Chapter 3 Taxonomy: Definition of Pain Terms and and Chronic Pain Syndromes Flashcards
Acute Pain
Pain resulting from nociceptor activation due to damage to tissues. Acute pain typically resolves once the tissue damage is repaired.
Analgesia
Absence of pain in response to a stimulus that is normally painful
Anesthesia
Absence of all sensory modalities.
Anesthesia dolorosa
Pain in an area or region that is anesthetic.
Carpal tunnel syndrome
Pain in the hand, usually occurring at night, due to entrapment of the median nerve in the carpal tunnel. The quality of the pain is a pins-and-needles sensation, stinging, burning, or aching.
There may be decreased sensation on the tips of
the first to third fingers, positive Tinel’s sign, and,
rarely, atrophy of the thenar muscles.
Central pain
Regional pain caused by a primary lesion or dysfunction in the central nervous system,
usually associated with abnormal sensibility to temperature and to noxious stimulation.
Chronic pain
Pain that persists beyond the course
of an acute disease or a reasonable time for an injury to heal or that is associated with a chronic pathologic process that causes continuous pain or the pain recurs at intervals of months or years. Some investigators use duration of >/ = 6 months to designate pain as chronic.
Complex regional pain syndrome (CRPS)
A term describing a variety of painful conditions following injury that appear regionally, having a distal predominance of abnormal findings, exceeding in both magnitude and duration the expected clinical course of the inciting event, often resulting in significant impairment of motor function, and showing variable progression
over time. CRPS is a term for disorders previously
called reflex sympathetic dystrophy (RSD).
CRPS type I (RSD)
- Type I is a syndrome that develops after an initiating noxious event.
- Spontaneous pain or allodynia/hyperalgesia
occurs, which is not limited to the territory of a
single peripheral nerve, and is disproportionate
to the inciting event. - There is or has been evidence of edema, skin
blood flow abnormality, or abnormal sudomotor
activity in the region of the pain since the inciting
event. - This diagnosis is excluded by the existence of
conditions that would otherwise account for the
degree of pain and dysfunction.
CRPS type II (causalgia)
- Type II is a syndrome that develops after a
nerve injury. Spontaneous pain or allodynia/
hyperalgesia occurs, and is not necessarily
limited to the territory of the injured nerve. - There is or has been evidence of edema, skin
blood flow abnormality, or abnormal sudomotor
activity in the region of the pain since the inciting
event. - This diagnosis is excluded by the existence of
conditions that would otherwise account for the
degree of pain and dysfunction.
Cubital tunnel syndrome
Entrapment of the ulnar nerve in a fibro-osseous tunnel formed by the trochlear groove between the olecranon process and the medial epicondyle of the humerus. A myofascial covering converts the groove to a tunnel, which causes the nerve
entrapment. There is pain, numbness, and paresthesia in the distribution of the ulnar nerve and, sometimes, weakness and atrophy in the same distribution. Tinel’s sign is positive at the elbow
Deafferentation pain
Pain due to loss of sensory input into the central nervous system. This may occur with lesions of peripheral nerves such as avulsion of the brachial plexus or due to pathology of the central nervous system.
Dysesthesia
An unpleasant abnormal evoked sensation,
whether spontaneous or evoked.
Fibromyalgia
Diffuse musculoskeletal aching and
pain with multiple predictable tender points. There is
pain on digital palpation in at least 11 of 18 tender sites
Painful regions of Fibromyalgia
Head Left arm Right arm Left leg Right leg Front chest Front abdomen Lower back Upper back
Hyperalgesia
An increased response to a stimulus
that is normally painful.
Hyperalgesia is severe pain in response to mild noxious stimuli, such as a pinprick.
Hyperesthesia
Hyperalgesia
Allodynia
Increased sensitivity to stimulation; this excludes the special senses.
Hyperesthesia is a sensation out of proportion
to the stimuli applied.
Hyperesthesia is further divided into hyperalgesia and allodynia.
Allodynia is the sensation of pain in response to
a non-noxious stimuli (e.g., light touch, fabric on skin).
Allodynia is a physical examination finding in many neuropathic pain states and its distribution, frequently nondermatomal
Hyperpathia
A painful syndrome, characterized by
increased reaction to a stimulus, especially a repetitive stimulus, as well as increased threshold.
Hypoalgesia
Diminished sensitivity to noxious
stimulation.
Hypoesthesia
Diminished sensitivity to stimulation;
this excludes the special senses.
Lateral epicondylitis (tennis elbow)
Pain in the lateral epicondylar region of the elbow due to strain or partial tear of the extensor tendon of the wrist.
The pain may radiate to the lateral forearm or to the upper arm. There is pain in the elbow during grasping and supination of the wrist and on repeated wrist dorsiflexion.
Physical
examination shows tenderness of the wrist extensor tendon approximately 5 cm distal to the epicondyle
Neuralgia
Pain in the distribution of a nerve or nerves
Neuritis
Inflammation of a nerve or nerves. (Not to
be used unless inflammation is thought to be present.)
Neurogenic pain
Pain initiated or caused by a primary lesion, dysfunction, or transitory perturbation in
the peripheral or central nervous system.
