pain disorder

disorder /dis·or·der/ (dis-or´der) a derangement or abnormality of function; a morbid physical or mental state.

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acute stress disorder  an anxiety disorder characterized by development of anxiety, dissociative, and other symptoms within one month following exposure to an extremely traumatic event. If persistent, it may become posttraumatic stress disorder.

adjustment disorder  maladaptive reaction to identifiable stress (e.g., divorce, illness), which is assumed to remit when the stress ceases or when the patient adapts.

affective disorders  mood d's.

amnestic disorders  mental disorders characterized by acquired impairment in the ability to learn and recall new information, sometimes accompanied by inability to recall previously learned information.

anxiety disorders  mental disorders in which anxiety and avoidance behavior predominate, i.e., panic disorder, agoraphobia, social phobia, specific phobia, obsessive-compulsive disorder, posttraumatic stress disorder, acute stress disorder, generalized anxiety disorder, and substance-induced anxiety disorder.

attention-deficit/hyperactivity disorder  a controversial childhood mental disorder with onset before age seven, and characterized by inattention (e.g., distractibility, forgetfulness, not appearing to listen), by hyperactivity and impulsivity (e.g., restlessness, excessive running or climbing, excessive talking, and other disruptive behavior), or by a combination of both types of behavior.

autistic disorder  autism; a severe pervasive developmental disorder with onset usually before three years of age and a biological basis; it is characterized by qualitative impairment in reciprocal social interaction, verbal and nonverbal communication, and capacity for symbolic play, by restricted and unusual repertoire of activities and interests, and often by cognitive impairment.

behavior disorder  conduct d.

binge-eating disorder  an eating disorder characterized by repeated episodes of binge eating, as in bulimia nervosa, but not followed by inappropriate compensatory behavior such as purging, fasting, or excessive exercise.

bipolar disorders  mood disorders with a history of manic, mixed, or hypomanic episodes, usually with present or previous history of one or more major depressive episodes; included are bipolar I d., characterized by one or more manic or mixed episodes, bipolar II d., characterized by one or more hypomanic episodes but no manic episodes, and cyclothymic disorder. The term is sometimes used in the singular to denote either bipolar I disorder, bipolar II disorder, or both.

body dysmorphic disorder  a somatoform disorder characterized by a normal-looking person's preoccupation with an imagined defect in appearance.

breathing-related sleep disorder  any of several disorders characterized by sleep disruption due to some sleep-related breathing problem, resulting in excessive sleepiness or insomnia.

brief psychotic disorder  an episode of psychotic symptoms with sudden onset, lasting less than one month.

catatonic disorder  catatonia due to the physiological effects of a general medical condition and neither better accounted for by another mental disorder nor occurring exclusively during delirium.

character disorders  personality d's.

childhood disintegrative disorder  pervasive developmental disorder characterized by marked regression in various developmental skills, including language, play, and social and motor skills, after two to ten years of initial normal development.

circadian rhythm sleep disorder  a lack of synchrony between the schedule of sleeping and waking required by the external environment and that of a person's own circadian rhythm.

collagen disorder  an inborn error of metabolism involving abnormal structure or metabolism of collagen, e.g., Marfan syndrome, cutis laxa. Cf. collagen disease.

communication disorders  mental disorders characterized by difficulties with speech or language, severe enough to interfere academically, occupationally, or socially.

conduct disorder  a type of disruptive behavior disorder of childhood and adolescence marked by persistent violation of the rights of others or of age-appropriate societal norms or rules.

conversion disorder  a somatoform disorder characterized by conversion symptoms (loss or alteration of voluntary motor or sensory functioning suggesting physical illness) with no physiological basis and not produced intentionally or feigned; a psychological basis is suggested by exacerbation of symptoms during psychological stress, relief from tension (primary gain), or gain of outside support or attention (secondary gains).

cyclothymic disorder  a mood disorder characterized by alternating cycles of hypomanic and depressive periods with symptoms like those of manic and major depressive episodes but of lesser severity.

delusional disorder  a mental disorder marked by well-organized, logically consistent delusions of grandeur, persecution, or jealousy, with no other psychotic feature. There are six types: persecutory, jealous, erotomanic, somatic, grandiose, and mixed.

