Chapter 3 Taxonomy: Definition of Pain Terms and and Chronic Pain Syndromes

Question 1

Acute Pain

Answer 1

Pain resulting from nociceptor activation due to damage to tissues. Acute pain typically resolves once the tissue damage is repaired.

Question 2

Analgesia

Answer 2

Absence of pain in response to a stimulus that is normally painful

Question 3

Anesthesia

Answer 3

Absence of all sensory modalities.

Question 4

Anesthesia dolorosa

Answer 4

Pain in an area or region that is anesthetic.

Question 5

Carpal tunnel syndrome

Answer 5

Pain in the hand, usually occurring at night, due to entrapment of the median nerve in the carpal tunnel. The quality of the pain is a pins-and-needles sensation, stinging, burning, or aching.
There may be decreased sensation on the tips of
the first to third fingers, positive Tinel’s sign, and,
rarely, atrophy of the thenar muscles.

Question 6

Central pain

Answer 6

Regional pain caused by a primary lesion or dysfunction in the central nervous system,
usually associated with abnormal sensibility to temperature and to noxious stimulation.

Question 7

Chronic pain

Answer 7

Pain that persists beyond the course
of an acute disease or a reasonable time for an injury to heal or that is associated with a chronic pathologic process that causes continuous pain or the pain recurs at intervals of months or years. Some investigators use duration of >/ = 6 months to designate pain as chronic.

Question 8

Complex regional pain syndrome (CRPS)

Answer 8

A term describing a variety of painful conditions following injury that appear regionally, having a distal predominance of abnormal findings, exceeding in both magnitude and duration the expected clinical course of the inciting event, often resulting in significant impairment of motor function, and showing variable progression
over time. CRPS is a term for disorders previously
called reflex sympathetic dystrophy (RSD).

Question 9

CRPS type I (RSD)

Answer 9

1. Type I is a syndrome that develops after an initiating noxious event.
2. Spontaneous pain or allodynia/hyperalgesia
   occurs, which is not limited to the territory of a
   single peripheral nerve, and is disproportionate
   to the inciting event.
3. There is or has been evidence of edema, skin
   blood flow abnormality, or abnormal sudomotor
   activity in the region of the pain since the inciting
   event.
4. This diagnosis is excluded by the existence of
   conditions that would otherwise account for the
   degree of pain and dysfunction.

Question 10

CRPS type II (causalgia)

Answer 10

1. Type II is a syndrome that develops after a
   nerve injury. Spontaneous pain or allodynia/
   hyperalgesia occurs, and is not necessarily
   limited to the territory of the injured nerve.
2. There is or has been evidence of edema, skin
   blood flow abnormality, or abnormal sudomotor
   activity in the region of the pain since the inciting
   event.
3. This diagnosis is excluded by the existence of
   conditions that would otherwise account for the
   degree of pain and dysfunction.

Question 11

Cubital tunnel syndrome

Answer 11

Entrapment of the ulnar nerve in a fibro-osseous tunnel formed by the trochlear groove between the olecranon process and the medial epicondyle of the humerus. A myofascial covering converts the groove to a tunnel, which causes the nerve
entrapment. There is pain, numbness, and paresthesia in the distribution of the ulnar nerve and, sometimes, weakness and atrophy in the same distribution. Tinel’s sign is positive at the elbow

Question 12

Deafferentation pain

Answer 12

Pain due to loss of sensory input into the central nervous system. This may occur with lesions of peripheral nerves such as avulsion of the brachial plexus or due to pathology of the central nervous system.

Question 13

Dysesthesia

Answer 13

An unpleasant abnormal evoked sensation,

whether spontaneous or evoked.

Question 14

Fibromyalgia

Answer 14

Diffuse musculoskeletal aching and
pain with multiple predictable tender points. There is
pain on digital palpation in at least 11 of 18 tender sites

Question 15

Tender sites of Fibromylagia

Answer 15

Occiput: bilateral, at the suboccipital muscle
insertions.
Low cervical: bilateral, at the anterior aspects of
the intertransverse process at C5–C7.
Trapezius: bilateral, at the midpoint of the upper
border.
Supraspinatus: bilateral, at the origins above the
scapula spine near the medial border.
Second rib: bilateral, at the second costochondral
junctions, just lateral to the junctions on upper
surfaces.
Lateral epicondyle: bilateral, 2 cm distal to the
epicondyles.
Gluteal: bilateral, in the upper outer quadrants
of the buttocks in the anterior fold of muscle.
Greater trochanter: bilateral, posterior to the
trochanteric prominence.
Knees: bilateral, at the medial fat pad proximal to
the joint line.

