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Pain Terminology Cheat Sheet by

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Pain Termin­ology

Acute Pain: Pain that is usually temporary and results from something specific, such as a surgery, an injury, or an infection.
Knowing if pain is acute rather than persistent guides treatment decisions
Monitor acute pain for signs of improv­ement as expected
Ineffe­ctively treated acute pain can turn into persistent or chronic pain.

Addi­cti­on: A primary, chronic, neurob­iol­ogical disease, with genetic, psycho­social, and enviro­nmental factors influe­ncing its develo­pment and manife­sta­tions.
Addiction to opioids as a result of pain management is uncommon among people living in nursing homes.
Tolerance and physical dependence are normal physio­logic responses to chronic medication admini­str­ation, whereas addiction is a disease that is not a normal or common response to opiate use.
Addiction is more likely to occur in older adults with multiple risk factors for addiction, such as a genetic predis­pos­ition, a history of addictive behavior, or a history of abuse and/or neglect.
It is recomm­ended that pain be adequately controlled before reaching conclu­sions about concerns related to addictive behaviors.
An indivi­dual’s behaviors that may suggest addiction sometimes reflect unrelieved pain or other problems (See Pseudo­add­iction, below) unrelated to addiction.
Good clinical judgment must be used in determ­ining whether the observed pattern of behaviors signals addiction or reflects a different issue such as unrelieved pain or psycho­logical distress.
Behaviors that are associated with proble­matic drug use and possible addiction are: use of analgesic medica­tions for other than analgesic effects (e.g., to feel euphoric, less anxious) non-co­mpl­iance with recomm­ended non-opioid treatments or evalua­tions; insistence on rapid-­onset formul­ati­ons­/routes of admini­str­ation; reports of no relief whatsoever by any non-opioid treatm­ents. Observ­ation of these behaviors should be documented and invest­igated further with the older adult and other pain-team members.
Recogn­ition of the disease is made in the presence of one or more of the following behaviors: impaired control over drug use, compulsive use, continued use despite harm, and craving.
No single event is diagnostic of an addictive disorder. Rather, the diagnosis of substance abuse/­add­iction is made in response to a pattern of behavior that usually becomes obvious over time.

continued

Adjuvant analge­sic: A drug that has a primary purpose other than pain relief but can also serve as an analgesic for some painful conditions
Some examples include tricyclic antide­pre­ssants or antico­nvu­lsants

Allo­dyn­ia: A nonpainful stimulus felt as painful in spite of normal­-ap­pearing tissues
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.

Brea­kth­rough Pain: Pain that increases above the level of pain addressed by the ongoing analge­sics; this would include incident pain and end-of­-dose failure.
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.

Dura­tion: How long the pain has been experi­enced and continues to be present (lasting minutes or hours)
Inform­ation is critical for evaluating the effect­iveness of the treatment plan.
Duration of pain can be gathered as part of a compre­hensive history of the pain as well as each time pain is assessed.

Freq­uen­cy: Number of occurr­ences in a specified period of time; how often pain is experi­enced in a given period.
Knowing the frequency of pain is useful in developing treatment strategies and for indivi­dua­lized scheduling of care activi­ties.

Inci­den­t-r­elated pain: Pain triggered by specific movements or activi­ties.
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.

Inte­nsity (or Severi­ty): The older adult’s descri­ptive rating of the pain experi­ence.
Usually helpful to identify intensity for older adult’s ‘worst pain’ over a specified period of time as well as ‘the best the pain gets’
Assessing the older adult’s present pain rating and an identified pain rating acceptable to the older adult is also important.
Use the most approp­riate scale indivi­dua­lized to the older adult’s cognitive and sensory abilities.

continued 2

Loca­tion: Anatomic site(s) of pain
Older adults often have pain in more than one location.
Identify and document all sites with corres­ponding intensity and character.
Pain maps are very useful in docume­nting all pain locations, guiding therapy, and as a tool in providing daily care (e.g., CNAs can use the pain map to establish the least painful ways to turn and/or ambulate the person they’re working with).

Musc­ulo­ske­letal pain (or somatic pain): Pain of the muscles, joints, connective tissues and bones
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.

Noci­cep­tive: Pain caused by tissue injury in the joints, bones, muscles and various internal organs. In contrast to neurop­athic pain, the patient's nervous system is functi­oning normally, transm­itting inform­ation about the injury to the brain.
Nocice­ptive pain is typically well localized, constant, and often with an aching or throbbing quality.
Usually time limited: when the tissue damage heals, the pain typically resolves. However, arthritis is a common nocice­ptive pain in older adults, and is not time limited.)
Another charac­ter­istic of nocice­ptive pain is that it tends to respond well to treatment with opioids.
Visceral pain is a subtype of nocice­ptive pain that involves the internal organs and tends to be episodic and poorly localized.