Neuropathic pain
Pain initiated or caused by a primary lesion or dysfunction in the peripheral or central nervous systems
Central neuropathic pain
A lesion in the central nervous system causing pain. These include thalamic pain syndrome, poststroke pain, and postspinal cord injury pain
Peripheral neuropathic pain
Pain caused by a lesion or dysfunction of the central nervous system.
Examples are postherpetic neuralgia (PHN), painful diabetic neuropathy (PDN), and complex regional pain syndrome (CRPS).
Neuropathy
A disturbance of function or pathologic change in a nerve. This may involve one nerve (mononeuropathy), several nerves (mononeuropathy
multiplex), or it may be bilateral or symmetrical
(polyneuropathy)
Nociceptive pain
Pain caused by activation of nociceptive
afferent fibers. This type of pain satisfies the
criteria for pain transmission, that is, transmission to the spinal cord, thalamus, and then to the cerebral cortex.
Somatic pain
Pain carried along the sensory fibers; this pain is usually discrete and intense.
Visceral pain
Pain carried by the sympathetic fibers; this pain is diffuse and poorly localized
Nociceptor
A receptor preferentially sensitive to a noxious stimulus or to a stimulus that would become
noxious if prolonged.
Noxious stimulus
A stimulus that is actually or potentially damaging to body tissue.
Pain
An unpleasant sensory and emotional experience
associated with actual or potential tissue damage,
or described in terms of damage.
Pain of psychological origin
Delusional or hallucinatory: pain of psychological
origin and attributed by the patient to a specific
delusional cause.
l Hysterical, conversion, or hypochondriac: pain
specifically attributable to the thought process,
emotional state, or personality of the patient in
the absence of an organic or delusional cause or
tension mechanism.
l Pain associated with depression: pain occurring
in the course of a depressive illness, not preceding
the depression and not attributable to any
other cause.
Pain threshold
The least experience of pain that a subject can recognize.
Pain tolerance level
The greatest level of pain that a subject is prepared to tolerate.
Paresthesia vs. Dysesthesia
Paresthesia—An abnormal sensation, whether spontaneous or evoked. (Note: Paresthesia is an abnormal sensation that is not unpleasant, while dysesthesia is an abnormal sensation that is considered unpleasant.
Dysesthesia does not include all abnormal sensations, but only those that are unpleasant.)
Peripheral neuropathy
Constant or intermittent burning, aching, or lancinating limb pain due to generalized or focal diseases of peripheral nerves.
Phantom pain
Pain referred to a surgically removed limb or portion thereof.
Piriformis syndrome
Pain in the buttock and posterior thigh due to myofascial injury of the piriformis muscle itself or dysfunction of the sacroiliac joint or pain in the posterior leg and foot, groin, and perineum due to entrapment of the sciatic or other nerves by the
piriformis muscle within the greater sciatic foramen, or a combination of these causes.
Post-thoracotomy pain syndrome
Pain along a thoracotomy scar persisting at least 2 months after a thoracotomy.
There is an aching sensation in the distribution
of the surgical incision. Sensory loss and tenderness may be present along the thoracotomy scar. A trigger point may be present, secondary to a neuroma, that responds to a trigger-point injection.
Radicular pain
Pain perceived as arising in a limb or the trunk wall caused by ectopic activation of nociceptive
afferent fibers in a spinal nerve or its roots or other
neuropathic mechanisms. The pain is usually lancinating and travels in a narrow band.
Etiologic causes include anatomic lesions affecting the spinal nerve and dorsal root ganglion including herniated intervertebral disc and spinal stenosis.
Radiculopathy
Objective loss of sensory and/or motor function as a result of conduction block in axons of a spinal nerve or its roots.
Symptoms include numbness and weakness in the distribution of the affected nerve. Neurologic examination and diagnostic tests confirm the neurologic abnormality.
(Note: Radicular pain and radiculopathy are not synonymous.
The former is a symptom caused by ectopic
impulse generation. The latter relates to objective
neurological signs due to conduction block. The two
conditions may coexist and may be caused by the
same lesion.)
Raynaud’s disease vs. Raynaud’s phenomenon
Raynaud’s disease — Episodic attacks of aching, burning pain associated with vasoconstriction of the arteries of the extremities in response to cold or emotional stimuli.
Raynaud’s phenomenon—Attacks like those of Raynaud’s disease but related to one or more other disease processes.
Systemic and vascular diseases such as collagen
disease, arteriosclerosis obliterans, nerve injuries, and occupational trauma may all contribute to the development of Raynaud’s phenomenon.
Referred pain
Pain perceived as occurring in a region
of the body topographically distinct from the region in which the actual source of pain is located.
Somatic
Derived from the Greek word for “body.”
Although somatosensory input refers to sensory signals from all tissues of the body including skin, viscera, muscles, and joints, it usually signifies input from body tissue other than the viscera.
Stump pain
Pain at the site of an extremity amputation.
Suffering
A state of severe distress associated with
events that threaten the intactness of the person; it may or may not be associated with pain.
Stylohyoid process syndrome (Eagle’s syndrome)
Pain following trauma in the region of a calcified stylohyoid ligament.
Thoracic outlet syndrome
Pain in the root of the neck, head, and shoulder, radiating down the arm into the hand due to compression of the brachial plexus by the hypertrophied muscle, congenital bands, posttraumatic fibrosis, the cervical rib or band, or the malformed first thoracic rib.
