TERM

DEFINITION

HOW TO USE CLINICALLY

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.

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.

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.

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.

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.

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

Visceral pain

Pain of the body’s internal organs

• This pain is often poorly localized and usually constant
• It is often described as deep and aching and is often referred to other sites.

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. 

Neuropathic pain

Pain initiated or caused by a primary lesion or dysfunction in the nervous system

• Neuropathic pain may have a burning, deeply aching quality accompanied by some sudden sharp lancing pain and often radiates down a nerve path.
• Older adults may have numbness, tingling, or skin sensitivity over the area of skin.

Allodynia

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

• Common in many neuropathic pain conditions
• An example of a older adult experiencing allodynia is one who is uncomfortable with the bed sheets resting on their feet or legs.