depersonalization disorder  a dissociative disorder characterized by intense, prolonged, or otherwise troubling feelings of detachment from one's body or thoughts, not secondary to another mental disorder.

depressive disorders  mood disorders in which depression is unaccompanied by manic or hypomanic episodes.

developmental coordination disorder  problematic or delayed development of gross and fine motor coordination skills, not due to a neurological disorder or to general mental retardation, resulting in the appearance of clumsiness.

disruptive behavior disorders  a group of mental disorders of children and adolescents consisting of behavior that violates social norms and is disruptive.

dissociative disorders  mental disorders characterized by sudden, temporary alterations in identity, memory, or consciousness, segregating normally integrated parts of one's personality from one's dominant identity.

dissociative identity disorder  a dissociative disorder characterized by the existence in an individual of two or more distinct personalities, with at least two of the personalities controlling the patient's behavior in turns. The host personality usually is totally unaware of the alternate personalities; alternate personalities may or may not have awareness of the others.

dream anxiety disorder  nightmare d.

dysthymic disorder  a mood disorder characterized by depressed feeling, loss of interest or pleasure in one's usual activities, and other symptoms typical of depression but tending to be longer in duration and less severe than in major depressive disorder.

eating disorder  abnormal feeding habits associated with psychological factors, including anorexia nervosa, bulimia nervosa, pica, and rumination disorder.

expressive language disorder  a communication disorder occurring in children and characterized by problems with the expression of language, either oral or signed.

factitious disorder  a mental disorder characterized by repeated, intentional simulation of physical or psychological signs and symptoms of illness for no apparent purpose other than obtaining treatment.

factitious disorder by proxy  a form of factitious disorder in which one person (usually a mother) intentionally fabricates or induces physical (Munchausen syndrome by proxy) or psychological disorders in another person under their care (usually their child) and subjects that person to needless diagnostic procedures or treatment, without any external incentives for the behavior.

female orgasmic disorder  consistently delayed or absent orgasm in a female, even after a normal phase of sexual excitement and adequate stimulation.

female sexual arousal disorder  a sexual dysfunction involving failure by a female either to attain or maintain lubrication and swelling during sexual activity, after adequate stimulation.

functional disorder  a disorder of physiological function having no known organic basis.

gender identity disorder  a disturbance of gender identification in which the affected person has an overwhelming desire to change their anatomic sex or insists that they are of the opposite sex, with persistent discomfort about their assigned sex or about filling its usual gender role.

generalized anxiety disorder  (GAD) an anxiety disorder characterized by excessive, uncontrollable worry about two or more life circumstances for six months or more.

hypoactive sexual desire disorder  a sexual dysfunction consisting of persistently or recurrently low level or absence of sexual fantasies and desire for sexual activity.

impulse control disorders  a group of mental disorders characterized by repeated failure to resist an impulse to perform some act harmful to oneself or to others.

induced psychotic disorder  shared psychotic d.

intermittent explosive disorder  an impulse control disorder characterized by multiple discrete episodes of loss of control of aggressive impulses resulting in serious assault or destruction of property that are out of proportion to any precipitating stressors.

learning disorders  a group of disorders characterized by academic functioning that is substantially below the level expected on the basis of the patient's age, intelligence, and education.

lymphoproliferative disorders  a group of malignant neoplasms arising from cells related to the common multipotential lymphoreticular cell, including lymphocytic, histiocytic, and monocytic leukemias, multiple myeloma, plasmacytoma, and Hodgkin's disease.

lymphoreticular disorders  a group of disorders of the lymphoreticular system, characterized by the proliferation of lymphocytes or lymphoid tissues.

major depressive disorder  a mood disorder characterized by the occurrence of one or more major depressive episodes and the absence of any history of manic, mixed, or hypomanic episodes.

male erectile disorder  a sexual dysfunction involving failure by a male to attain or maintain an adequate erection until completion of sexual relations.

male orgasmic disorder  consistently delayed or absent orgasm in a male, even after a normal phase of sexual excitement and stimulation adequate for his age.

manic-depressive disorder  former name for a mood disorder now known as bipolar I d. or bipolar II d. and often called bipolar d. (q.v.).

mendelian disorder  a genetic disease showing a mendelian pattern of inheritance, caused by a single mutation in the structure of DNA, which causes a single basic defect with pathologic consequences.

