Pain

Kajanan Nithiyananthan -

High-Yield Tips

  • TBA

Definition

Pain is:

"an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage" - Merskey 1994
"subjective and indicates that each individual learns the application of the word through experiences releated to injury in early life, and characterizes the experience as unpleasant, and therefore emotional as well as sensory in nature" - IASP 2019

Pain vs Tenderness

  • Tenderness is the aforementioned experience, elicited by direct contact with part of the body whereas pain can occur at rest, without contact

Classification

Acute vs Chronic

  • Acute: recent onset, duration is < 7d, usually associated with an identifiable cause
  • Chronic: pain that lasts or recurs for longer than 3mo

Nociceptive vs Neuropathic

  • Nociceptive: activation of normal pain fibres by noxious stimuli e.g. injury, disease, inflammation
  • Neuropathic: injury or disease affecting peripheral or central nervous system, or both
  • Mixed: both nociceptive and neuropathic

Clinical Presentation

History

These are the important things to ask about on a pain history.

  • SOCRATES
    • Severity is particularly useful as a more 'objective' measure of pain pre- and post-intervention
  • Red flags
  • Age and weight
  • Comorbidities - renal or hepatic
  • Medication history including allergies
  • Previously used analgesic agents and their efficacy (i.e. what works well vs what doesn't)
  • Cognitive baseline i.e. their ability to recognise pain and request PRN pain relief

Examination

Resources

  1. Lecture by Dr Rebekah Potter
  2. Lecture by Dr Jennifer Schneider
  3. ANZCA: Acute Pain Management: Scientific Evidence 5th Ed.