Neur­opathic pain: Pain initiated or caused by a primary lesion or dysfun­ction in the nervous system
Some of the words commonly used to describe neurop­athic pain symptoms include burning, tingling, numb, squeezing, and itching. There may be electric shooting sensat­ions, often radiating down a nerve path with accomp­anying sensit­ivity over the area of skin.
Pain may persist for months or years beyond the apparent healing of any damaged tissues.
Neurop­athic pain is frequently chronic, and tends to respond less well to treatment with opioids, but may respond well to other drugs such as anti-s­eizure and antide­pre­ssant medica­tions.
Usually, neurop­athic problems are not fully revers­ible, but partial improv­ement is often possible.

continued 3

Onset: Desc­ription of the experience of the beginning of the pain.
The older adult may describe a sudden or gradual develo­pment of the pain, associated with a known injury or illness.
Asking about onset can also help identify pain triggered by specific movement or activity.
Asking about onset can also help to distin­guish between acute and persistent pain.

Pain: An unpleasant sensory and emotional experience associated with or described in terms of actual or potential tissue damage.
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.

Pattern (or Rhythm): The course of the pain over time including variat­ions, often influenced by times of day (e.g., certain hours of the day, night or day, monthly patterns), periods of rest, or specific or general activi­ty/­mov­ement.
Older adults can experience constant and/or episodic pain.
Analgesic therapy should be tailored to these patterns.
For example, short-­acting analgesics are most approp­riate for episodic pain, whereas long-a­cting agents are best for constant pain. Routinely dosed, short-­acting agents may work well as an altern­ative to long-a­cting opioids in older adults.
Older adults with both constant pain and episodic increases in pain (break­through pain) need both short-­acting and long-a­cting medica­tions.

Pers­istent pain (chronic or constant pain): A painful experience that continues for a prolonged period of time that may or may not be associated with a recogn­izable disease process
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.

Physical Depend­ence: The body’s normal response to the continued use of several classes of medica­tions.
Physical dependence is a normal physio­logic response that occurs with many classes of medica­tions (e.g., beta blockers, alpha-2 adrenergic agents, cortic­ost­eroids, opioids and others).
Withdrawal can be precip­itated by: stopping the medication abruptly, rapidly reducing the dose, decreasing blood level of the drug, and/or admini­str­ation of an antagonist (e.g., naloxone).
Withdrawal symptoms are typically expected
Gradual, planned tapering of the medication can usually eliminate any withdrawal symptoms.
Monitoring of clinical symptoms during the tapering process is recomm­ended.

Continued 4

Pseu­doa­ddi­ction: Deve­lopment of abuse-like behaviors that are driven by desper­ation surrou­nding unrelieved pain and are eliminated by effective pain manage­ment.
Behaviors that fall under the term ‘pseud­oad­dic­tion’ include those behaviors in which older adults with unrelieved pain become focused on obtaining medica­tions, start “clock watching”, or otherwise seem inappr­opr­iately “drug seeking”.
Behaviors considered to be related to pseudo­add­iction may place the older adult, prescr­iber, or others at risk. When these behaviors occur, a careful assessment of the effect­iveness of the current pain treatment plan should take place.
Addiction and pseudo­add­iction can both be present at the same time.
Caution must be taken not to ignore a coexisting addiction even when some behaviors are considered to be pseudo­add­iction. When more obvious, overt and potent­ially harmful drug-r­elated behaviors (e.g., forging prescr­ipt­ions) are also present, the pain team must assess for a coexisting addiction.

Quality (or Charac­ter): Desc­ription of the charac­ter­istics of the pain, preferably in the words used by the older adult to describe the pain.
Helpful in determ­ining the type of pain to guide the most approp­riate analgesic.
If the older adult has difficulty describing the pain, it may be helpful to offer examples of descri­ptions.
These may include the following: aching, sore, cramping, pounding, sharp, throbbing, dull, nagging, penetr­ating, shooting, numb, tingling, spasm, burning, gnawing, pressu­re-­like, radiating, stabbing, tingling, tender, knife-­like, etc.
Knowing the quality of pain may assist in distin­gui­shing between types of pain: acute, chronic, nocice­ptive, and neurop­athic.

Refr­actory pain: Resi­stant to ordinary treatment
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.

Tole­rance: The body’s normal response to continued exposure to a medica­tion, resulting in a reduction of one or more of the drug’s effects over time.
Tolerance may occur to both the desired (i.e., analgesia) and undesired (e.g., nausea) drug effects.
Tolerance tends to develop at different rates for different effects; for example, in the case of opioids, tolerance usually develops more slowly to the pain relieving effects than to respir­atory depres­sion, and tolerance to the consti­pating effects often do not occur at all.
Tolerance to the pain relieving effects of opioids will likely occur in some, but not all, older adults.
When tolerance to the pain relieving effects of opioids does occur, an increase in dose is recomm­ended.

Visceral pain: Pain of the body’s internal organs, a subtype of nocice­ptive pain
This pain is often poorly localized and usually constant
It is often described as deep & aching and is often referred to other sites.

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