mental disorder  any clinically significant behavioral or psychological syndrome characterized by the presence of distressing symptoms, impairment of functioning, or significantly increased risk of suffering death, pain, or other disability.

minor depressive disorder  a mood disorder closely resembling major depressive disorder and dysthymic disorder but intermediate in severity between the two.

mixed receptive-expressive language disorder  a communication disorder involving both the expression and the comprehension of language, either spoken or signed.

monogenic disorder  mendelian d.

mood disorders  mental disorders characterized by disturbances of mood manifested as one or more episodes of mania, hypomania, depression, or some combination, the two main subcategories being bipolar disorders and depressive disorders.

motor skills disorder  any disorder characterized by inadequate development of motor coordination severe enough to restrict locomotion or the ability to perform tasks, schoolwork, or other activities.

multifactorial disorder  one caused by the interaction of genetic and sometimes also nongenetic, environmental factors, e.g., diabetes mellitus.

multiple personality disorder  dissociative identity d.

myeloproliferative disorders  a group of usually neoplastic diseases possibly related histogenetically, including granulocytic leukemias, myelomonocytic leukemias, polycythemia vera, and myelofibroerythroleukemia.

neurotic disorder  neurosis.

nightmare disorder  repeated episodes of nightmares that awaken the sleeper, with full orientation and alertness and vivid recall of the dreams.

obsessive-compulsive disorder  (OCD) an anxiety disorder characterized by recurrent obsessions or compulsions, which are severe enough to interfere significantly with personal or social functioning. Cf. obsessive-compulsive personality disorder, under personality .

obsessive-compulsive personality disorder  see under personality.

oppositional defiant disorder  a type of disruptive behavior disorder characterized by a recurrent pattern of defiant, hostile, disobedient, and negativistic behavior directed toward those in authority.

organic mental disorder  a term formerly used to denote any mental disorder with a specifically known or presumed organic etiology. It was sometimes used synonymously with organic mental syndrome.

orgasmic disorders  sexual dysfunctions characterized by inhibited or premature orgasm; see female orgasmic d., male orgasmic d., and premature ejaculation.

pain disorder  a somatoform disorder characterized by a chief complaint of severe chronic pain which is neither feigned nor intentionally produced, but in which psychological factors appear to play a major role in onset, severity, exacerbation, or maintenance.

panic disorder  an anxiety disorder characterized by attacks of panic (anxiety), fear, or terror, by feelings of unreality, or by fears of dying, or losing control, together with somatic signs such as dyspnea, choking, palpitations, dizziness, vertigo, flushing or pallor, and sweating. It may occur with or, rarely, without agoraphobia.

paranoid disorder  older term for delusional d.

personality disorders  a category of mental disorders characterized by enduring, inflexible, and maladaptive personality traits that deviate markedly from cultural expectations and either generate subjective distress or significantly impair functioning. For specific disorders, see under personality.

pervasive developmental disorders  disorders in which there is impaired development in multiple areas, including reciprocal social interactions, verbal and nonverbal communications, and imaginative activity, as in autistic disorder.

phagocytic dysfunction disorders  a group of immunodeficiency conditions characterized by disordered phagocytic activity, occurring as both extrinsic and intrinsic types. Bacterial or fungal infections may range from mild skin infection to fatal systemic infection.

phobic disorders  see phobia.

phonological disorder  a communication disorder characterized by failure to use age- and dialect-appropriate sounds in speaking, with errors occurring in the selection, production, or articulation of sounds.

plasma cell disorders  see under dyscrasia.

postconcussional disorder  see under syndrome.

posttraumatic stress disorder  (PTSD) an anxiety disorder caused by an intensely traumatic event, characterized by mentally reexperiencing the trauma, avoidance of trauma-associated stimuli, numbing of emotional responsiveness, and hyperalertness and difficulty in sleeping, remembering, or concentrating.

premenstrual dysphoric disorder  premenstrual syndrome viewed as a psychiatric disorder.

psychoactive substance use disorders  substance use d's.

psychosomatic disorder  one in which the physical symptoms are caused or exacerbated by psychological factors, as in migraine headaches, lower back pain, or irritable bowel syndrome.

