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. Available at: http://www.ampainsoc.org/advocacy/opioids2.htm, Accessed April 28, 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 http://www.ampainsoc.org/advocacy/pdf/rights.pdf.  Accessed April 28, 2009 .

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.ampainsoc.org/advocacy/promoting.htm.  Accessed April 28, 2009.

Fine, PG, Portenoy, RK: A Clinical Guide to Opioid Analgesia,  New York: McGraw Hill, 2004; Available at:  www.stoppain.org/pcd/content/forpros/opioidbook.asp.  Accessed April 28, 2009.

Go back to Top