1. A delta fibers

2. C fibers

• myelinated fibers
• larger in diameter
• transmit the pain signal rapidly to the CNS
• very localized, short-term, and sharp sensations

• unmyelinated and smaller fibers
• transmit the signal slowly
• sensations are diffuse and aching
• sensations persist after the initial injury

• a specified area of the spinal cord
• lamina II
• receives sensory input from various areas of the body

1. transduction

2.transmission

3. perception

4. modulation

• the second phase of nociception
• the pain impulse moves from the level of the spinal cord to the brain

• third phase of nociception
• indicates the conscious awareness of a painful sensation

• the fourth phase of nociception
• the pain message is inhibited

• indicates a type of pain that does not adhere to typical and predictable manifestations
• implies an abnormal processing of the pain message
• most difficult type of pain to assess and treat
• pain is present long after healing
• pain cannot be identified through imaging

• pain that originates from the larger interior organs 
• often accompanied by autonomic responses such as vomiting, nausea, pallor, and diaphoresis

• pain that is felt at a particular site but originates from another location
• may originate from visceral or somatic structures

• short term pain
• self-limiting
• often follows a predictable trajectory
• dissipates after an injury heals 
• serves a self-protective purpose because it warns the individual of actual/potential tissue damage

• pain that continues for 6 months or longer
• two types: malignant and nonmalignant
• does not stop after healing
• outlasts its protective purpose
• level of pain intensity does not correspond with the physical findings
• originates from abnormal processing of pain fibers from peripheral or central sites

• cancer related pain
• often parallels the pathology created by tumor cells
• pain induced by tissue necrosis or stretching of an organ by the growing tumor
• pain fluctuates within the course of the disease

• often associated with musculoskeletal conditions 
• arthritis, low back pain, fibromyalgia 

• poor weight gain
• learning disabilities
• psychiatric disorders
• alcoholism

• arthritis
• osteoarthritis
• osteoporosis 
• peripheral vascular disease
• cancer
• peripheral neuropathies
• chronic constipation 
• angina

limbic system 

(does not affect somatosensory cortex)

• societal expectations
• hormones
• genetic make-up

1. where is your pain?
2. when did your pain start?
3. what does your pain feel like?
4. how much pain do you have now?
5. what makes your pain better/worse?
6. how does pain limit your function or activities?
7. how do you usually behave when you are in pain? how would others know that you are in pain?
8. what does this pain mean to you? why do you think you are having pain?

• behavioral interventions
• pharmacologic interventions 
• non-pharmacologic interventions 

• a baseline intensity
• track changes
• gives some degree of evaluation to a treatment modality 

asks a patient to choose a number that rates a level of pain

0 = no pain // 10 = most pain

describes pain intensity as:

• no pain
• mild pain
• moderate pain
• severe pain

• joint motion normally causes no tenderness or pain

• bruising
• lesions
• open wounds
• tissue damage
• bulging 
• change in hair distribution 
• absent/increased pain sensation

• swelling
• bulging 
• herniation 
• inflammation 
• organ enlargement 

• nature of the pain (acute vs. chronic)
• age
• cultural/gender expectations

• gaurding
• grimacing 
• vocalizations (moaning)
• agitation 
• restlessness
• stillness
• diaphoresis 
• change in vital signs

• difficult to identify because not easily shown by patient
• sigh frequently
• bracing, rubbing, diminished activity
• change in appetite 

• crying 
• requires O2 for saturation >95%
• increased vital signs
• expression
• sleepless

• a chronic progressive nerve condition, characterized by burning pain, swelling, stiffness, and discoloration, of the affected extremity
• affects both men and women 40-60 years old

• swelling
• disappearance of skin wrinkles
• cool skin temperature
• discoloration
• brittle nails
• atrophic changes