Pain Management
Definitions of Pain
Common Barriers
Important Terms
Morphine Myths
Duty to Relieve Pain
Five Principles
Fifth Vital Sign
Pain Assessment
Begin with the patient
Types of pain

Symptom Management
Types of Pain

Acute Pain
Pain that has a clear cause, has meaning, has an endpoint or is reversible, and there can be observable signs associated with it, such as elevated blood pressure, heart rate, and facial grimacing.

Chronic Pain
Pain that has a cause that is not immediately obvious, can last weeks, months, or even a lifetime. There are typically no changes in vital signs or other visible expressions of pain. The patient’s report of pain, again, is the most reliable beginning to an appropriate pain assessment.

In addition to these two common terms for types of pain are three other important types of pain. Knowing these terms and what they mean deepens the understanding of pain and how it is treated:

Nociceptive Pain
Nociception is the route pain takes from its start until it becomes conscious. The four steps of nociception are:

Transduction: The noxious stimuli at the sensory nerve ending changes to an impulse.

Transmission: That impulse is transmitted from the nerve ending to the brain.

Perception: Pain is recognized and responded to in the brain.

Modulation: Activation of descending pathways from the brain that attempt to inhibit the pain transmission. (McCaffrey, 1999)

Nociceptive pain occurs when there has been direct tissue damage, tumor infiltration of the soft tissue or viscera, or the direct stimulation of afferent nerves.

Two types of Nociceptive pain:
Somatic pain
is well localized, and is described as an aching, throbbing or gnawing sensation. Some examples of somatic pain are bone pain, joint, muscle or skeletal pain, or pain from an incision.
Pharmacological treatment: Somatic pain can be usually be controlled with common analgesics, such as non-steroidal anti-inflammatory drugs (NSAIDS) for mild pain, opioids for more severe pain. In some cases, radiation therapy may be helpful.
Visceral pain is not well localized and is described as a feeling of pressure, cramping or squeezing in quality. Examples of visceral pain are pain from tumor obstruction of an outlet, such as bowel obstruction, or stretching of the viscera around an organ from tumor growth, as in liver cancer.
Pharmacological treatment: NSAIDs or other common analgesics; antineoplastic treatments are sometimes used as well.

Neuropathic Pain
Neuropathic pain occurs when there has been an injury to peripheral or central nerves. Tumor infiltration or compression of a nerve, an incision, compression of the spinal cord, or a CVA can all be the underlying cause of neuropathic pain.

Neuropathic pain is described as shooting, burning, tingling or burning, often traveling along a nerve pathway

Mixed Nociceptive and Neuropathic Pain
Mixed pain types are common in serious or end-stage disease processes.

Treatment depends upon a thorough pain assessment and a combination of pharmacological agents, such as NSAIDs and opioids, and other adjuvant medications.