psychotic disorder  psychosis.

reactive attachment disorder  a mental disorder of infancy or early childhood characterized by notably unusual and developmentally inappropriate social relatedness, usually associated with grossly pathological care.

rumination disorder  excessive rumination of food by infants, after a period of normal eating habits, potentially leading to death by malnutrition.

schizoaffective disorder  a mental disorder in which symptoms of a mood disorder occur along with prominent psychotic symptoms characteristic of schizophrenia.

schizophreniform disorder  a mental disorder with the signs and symptoms of schizophrenia but of less than six months' duration.

seasonal affective disorder  (SAD) depression with fatigue, lethargy, oversleeping, overeating, and carbohydrate craving recurring cyclically during specific seasons, most commonly the winter months.

separation anxiety disorder  prolonged, developmentally inappropriate, excessive anxiety and distress in a child concerning removal from parents, home, or familiar surroundings.

sexual disorders 

1. any disorders involving sexual functioning, desire, or performance.

2. specifically, any such disorder that is caused at least in part by psychological factors; divided into sexual dysfunctions and paraphilias.

sexual arousal disorders  sexual dysfunctions characterized by alterations in sexual arousal; see female sexual arousal d. and male erectile d.

sexual aversion disorder  feelings of repugnance for and active avoidance of genital sexual contact with a partner, causing substantial distress or interpersonal difficulty.

sexual desire disorders  sexual dysfunctions characterized by alteration in sexual desire; see hypoactive sexual desire d. and sexual aversion d.

sexual pain disorders  sexual dysfunctions characterized by pain associated with intercourse; it includes dyspareunia and vaginismus not due to a general medical condition.

shared psychotic disorder  a delusional system that develops in one or more persons as a result of a close relationship with someone who already has a psychotic disorder with prominent delusions.

sleep disorders  chronic disorders involving sleep, either primary (dyssomnias, parasomnias) or secondary to factors including a general medical condition, mental disorder, or substance use.

sleep terror disorder  a sleep disorder of repeated episodes of pavor nocturnus.

sleepwalking disorder  a sleep disorder of the parasomnia group, consisting of repeated episodes of somnambulism.

social anxiety disorder  social phobia.

somatization disorder  a somatoform disorder characterized by multiple somatic complaints, including a combination of pain, gastrointestinal, sexual, and neurological symptoms, and not fully explainable by any known general medical condition or the direct effect of a substance, but not intentionally feigned or produced.

somatoform disorders  mental disorders characterized by symptoms suggesting physical disorders of psychogenic origin but not under voluntary control, e.g., body dysmorphic disorder, conversion disorder, hypochondriasis, pain disorder, somatization disorder, and undifferentiated somatoform disorder.

somatoform pain disorder  pain d.

speech disorder  defective ability to speak; it may be either psychogenic (see communication d. ) or neurogenic. See also aphasia, aphonia, dysphasia, and dysphonia.

stereotypic movement disorder  a mental disorder characterized by repetitive nonfunctional motor behavior that often appears to be driven and can result in serious self-inflicted injuries.

substance-induced disorders  a subgroup of the substance-related disorders comprising a variety of behavioral or psychological anomalies resulting from ingestion of or exposure to a drug of abuse, medication, or toxin. Cf. substance use d's.

substance-related disorders  any of the mental disorders associated with excessive use of or exposure to psychoactive substances, including drugs of abuse, medications, and toxins. The group is divided into substance use d's and substance-induced d's .

substance use disorders  a subgroup of the substance-related disorders, in which psychoactive substance use or abuse repeatedly results in significantly adverse consequences. The group comprises substance abuse and substance dependence.

undifferentiated somatoform disorder  one or more physical complaints, not intentionally produced or feigned and persisting for at least six months, that cannot be fully explained by a general medical condition or the direct effects of a substance.

unipolar disorders  depressive d's.

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pain [pān]

a feeling of distress, suffering, or agony, caused by stimulation of specialized nerve endings. Its purpose is chiefly protective; it acts as a warning that tissues are being damaged and induces the sufferer to remove or withdraw from the source. The North American Nursing Diagnosis Association has accepted pain as a nursing diagnosis, defining it as a state in which an individual experiences and reports severe discomfort or an uncomfortable sensation; the reporting of pain may be either by direct verbal communication or by encoded descriptors.