Question 16

Hyperalgesia

Answer 16

An increased response to a stimulus
that is normally painful.
Hyperalgesia is severe pain in response to mild noxious stimuli, such as a pinprick.

Question 17

Hyperesthesia

Hyperalgesia

Allodynia

Answer 17

Increased sensitivity to stimulation; this excludes the special senses.
Hyperesthesia is a sensation out of proportion
to the stimuli applied.
Hyperesthesia is further divided into hyperalgesia and allodynia.
Allodynia is the sensation of pain in response to
a non-noxious stimuli (e.g., light touch, fabric on skin).
Allodynia is a physical examination finding in many neuropathic pain states and its distribution, frequently nondermatomal

Question 18

Hyperpathia

Answer 18

A painful syndrome, characterized by

increased reaction to a stimulus, especially a repetitive stimulus, as well as increased threshold.

Question 19

Hypoalgesia

Answer 19

Diminished sensitivity to noxious

stimulation.

Question 20

Hypoesthesia

Answer 20

Diminished sensitivity to stimulation;

this excludes the special senses.

Question 21

Lateral epicondylitis (tennis elbow)

Answer 21

Pain in the lateral epicondylar region of the elbow due to strain or partial tear of the extensor tendon of the wrist.
The pain may radiate to the lateral forearm or to the upper arm. There is pain in the elbow during grasping and supination of the wrist and on repeated wrist dorsiflexion.
Physical
examination shows tenderness of the wrist extensor tendon approximately 5 cm distal to the epicondyle

Question 22

Neuralgia

Answer 22

Pain in the distribution of a nerve or nerves

Question 23

Neuritis

Answer 23

Inflammation of a nerve or nerves. (Not to

be used unless inflammation is thought to be present.)

Question 24

Neurogenic pain

Answer 24

Pain initiated or caused by a primary lesion, dysfunction, or transitory perturbation in
the peripheral or central nervous system.

Question 25

Neuropathic pain

Answer 25

Pain initiated or caused by a primary lesion or dysfunction in the peripheral or central nervous systems

Question 26

Central neuropathic pain

Answer 26

A lesion in the central nervous system causing pain. These include thalamic pain syndrome, poststroke pain, and postspinal cord injury pain

Question 27

Peripheral neuropathic pain

Answer 27

Pain caused by a lesion or dysfunction of the central nervous system.
Examples are postherpetic neuralgia (PHN), painful diabetic neuropathy (PDN), and complex regional pain syndrome (CRPS).

Question 28

Neuropathy

Answer 28

A disturbance of function or pathologic change in a nerve. This may involve one nerve (mononeuropathy), several nerves (mononeuropathy
multiplex), or it may be bilateral or symmetrical
(polyneuropathy)

Question 29

Nociceptive pain

Answer 29

Pain caused by activation of nociceptive
afferent fibers. This type of pain satisfies the
criteria for pain transmission, that is, transmission to the spinal cord, thalamus, and then to the cerebral cortex.

Question 30

Somatic pain

Answer 30

Pain carried along the sensory fibers; this pain is usually discrete and intense.

Question 31

Visceral pain

Answer 31

Pain carried by the sympathetic fibers; this pain is diffuse and poorly localized

Question 32

Nociceptor

Answer 32

A receptor preferentially sensitive to a noxious stimulus or to a stimulus that would become
noxious if prolonged.

Question 33

Noxious stimulus

Answer 33

A stimulus that is actually or potentially damaging to body tissue.

Question 34

Pain

Answer 34

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

Question 35

Pain of psychological origin

Answer 35

Delusional or hallucinatory: pain of psychological
origin and attributed by the patient to a specific
delusional cause.
l Hysterical, conversion, or hypochondriac: pain
specifically attributable to the thought process,
emotional state, or personality of the patient in
the absence of an organic or delusional cause or
tension mechanism.
l Pain associated with depression: pain occurring
in the course of a depressive illness, not preceding
the depression and not attributable to any
other cause.

