharp, aching, throbbing, stabbing - well localized | Fracture, incisional pain, arthritis, cellulitis |
| Visceral | Internal organs (bowel, bladder, ovaries) | Deep, aching, colicky, gnawing - poorly localized, may be referred | Early appendicitis, intestinal obstruction, liver metastases |
2. Neuropathic Pain
Caused by injury, disease, or dysfunction of the nervous system itself (not from tissue damage). Pain travels on damaged nerves.
- Character: burning, "pins and needles," shooting, electric-like, stabbing - often with background of aching
- May be associated with allodynia (pain from normally non-painful stimuli) and hyperalgesia (exaggerated response to painful stimuli)
- Subtypes:
- Peripheral neuropathic: sciatica, nerve entrapment, diabetic neuropathy, postherpetic neuralgia
- Central neuropathic: brain injury, stroke, Parkinson's disease, thalamic pain
- Treatment: tricyclic antidepressants, anticonvulsants (gabapentinoids), nerve blocks
3. Nociplastic Pain
Caused by altered nociception in the absence of demonstrable tissue damage or nerve injury.
- Character: widespread, intense - often with fatigue, insomnia, memory difficulty, mood disturbance
- Examples: fibromyalgia, complex regional pain syndrome (CRPS), depression-associated pain
- Treatment: TCAs, SNRIs, gabapentinoids
4. Myofascial Pain
Pain originating in the muscles, often from biomechanical changes. Relevant especially in head & neck cancer patients post-surgery or radiotherapy.
Classification II: By Duration
| Type | Definition |
|---|---|
| Acute pain | Short-lived; serves protective function; physiologic responses (tachycardia, diaphoresis) prominent |
| Chronic pain | Persists beyond normal healing time (generally >6 months); becomes a disease in itself with permanent CNS changes; strongly influenced by psychological and social factors |
Chronic pain may be accompanied by neuroendocrine dysregulation, fatigue, dysphoria, and impaired mental performance. - Rheumatology, 2-Volume Set (2022)
Classification III: By Character/Quality (Surgical Perspective)
From S. Das - A Manual on Clinical Surgery, 13th Ed.:
| Type | Description | Typical Condition |
|---|---|---|
| Vague aching | Mild, continuous, non-specific | Non-specific dull pain |
| Burning | Sensation like contact with hot object | Peptic ulcer, reflux oesophagitis |
| Throbbing | Pulsating sensation | Pyogenic abscess |
| Scalding | Burning felt during micturition | Cystitis, pyelonephritis, urethritis |
| Pins & needles | Pricking sensation in skin distribution | Peripheral sensory nerve injury |
| Shooting | Pain shooting along a nerve | Sciatica |
| Stabbing | Sudden, severe, sharp, short-lived | Acute perforation of peptic ulcer |
| Constricting | Iron band tightening around chest | Angina pectoris, MI |
| Distension | Tightness from increased pressure in a walled structure | Hollow viscus distension |
| Colic | Griping, sudden onset and offset, wave-like | Ureteric / biliary / intestinal / appendicular colic |
| Twisting | Sensation of something twisting inside | Volvulus, torsion of testis/ovarian cyst |
Classification IV: Breakthrough & Special Pain Types
| Type | Definition |
|---|---|
| Breakthrough pain | Exacerbation in the setting of otherwise controlled pain (occurs in ~40% of cancer pain patients) |
| Incident pain | Breakthrough pain triggered by a specific activity (e.g., turning a patient, dressing change) - predictable, can be pre-empted |
| Spontaneous breakthrough pain | Unpredictable, no known trigger |
| End-of-dose failure | Breakthrough pain at the end of an analgesic dose's effective period |
Key Terms to Know
- Allodynia: Pain from a normally non-painful stimulus (e.g., light touch)
- Hyperalgesia: Exaggerated pain response to a painful stimulus
- Referred pain: Visceral pain felt at a site distant from the organ (e.g., shoulder pain from diaphragmatic irritation)
Sources: S. Das Manual on Clinical Surgery 13th Ed. | Sabiston Textbook of Surgery | Harriet Lane Handbook 23rd Ed. | Rheumatology (Elsevier 2022) | Cummings Otolaryngology | Harrison's Principles of Internal Medicine 22nd Ed.
This is a shared conversation. Sign in to Orris to start your own chat.