Pain Receptors and Stimuli. All receptors for pain stimuli are free nerve endings of groups of myelinated or unmyelinated neural fibers abundantly distributed in the superficial layers of the skin and in certain deeper tissues such as the periosteum, surfaces of the joints, arterial walls, and the falx and tentorium of the cranial cavity. The distribution of pain receptors in the gastrointestinal mucosa apparently is similar to that in the skin; thus, the mucosa is quite sensitive to irritation and other painful stimuli. Although the parenchyma of the liver and the alveoli of the lungs are almost entirely insensitive to pain, the liver and bile ducts are extremely sensitive, as are the bronchi and parietal pleura.

Some pain receptors are selective in their response to stimuli, but most are sensitive to more than one of the following types of excitation: (1) mechanical stress of trauma; (2) extremes of heat and cold; and (3) chemical substances, such as histamine, potassium ions, acids, prostaglandins, bradykinin, and acetylcholine. Pain receptors, unlike other sensory receptors in the body, do not adapt or become less sensitive to repeated stimulation. Under certain conditions the receptors become more sensitive over a period of time. This accounts for the fact that as long as a traumatic stimulus persists the person will continue to be aware that damage to the tissues is occurring.

The body is able to recognize tissue damage because when cells are destroyed they release the chemical substances previously mentioned. These substances can stimulate pain receptors or cause direct damage to the nerve endings themselves. A lack of oxygen supply to the tissues can also produce pain by causing the release of chemicals from ischemic tissue. Muscle spasm is another cause of pain, probably because it has the indirect effect of causing ischemia and stimulation of chemosensitive pain receptors.

Transmission and Recognition of Pain. When superficial pain receptors are excited the impulses are transmitted from these surface receptors to synapses in the gray matter (substantia gelatinosa) of the dorsal horns of the spinal cord. They then travel upward along the sensory pathways to the thalamus, which is the main sensory relay station of the brain. The dorsomedial nucleus of the thalamus projects to the prefrontal cortex of the brain. The conscious perception of pain probably takes place in the thalamus and lower centers; interpretation of the quality of pain is probably the role of the cerebral cortex.

The perception of pain by an individual is highly complex and individualized, and is subject to a variety of external and internal influences. The cerebral cortex is concerned with the appreciation of pain and its quality, location, type, and intensity; thus, an intact sensory cortex is essential to the perception of pain. In addition to neural influences that transmit and modulate sensory input, the perception of pain is affected by psychological and cultural responses to pain-related stimuli. A person can be unaware of pain at the time of an acute injury or other very stressful situation, when in a state of depression, or when experiencing an emotional crisis. Cultural influences also precondition the perception of and response to painful stimuli. The reaction to similar circumstances can range from complete stoicism to histrionic behavior.

Pain Control. There are several theories related to the physiologic control of pain but none has been completely verified. One of the best known is that of Mellzak and Wall, the gate control theory, which proposed that pain impulses were mediated in the substantia gelatinosa of the spinal cord with the dorsal horns acting as “gates” that controlled entry of pain signals into the central pain pathways. Also, pain signals would compete with tactile signals with the two constantly balanced against each other.

Since this theory was first proposed, researchers have shown that the neuronal circuitry it hypothesizes is not precisely correct. Nevertheless, there are internal systems that are now known to occur naturally in the body for controlling and mediating pain. One such system, the opioid system, involves the production of morphinelike substances called enkephalins and endorphins. Both are naturally occurring analgesics found in various parts of the brain and spinal cord that are concerned with pain perception and the transmission of pain signals. Signals arising from stimulation of neurons in the gray matter of the brain stem travel downward to the dorsal horns of the spinal cord where incoming pain impulses from the periphery terminate. The descending signals block or significantly reduce the transmission of pain signals upward along the spinal cord to the brain where pain is perceived by releasing these substances.

In addition to the brain's opioid system for controlling the transmission of pain impulses along the spinal cord, there is another mechanism for the control of pain. The stimulation of large sensory fibers extending from the tactile receptors in the skin can suppress the transmission of pain signals from thinner nerve fibers. It is as if the nerve pathways to the brain can accommodate only one type of signal at a time, and when two kinds of impulses simultaneously arrive at the dorsal horns, the tactile sensation takes precedence over the sensation of pain.