Question 36

Pain threshold

Answer 36

The least experience of pain that a subject can recognize.

Question 37

Pain tolerance level

Answer 37

The greatest level of pain that a subject is prepared to tolerate.

Question 38

Paresthesia vs. Dysesthesia

Answer 38

Paresthesia—An abnormal sensation, whether spontaneous or evoked. (Note: Paresthesia is an abnormal sensation that is not unpleasant, while dysesthesia is an abnormal sensation that is considered unpleasant.
Dysesthesia does not include all abnormal sensations, but only those that are unpleasant.)

Question 39

Peripheral neuropathy

Answer 39

Constant or intermittent burning, aching, or lancinating limb pain due to generalized or focal diseases of peripheral nerves.

Question 40

Phantom pain

Answer 40

Pain referred to a surgically removed limb or portion thereof.

Question 41

Piriformis syndrome

Answer 41

Pain in the buttock and posterior thigh due to myofascial injury of the piriformis muscle itself or dysfunction of the sacroiliac joint or pain in the posterior leg and foot, groin, and perineum due to entrapment of the sciatic or other nerves by the
piriformis muscle within the greater sciatic foramen, or a combination of these causes.

Question 42

Post-thoracotomy pain syndrome

Answer 42

Pain along a thoracotomy scar persisting at least 2 months after a thoracotomy.
There is an aching sensation in the distribution
of the surgical incision. Sensory loss and tenderness may be present along the thoracotomy scar. A trigger point may be present, secondary to a neuroma, that responds to a trigger-point injection.

Question 43

Radicular pain

Answer 43

Pain perceived as arising in a limb or the trunk wall caused by ectopic activation of nociceptive
afferent fibers in a spinal nerve or its roots or other
neuropathic mechanisms. The pain is usually lancinating and travels in a narrow band.
Etiologic causes include anatomic lesions affecting the spinal nerve and dorsal root ganglion including herniated intervertebral disc and spinal stenosis.

Question 44

Radiculopathy

Answer 44

Objective loss of sensory and/or motor function as a result of conduction block in axons of a spinal nerve or its roots.
Symptoms include numbness and weakness in the distribution of the affected nerve. Neurologic examination and diagnostic tests confirm the neurologic abnormality.
(Note: Radicular pain and radiculopathy are not synonymous.
The former is a symptom caused by ectopic
impulse generation. The latter relates to objective
neurological signs due to conduction block. The two
conditions may coexist and may be caused by the
same lesion.)

Question 45

Raynaud’s disease vs. Raynaud’s phenomenon

Answer 45

Raynaud’s disease — Episodic attacks of aching, burning pain associated with vasoconstriction of the arteries of the extremities in response to cold or emotional stimuli.
Raynaud’s phenomenon—Attacks like those of Raynaud’s disease but related to one or more other disease processes.
Systemic and vascular diseases such as collagen
disease, arteriosclerosis obliterans, nerve injuries, and occupational trauma may all contribute to the development of Raynaud’s phenomenon.

Question 46

Referred pain

Answer 46

Pain perceived as occurring in a region

of the body topographically distinct from the region in which the actual source of pain is located.

Question 47

Somatic

Answer 47

Derived from the Greek word for “body.”
Although somatosensory input refers to sensory signals from all tissues of the body including skin, viscera, muscles, and joints, it usually signifies input from body tissue other than the viscera.

Question 48

Stump pain

Answer 48

Pain at the site of an extremity amputation.

Question 49

Suffering

Answer 49

A state of severe distress associated with

events that threaten the intactness of the person; it may or may not be associated with pain.

Question 50

Stylohyoid process syndrome (Eagle’s syndrome)

Answer 50

Pain following trauma in the region of a calcified stylohyoid ligament.

Question 51

Thoracic outlet syndrome

Answer 51

Pain in the root of the neck, head, and shoulder, radiating down the arm into the hand due to compression of the brachial plexus by the hypertrophied muscle, congenital bands, posttraumatic fibrosis, the cervical rib or band, or the malformed first thoracic rib.