Professional Documents
Culture Documents
Outline
What is pain? Definition of pain
Classification of pain
Differences between acute and chronic
pain
Principles of management of patient with
chronic non-cancer pain
Principles of management of patient with
cancer pain
What happens to a patient at a Pain Clinic?
What is Pain?
International Association for the Study of
Pain
Pain is "an unpleasant sensory and emotional
experience associated with actual or potential
tissue damage, or described in terms of such
damage.
Merskey,1964
International Association for
the Study of Pain (IASP)
To patient ..
PAIN
HURTS
Classification of Pain
Classification of Pain
Not all pain is the same!
Three main questions:
1. How long has the patient had pain?
2. What is the cause?
3. What is the pain mechanism?
Classification of Pain
Duration
Cause
Mechanis
m
Acute
Chronic
Acute on chronic
Cancer
Non-cancer
Nociceptive (physiological)
Neuropathic (pathological)
Chronic
Pain persisting beyond healing of injury
Often no identifiable cause
(Pain lasting for more than 3 months)
Non-cancer pain
Many different causes
Acute or chronic
Nociceptive Pain
Obvious tissue injury or illness
Physiological pain
Description
Sharp dull
Well localised
Neuropathic Pain
Nervous system damage or abnormality
Pathological pain
Tissue injury may not be obvious
Description
Burning, shooting numbness, pins and needles,
allodynia
Not well localised
N e u ro p a th ic &p a in &
P a th o lo gic a l&p a in &
C a u se !
O b v io u s !t is s u e !in ju r y !
N e r v e !in ju r y !o r !
C e n t r a l/ p e r ip h e r a l!n e r v o u s !
s y s t e m !a b n o r m a lit y !
F u n c t io n !
P r o t e c t iv e !f u n c t io n !
N o !d is c e r n a b le !b io lo g ic a l!
f u n c t io n !
D e s c r ip t io n !o f !p a in !
Sh arp !
D u ll!
T h r o b b in g !
W e ll!lo c a lis e d !
B u r n in g !
S h o o t in g !
S t a b b in g ,!la n c in a t in g !
P o o r ly !lo c a lis e d !
A g g r a v a t in g !/ !r e lie v in g !
fa cto r s!
A g g r a v a t e d !b y !m o v e m e n t !
R e lie v e d !b y !r e s t !
S p o n t a n e o u s !p a in !
O t h e r !s y m p t o m s !
N o n e !o r !r e la t e d !t o !u n d e r ly in g ! N u m b n e s s !
p a t h o lo g y !
P in s !a n d !n e e d le s !
A llo d y n ia !
D y s a e s t h e s ia s !
&
N e u ro p a t h ic &P a in &
&
Spectrum of Pain
ACUTE
PAIN
Healing
NO PAIN
Insidious onset
CHRONIC
PAIN
ACUTE
PAIN
CHRONIC
PAIN
Chronic Pain
Onset and
timing
Signal
Severity
CNS
involvement
Psychological
effects
Common
causes /
examples
ASSESSMENT OF THE
CHRONIC PAIN PATIENT
A : Aggravating factors
What makes the pain worse?
I : Intensity
How bad is the pain?
Associated symptoms:
elsewhere?
stimulus), hyperalgesia (pain out of proportion to a painful
stimulus)
How does the pain affect your sleep? Your appetite? Your
mood? Your daily activities? Your relationships? Your work?
Past History:
Other information:
In the management of chronic pain, emphasis is on selfmanagement (what the patient can do for him/herself)
and achieving long-term changes (e.g. from exercise)
rather than short-term gains (e.g. from short acting
analgesic medications).
Summary
Pain can be classified as acute or chronic, cancer or noncancer and nociceptive or neuropathic
Acute and chronic pain are different
Acute pain is a symptom of tissue damage
Chronic pain is a disease of the nervous system