The discovery of endorphins and the inhibition of pain transmission by tactile signals has provided a scientific explanation for the effectiveness of such techniques as relaxation, massage, application of liniments, and acupuncture in the control of pain and discomfort.

Assessment of Pain. Pain is a subjective phenomenon that is present when the person who is experiencing it says it is. The person reporting personal discomfort or pain is the most reliable source of information about its location, quality, intensity, onset, precipitating or aggravating factors, and measures that bring relief.

Objective signs of pain can help verify what a patient says about pain, but such data are not used to prove or disprove whether it is present. Physiologic signs of moderate and superficial pain are responses of the sympathetic nervous system. They include rapid, shallow, or guarded respiratory movements, pallor, diaphoresis, increased pulse rate, elevated blood pressure, dilated pupils, and tenseness of the skeletal muscles. Pain that is severe or located deep in body cavities acts as a stimulant to parasympathetic neurons and is evidenced by a drop in blood pressure, slowing of pulse, pallor, nausea and vomiting, weakness, and sometimes a loss of consciousness.

Behavioral signs of pain include crying, moaning, tossing about in bed, pacing the floor, lying quietly but tensely in one position, drawing the knees upward toward the abdomen, rubbing the painful part, and a pinched facial expression or grimacing. The person in pain also may have difficulty concentrating and remembering and may be totally self-centered and preoccupied with the pain.

Psychosocial aspects of tolerance for pain and reactions to it are less easily identifiable and more complex than physiologic responses. An individual's reaction to pain is subject to a variety of psychologic and cultural influences. These include previous experience with pain, training in regard to how one should respond to pain and discomfort, state of health, and the presence of fatigue or physical weakness. One's degree of attention to and distraction from painful stimuli can also affect one's perception of the intensity of pain. A thorough assessment of pain takes into consideration all of these psychosocial factors.

Management of Pain. Among the measures employed to provide relief from pain, administration of analgesic drugs is probably the one that is most often misunderstood and abused. When an analgesic drug has been ordered “as needed,” the patient should know that the drug is truly available when needed and that it will be given promptly when asked for. If the patient is forced to wait until someone else decides when an analgesic is needed, the patient may become angry, resentful, and tense, thus diminishing or completely negating the desired effect of the drug. Studies have shown that when analgesics are left at the bedside of terminally ill cancer patients to be taken at their discretion, fewer doses are taken than when they must rely on someone else to make the drug available. Habituation and addiction to analgesics probably result as much from not using other measures along with analgesics for pain control as from giving prescribed analgesics when they are ordered. Patient-controlled analgesia has been used safely and effectively.

When analgesics are not appropriate or sufficient or when there is a real danger of addiction, there are noninvasive techniques that can be used as alternatives or adjuncts to analgesic therapy. The selection of a particular technique for the management of pain depends on the cause of the pain, its intensity and duration, whether it is acute or chronic, and whether the patient perceives the technique as effective.

Distraction techniques provide a kind of sensory shielding to make the person less aware of discomfort. Distraction can be effective in the relief of brief periods of acute pain, such as that associated with minor surgical procedures under local anesthesia, wound débridement, and venipuncture.

Massage and gentle pressure activate the thick-fiber impulses and produce a preponderance of tactile signals to compete with pain signals. It is interesting that stimulation of the large sensory fibers leading from superficial sensory receptors in the skin can relieve pain at a site distant from the area being rubbed or otherwise stimulated. Since ischemia and muscle spasm can both produce discomfort, massage to improve circulation and frequent repositioning of the body and limbs to avoid circulatory stasis and promote muscle relaxation can be effective in the prevention and management of pain. Transcutaneous electrical nerve stimulation (TENS) units enhance the production of endorphins and enkephalins and can also relieve pain.

Specific relaxation techniques can help relieve physical and mental tension and stress and reduce pain. They have been especially effective in mitigating discomfort during labor and delivery but can be used in a variety of situations. Learning proper relaxation techniques is not easy for some people, but once these techniques have been mastered they can be of great benefit in the management of chronic ongoing pain. The intensity of pain also can be reduced by stimulating the skin through applications of either heat or cold, menthol ointments, and liniments. Contralateral stimulation involves stimulating the skin in an area on the side opposite a painful region. Stimulation can be done by rubbing, massaging, or applying heat or cold.

