sympathetic pain

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(pan) [Fr. peine, fr L. poena, a fine, a penalty, punishment]
As defined by the International Association for the Study of Pain, an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage. Pain includes not only the perception of an uncomfortable stimulus but also the response to that perception. About half of those who seek medical help do so because of the primary complaint of pain. Acute pain occurs with an injury or illness; is often accompanied by anxiety, diaphoresis, nausea, and vital sign changes such as tachycardia or hypertension; and should end after the noxious stimulus is removed or any organ damage heals. Chronic or persistent pain is discomfort that lasts beyond the normal healing period. Pain may arise in nearly any organ system and may have different characteristics in each. Musculoskeletal pain often is exacerbated by movement and may be accompanied by joint swelling or muscle spasm. Myofascial pain is marked by trigger-point tenderness. Visceral pain often is diffuse or vaguely localized, whereas pain from the lining of body cavities often is localized precisely, very intense, and exquisitely sensitive to palpation or movement. Neuropathic (nerve) pain usually stings or burns, or may be described as numbness, tingling, or shooting sensations. Colicky pain fluctuates in intensity from severe to mild, and usually occurs in waves. Referred pain results when an injury or disease occurs in one body part but is felt in another.

Several factors influence the experience of pain. Among these are the nature of the injury or illness causing the symptom, the physical and emotional health of the patient, the acuity or chronicity of the symptom, the social milieu and/or cultural upbringing of the patient, neurochemistry, memory, personality, and other features. See: table


Many clinicians use the mnemonic “COLDER” to aid the diagnosis of painful diseases. They will ask the patient to describe the Character, Onset, Location, and Duration of their painful symptoms, as well as the features that Exacerbate or Relieve it. For example: The pain of pleurisy typically is sharp in character, acute in onset, located along the chest wall, and long-lasting; it is worsened by deep breathing or coughing and relieved by analgesics or holding still. By contrast, the pain of myocardial ischemia usually is dull or heavy, gradual in onset, and located substernally. It may be worsened by activity (but not by taking a breath or coughing) and relieved by nitroglycerin.

In 2000, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) issued pain-management standards, in 2001 began surveying for compliance, and in 2004 added patient-safety goals, thus most U.S. health care facilities have devised policies and procedures that require pain-intensity rating as a routine part of care (the fifth vital sign). Pain intensity usually is assessed on a numerical scale, in which 0 = no pain, 1 to 3 = mild pain, 4 to 6 = moderate pain, and 7 to 10 = severe pain. However, obtaining a numerical rating of pain intensity is possible only if the patient is able to provide this report of the pain being experienced, which infants, children, the critically ill, and cognitively impaired usually are unable to do. The Wong’ Baker FACES scale, developed for pediatric use, has been used successfully in other patient populations. It uses visual representations of smiles or grimaces to depict the level of pain a patient feels.

Patient care

Health care professionals must be aware that pain in non-verbal patient can easily be overlooked and must make a conscious effort to ensure that pain in these patients is assessed and treated. Observing subtle behaviors and being sensitive to contextual clues are two pain methods used by health care professionals to try to determine when nonverbal patients are in pain. When this judgment is made, a trial of pain-relieving medication may be used. The responses of the patient and any complications of treatment should be carefully observed and appropriate changes made in dosing or the type of analgesic drug as indicated.

Because pain is a subjective and intensely personal problem, sympathetic care is an important part of its relief. In addition to administering analgesic drugs, health care professionals should use a wide range of techniques to help alleviate pain, including local application of cold and heat, tactile stimulation, relaxation techniques, diversion, and active listening, among others.

