___________________________________________________ Pain Assessment and Management, 2nd Edition
Self-Assessment Question 1 1. Which of the following statements accurately differentiates between acute and chronic pain? A) Acute pain is sharp, sudden, and lasts more than
PHYSIOLOGY AND PAIN CHARACTERISTICS
Pain is a multidimensional experience elicited by a unique nerve impulse pattern caused by genetic and sensory influences that are initiated by sensory stimuli or when stimuli are lacking (Ford, 2024). It involves the activation of numerous free nerve endings in the body called nociceptors, which are stimulated by thermal, mechanical, chemical, or noxious stimuli (Ford, 2024). These nerve endings are located within the skin, joint surfaces, and bone periosteum. When the nociceptors are stimulated, nerve impulses carry their signal to the spinal cord and up to the brain, which may interpret the impulses as pain. Figure 1 shows the pathway that pain takes from the site of injury up to and through the brain.
6months, often continuing after the underlying cause is resolved; chronic pain is typically short-term and resolves when the underlying cause is addressed. B) Acute pain is sharp, sudden, and caused by something specific, lasting less than 6 months, and typically resolves when the underlying cause is addressed; chronic pain persists for at least 3 to 6 months and continues even after the underlying cause has resolved. C) Acute pain often involves biological, psychological, and social factors and requires a multimodal approach; chronic pain is usually treated with a single interven- tion. D) Acute pain is generally associated with psychological factors; chronic pain is purely physiological and does not involve psychological or social factors.
TYPES OF PAIN
Defined as pain that persists for more than 3 months. Pain of this type is the sole complaint and cannot be better explained by another diagnosis. Characterized by emotional distress or functional disability. Pain that is caused by the primary cancer itself, the metastases, or the treatment provided. Pain that develops or increases after a surgical procedure or any injury to the tissue. This pain must persist beyond the typical healing process or 3 months after the procedure or damage occurs. Also known as nociceptive pain. Neuropathic pain is caused by an injury to the somatosensory nervous system. It can involve either the central or the peripheral systems. The client feels sharp tingling, burning, or numbness. Secondary headache and orofacial pain include all headache and orofacial pain disorders that have underlying causes. The pain must occur at least 50% of the days in the last 3 months with a duration of at least 2 hours per day. Visceral pain is poorly localized and diffuse. Described as a deep ache or cramping, this type of pain is associated with internal organs. This pain arises from bone, joints, muscles, vertebral column, tendons, or related soft tissue. It can be spontaneous or movement-induced. Includes radicular and myofascial pain.
Primary pain
Cancer-related pain
Postsurgical or posttraumatic
Neuropathic
Secondary headache or orofacial
Secondary visceral
Secondary musculoskeletal
Psychogenic What is now described in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) as somatic symptom disorder was previously referred to as psychogenic pain or pain disorder in earlier editions. This type of pain can be difficult to diagnose and can relate to unexplained symptoms or an actual physical diagnosis. The thoughts, feelings, and behaviors are out of proportion to the illness. Source: Adapted from American Psychiatric Association (2013), Muskin (2024), National Institute of Neurological Disorders and Stroke (2024), Treede et al. (2019), and World Health Organization (2024) Table 1
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