PAIN Ques ons and answers Newest RATED A+
2025/2026
pain
the most common symptom promp ng pa ents to visit primary care providers. More than 80%
of pa ents who visit physicians report pain. O en remains under treated.
nocicep ve pain
pain from a normal process that results in noxious s muli being perceived as painful. Explained
by ongoing ssue injury.
thermal, mechanical and chemical nociceptors that engage "withdrawal" reflex followed by
inflammatory response to protect injured ssue
func onal pain
pain sensi vity due to an abnormal processing or func on of the central nervous system in
response to normal s muli
neruopathic pain
Pain caused by lesions or other damage to the nervous system.
Diabe c peripheral neuropathy
progressive deteriora on of nerve func on that results in loss of sensory percep on
acute pain
is pain that occurs as a result of injury or surgery, under 3 months. Poorly treated acute pain can
cause psychological stress and compromise the immune system. Soma c acute pain is an injury
to skin, bone, joint, muscle and connec ve ssue. Visceral pain involves injury to nerves on
internal organs. Treat aggressively. Examples: cut hand, menstrual cramps.
chronic pain
can be intermi-ent or persistent, more than 3 months. Main affects include a) effects on
physical func on b) psychological changes c) social consequences and d) societal consequences.
Usually involving life threatening diseases such as cancers, aids, progressive neurological
diseases, end stage organ failure, demen a. Management should be mul modal with cogni ve
, interven ons, physical manipula ons, pharmacological agents, surgical interven ons, and
regional or spinal anesthesia.
chronic malignant pain
Painn is associated with a progressive life-threatening disease like cancer, aids, neurologic
diseases, end stage organ failure, and demen a. Goal is pain allevia on and preven on.
Dependence or addic on is not a concern. Pain not associated with life threatening disease and
las ng more than 6 months beyond the healing period is referred to as "chronic nonmalignant
pain."
What are some non-pharmacological approaches to pain?
imagery, distrac on, relaxa on, psychotherapy, biofeedback, cogni ve behavioral therapy,
support groups, and spiritual counseling. Physical therapy, heat, cold, water, ultrasound, TENS,
massage and therapeu c exercise.
WHO 3 step analgesic ladder
* 1- nonopioid
* 2 - opioid for mild to moderate pain
* 3 - opioid for moderate to severe pain
WHO first step pain ladder
mild pain/nonopioid analgesics such as NSAIDS or acetaminophen w/ or w/out adjuvants (such
as pregablin) .. "soreness." Med examples: apap 1000mg q 6hrs, ibu600mg q6 hrs
NSAIDs
Non-steroidal an -inflammatory drugs. associated with several clinically significant
contraindica ons and drug interac ons. NSAIDS are equally effec ve in analgesia, an pyre c
and an -inflammatory effects. Choice should include STEPS (simplicity, tolerability, evidence,
price, safety). If pa ent fails therapy with an agent from one class of NSAIDs, use of an agent
from another class is reasonable.
COX2 inhibitors
Celecoxib (Celebrex) selec ve agents (celecoxib) have ideal indica on in pa ents with high risk
for GI bleed, high intolerance of non-selec ve NSAIDS, or treatment failure with non-selec ve
agents. NSAIDs are of minimal value in neuropathic pain. NSAIDs produce a flat dose response
curve (celling effect) with higher doses providing no greater efficacy than moderate doses.
Acetaminophen