Since pain is a symptom and therefore of value in diagnosis, it is important to keep accurate records of the observations of the patient having pain. These observations should include the following: the nature of the pain, that is, whether it is described by the patient as being sharp, dull, burning, aching, etc.; the location of the pain, if the patient is able to determine this; the time of onset and the duration, and whether or not certain nursing measures and drugs are successful in obtaining relief; and the relation to other circumstances, such as the position of the patient, occurrence before or after eating, and stimuli in the environment such as heat or cold that may trigger the onset of pain.

Surgical procedures designed to alleviate pain. From Ignatavicius et al., 1999.

acute pain

1. one of the three categories of pain established by the International Association for the Study of Pain, denoting pain that is caused by occurrences such as traumatic injury, surgical procedures, or medical disorders; clinical symptoms often include increased heart rate, blood pressure, and respiratory rate, shallow respiration, agitation or restlessness, facial grimaces, or splinting.

2. a nursing diagnosis accepted by the North American Nursing Diagnosis Association, defined as an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage, with sudden or slow onset of any intensity from mild to severe with an anticipated or predictable end and a duration of less than 6 months.

bearing-down pain pain accompanying uterine contractions during the second stage of labor.

cancer pain one of the three categories of pain established by the International Association for the Study of Pain, denoting pain associated with malignancies and perceived by the individual patient; there are various scales ranking it from 0 to 10 according to level of severity.

chronic pain

1. one of the three categories of pain established by the International Association for the Study of Pain, denoting pain that is persistent, often lasting more than six months; clinical symptoms may be the same as for acute pain, or there may be no symptoms evident. The North American Nursing Diagnosis Association has accepted chronic pain as a nursing diagnosis.

2. a nursing diagnosis accepted by the North American Nursing Diagnosis Association, defined as an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage, with sudden or slow onset of any intensity from mild to severe, without an anticipated or predictable end, and with a duration of greater than 6 months.

pain disorder a somatoform disorder characterized by a chief complaint of severe chronic pain that causes substantial distress or impairment in functioning; the pain is neither feigned nor intentionally produced, and psychological factors appear to play a major role in its onset, severity, exacerbation, or maintenance. The pain is related to psychological conflicts and is made worse by environmental stress; it enables the patient to avoid an unpleasant activity or to obtain support and sympathy. Patients may visit many health care providers searching for relief and may consume excessive amounts of analgesics without any effect. They are difficult to treat because they strongly resist the idea that their symptoms have a psychological origin.

false p's ineffective pains during pregnancy that resemble labor pains, not accompanied by cervical dilatation; see also braxton-hicks contractions. Called also false labor.

gas p's see gas pains.

growing p's any of various types of recurrent limb pains resembling those of rheumatoid conditions, seen in early youth and formerly thought to be caused by the growing process.

hunger pain pain coming on at the time for feeling hunger for a meal; a symptom of gastric disorder.

intermenstrual pain pain accompanying ovulation, occurring during the period between the menses, usually about midway.

labor p's the rhythmic pains of increasing severity and frequency due to contraction of the uterus at childbirth; see also labor.

lancinating pain sharp darting pain.

phantom pain pain felt as if it were arising in an absent or amputated limb or organ; see also amputation.

psychogenic pain symptoms of physical pain having psychological origin; see pain disorder.

referred pain pain in a part other than that in which the cause that produced it is situated. Referred pain usually originates in one of the visceral organs but is felt in the skin or sometimes in another area deep inside the body. Referred pain probably occurs because pain signals from the viscera travel along the same neural pathways used by pain signals from the skin. The person perceives the pain but interprets it as having originated in the skin rather than in a deep-seated visceral organ.

Area of referred pain, anterior and posterior views.

rest pain a continuous unrelenting pain due to ischemia of the lower leg, beginning with or being aggravated by elevation and being relieved by sitting with legs in a dependent position or by standing.

root pain pain caused by disease of the sensory nerve roots and occurring in the cutaneous areas supplied by the affected roots.

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pain disorder

Somatiform pain disorder, see there