Pain

Definition: An unpleasant sensory and emotional experience associated with or described in terms of actual or potential tissue damage.

Clinical Use:

  • Pain is always subjective. It is unquestionably a sensation in a part or parts of the body, but it is also always unpleasant and therefore also an emotional experience.
  • Understanding this, it is often helpful to keep in mind that ‘pain is whatever the older adult says it is, occurring wherever he/she says it does’. Pain is not observable or visible.

Persistent Pain (Chronic or Constant Pain)

Definition: A painful experience that continues for a prolonged period of time that may or may not be associated with a recognizable disease process

Clinical Use:

  • It is estimated that up to 80% of people living in nursing homes live with persistent pain.
  • More than one clinical diagnosis typically contributes to persistent pain in the nursing home population, e.g., osteoarthritis, postherpatic neuralgia, spinal canal stenosis, cancer, post-stroke pain, diabetic peripheral neuropathy, and others.

Refractory Pain

Definition: Resistant to ordinary treatment

Clinical Use:

  • Older adults with refractory pain may need a referral to an outpatient pain clinic for a comprehensive, interdisciplinary evaluation and development of a treatment plan.

Incident-related Pain

Definition: Pain triggered by specific movements or activities.

Clinical Use:

  • Incident-related episodic pain is best treated by pre-medicating with a dose of short-acting opioid prior to the pain-inducing event, usually a PRN of a medication that is already prescribed.

Breakthrough Pain

Definition: Pain that increases above the level of pain addressed by the ongoing analgesics; this would include incident pain and end-of-dose failure.

Clinical Use:

  • This term is appropriate only in the Cancer Pain and Palliative Care setting. Patients with non-cancer pain experience paroxysmal pain (see definition below).
  • Breakthrough pain is reported by 2 out of 3 people with continuous persistent pain.
  • The pain may be sudden or gradual, brief or prolonged, spontaneous or predictable.

Paroxysmal Pain

Definition: Pain that suddenly increases or suddenly flares up.

Clinical Use:

  • Patients with non-cancer pain experience paroxysmal pain episodes (i.e. trigeminal neuralgia) or fluctuation of pain as part the natural course of the disease (i.e. patients with central pain syndromes), or pain flare-ups (pain that is provoked by activity, i.e. patient with low back pain who plays golf or tennis). 

Analgesia

Definition: The process of relieving or reducing pain; a state in which painful stimuli are so moderated that, although still perceptible they are no longer painful..

Clinical Use:

  • Analgesia denotes the process of relieving pain.
  • Patient remains fully conscious with the use of analgesia.

Adjuvant Analgesic

Definition: A drug that has a primary purpose other than pain relief but can also serve as an analgesic for some painful conditions

Clinical Use:

  • Some examples include tricyclic antidepressants or anticonvulsants.

Visceral Pain

Definition: Pain of the body’s internal organs

Clinical Use:

  • This pain is often poorly localized and usually constant.
  • It is often described as deep and aching and is often referred to other sites.

Musculoskeletal Pain (or Somatic Pain)

Definition: Pain of the muscles, joints, connective tissues and bones

Clinical Use:

  • This pain is relatively well localized,and is typically worse on movement.
  • It is often described as a dull, or ‘background’ aching pain, although the area may be tender to pressure.

Neuropathic Pain

Definition: Pain initiated or caused by a primary lesion or dysfunction in the nervous system.

Clinical Use: 

  • Neuropathic pain may have a burning, deeply aching quality accompanied by some sudden sharp lancing pain and often radiates down a nerve path.
  • Older adults may have numbness, tingling, or skin sensitivity over the area of skin.

Allodynia

Definition: A nonpainful stimulus felt as painful in spite of normal-appearing tissues

Clinical Use:

  • Common in many neuropathic pain conditions
  • An example of an older adult experiencing allodynia is one who is uncomfortable with the bed sheets resting on their feet or legs.

PDF iconPain Types Terminology - PDF version

References

Definitions Related to the Use of Opioids for the Treatment of Pain: a consensus document from the American  Academy of Pain Medicine the American Pain Society, and the American Society of Addiction Medicine, 2009.

Public Policy Statement on the Rights and Responsibilities of Healthcare Professionals in the Use of Opioids for the Treatment of Pain. A consensus document from the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine. Available at: https://www.semanticscholar.org.

Promoting Pain Relief and Preventing Abuse of Pain Medications: A Critical Balancing Act, a Joint Statement. From 21 Health Organizations and the Drug Enforcement Administration, 2001. Available at: http://www.deadiversion.usdoj.gov/pubs/advisories/painrelief.pdf.

Fine, P. G., & Portenoy, R. K. A Clinical Guide to Opioid Analgesia,  New York: McGraw Hill, 2004.

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