Nomenclature for the Pain Practitioner and Summary

When assessing any type of pain, physicians must categorize the patient's symptoms based on severity, onset, duration, and chronicity as treatment will vary depending on its nature and etiology. Acute pain is initially treated with short-acting non-opioid pharmacologic agents or combination opioid drugs (e.g., Percodan®, Lortab®, Vicodin®, Tylenol® #3).

Acute versus chronic pain is important to clearly differentiate. Acute pain is rapid in onset, self-limiting, a symptom of the disease, and the patient often presents in acute distress. Examples of acute pain include postoperative pain, obstetrical labor pain, and trauma or injury-related pain (Table 8.5) and characteristically is described as sudden, sharp, and localized pain. It is usually self-limited and may be associated with physiologic changes such as diaphoresis and increases in heart rate and blood pressure.

Table 8.5 Common diverse acute pain syndromes.

Postoperative pain Traumatic injury-related pain Burn pain

Acute herpes zoster Acute pain in obstetrics Sickle cell pain Cancer-related pain

Headache -Muscle tension -Vascular, migraine, aneursym -Complex: compound headache

Chest pain

-Angina/ischemia

-Esophagitis/reflux

-Pleuritic pain: effusion, pneumonia, inflammation

Abdominal pain -Acute pancreatitis

-Acute abdomen: perforation, obstruction, ischemic -Renal colic

Musculoskeletal pain (back pain) Neurogenic pain -Disk herniation -Nerve compression

It is necessary for clinicians to make a rapid assessment of etiology and of severity. The treatment plan for a clinician may include medications, including opiates, surgery, or other options.

Chronic pain is long-term pain classified as acute, moderate, and severe. It is often differentiated as malignant or non-malignant pain. Chronic pain is often described as gnawing, aching, and diffuse and is more gradual in onset and cessation than acute pain, which can also be simultaneously superimposed on top of the former. It can vary in intensity, may remit briefly, and has definite impact psychologically and socially. The treatment for such pain is often successful with traditional pharmacologic measures; however, often less traditional drugs and even non-pharmacologic therapies are necessary to achieve relief.

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