Principles of Pain Management



Type of Pain and Examples

Typical Description
Nonpharmacologic Treatments and Effective Drug Classes

Peripheral

Nociceptive: somatic (eg, tissue injury of bones, soft tissue, joints, muscles)

Arthritis, low-back pain, myofascial pain

Well localized, constant; aching, stabbing, gnawing, throbbing

Exercise, PT and CBT, other nondrug tx, APAP, topical anesthetics/NSAIDs, intraarticular corticosteroid, salsalate, NSAIDs, duloxetine, tramadol, hydrocodone/APAP, oxycodone, fentanyl, methadone

Acute postoperative, fracture, bone metastases

Well localized, constant; aching, stabbing, gnawing, throbbing

APAP, topical anesthetics/NSAIDs, nondrug tx (eg, massage, music), NSAIDs, opioids

Nociceptive: visceral (eg, tissue injury of visceral organs including heart, lungs, testes, and biliary system)

Renal colic

Constipation

Diffuse, poorly localized, referred to other sites, intermittent, paroxysmal; dull, colicky, squeezing, deep, cramping; often accompanied by nausea, vomiting, diaphoresis

Tx of underlying cause, APAP, IV NSAID, opioids with nondrug tx

Neuropathic: peripheral nervous system (eg, injury to nervous system—nerves and spinal cord)

Cervical or lumbar radiculopathy, postherpetic neuralgia, trigeminal neuralgia, diabetic neuropathy, phantom limb pain, herniated intervertebral disc, drug toxicities

Prolonged, usually constant, but can have paroxysms; sharp, burning, pricking, tingling, pins-and-needles, shooting electric-shock–like; associated with other sensory disturbances, eg, paresthesias and dysesthesias; allodynia, hyperalgesia, impaired motor function, atrophy, or abnormal deep tendon reflexes

Nondrug tx, topical anesthetics, TCAs, SNRIs, anticonvulsants, opioids

Central, Undetermined, or Mixed (eg, pain from neurologic dysfunction or combined and uncertain causes)

Myofascial pain syndrome, somatoform pain disorders, fibromyalgia; poststroke; temporomandibular joint dysfunction, tension HA

No identifiable pathologic processes or symptoms out of proportion to identifiable organic pathology; widespread musculoskeletal pain, stiffness, and weakness; fatigue, sleep disturbance; taut bands of muscles and trigger points; sensitivity to sensory stimuli

Exercise, PT and CBT, other nondrug psychologic tx, antidepressants, antianxiety agents

 

Iowa Particle Pattern