acute pain

Pain that typically is produced by sudden injury (e.g., fracture) or illness (e.g., acute infection) and is accompanied by physical signs such as increased heart rate, elevated blood pressure, pupillary dilation, sweating, or hyperventilation. Acute pain is typically sharp in character. It is relayed to the central nervous system rapidly by A delta nerve fibers. [Then, at the end of this entry please add the SYN:] fast pain Depending on the severity of the underlying stimulus, acute pain may be managed with acetaminophen or anti-inflammatory drugs, immobilization and elevation of the injured body part, or the topical application of heat or ice. Severe acute pain, such as that of broken ribs or of an ischemic part, may require narcotics, often with adjunctive agents like hydroxyzine for relief, or antiemetics. Acute pain should be managed aggressively. Synonym: fast pain

adnexal pain

Discomfort arising from the fallopian tubes and ovaries; usually due to inflammation, infection, or ectopic pregnancy.

back pain

Pain felt in or along the spine or musculature of the posterior thorax. It is usually characterized by dull, continuous pain and tenderness in the muscles or their attachments in the lower lumbar, lumbosacral, or sacroiliac regions. Back pain is often referred to the leg or legs, following the distribution of the sciatic nerve.


Common causes of back pain include pain caused by muscular or tendon strain, herniated intervertebral disk, lumbar spinal stenosis, or spondylolisthesis. Patients with a history of cancer may have back pain caused by metastatic tumors to the vertebrae and should be evaluated to be certain that damage to the spinal cord is not imminent. Patients with back pain and fever (esp. those with a history of injection drug use, tuberculosis, or recent back surgery) should be evaluated for epidural abscess or osteomyelitis.


Depending on the underlying cause of the back pain, treatment may include drugs, rest, massage, physical therapy, chiropractic, stretching exercises, injection therapy, and surgery, among others. Most nonmalignant causes of back pain improve with a few days of rest, analgesics, and antiinflammatory drugs, followed by 2 to 4 weeks of anti-inflammatory treatment, appropriate muscle strengthening, and patience. Pain caused by an osteoporotic fracture may prove more debilitating and longer-lasting. Back pain produced by a spinal metastasis can improve with corticosteroids, radiation therapy, intravenous bisphosphonates, and/or surgical decompression. Patients with a spinal epidural abscess will need surgical drainage of the infection and antibiotics.

Patient care

Prolonged bedrest is inadvisable in most patients with back pain. The treatment regimen is explained, implemented, and reinforced. Factors that precipitate symptoms are identified and preventive actions are discussed.

bearing-down pains

Rectal pressure and discomfort occurring during the second stage of labor, related to fetal descent and the woman's straining efforts to expel the fetus.

boring pain

Piercing, used to describe pain felt deep within the body.

breakthrough pain

Transient episodes of pain that occur in patients with chronic pain that has been previously reduced to tolerable levels. Breakthrough pain disrupts the well-being of cancer or hospice patients who have been prescribed regular doses of narcotic analgesics. The painful episodes may occur as a previous dose of pain-relieving medication wears off (“end-of-dose pain”), or after unusual or unanticipated body movements (“incident pain”).

Brodie pain

Pain caused near a joint affected with neuralgia when the skin is folded near it.

burning pain

Pain experienced in heat burns, superficial skin lesions, herpes zoster, and circumscribed neuralgias.

causalgic pain


central pain

Pain due to a lesion in the central nervous system.

chest pain

Discomfort felt in the upper abdomen, thorax, neck, or shoulders. Chest pain is one of the most common potentially serious complaints offered by patients in emergency departments, hospitals, outpatient settings, and physicians' offices. A broad array of diseases and conditions may cause it, including (but not limited to) angina pectoris or myocardial infarction; anxiety and hyperventilation; aortic dissection; costochondritis or injured ribs; cough, pneumonia, pleurisy, pneumothorax, or pulmonary emboli; esophageal diseases, such as reflux or esophagitis; gastritis, duodenitis, or peptic ulcer; and stones in the biliary tree.

chronic idiopathic pelvic pain

Abbreviation: CIPP
Unexplained pelvic pain in a woman that has lasted 6 months or longer. A complete medical, social, and sexual history must be obtained. In an experimental study, women with this illness reported more sexual partners, significantly more spontaneous abortions, and previous nongynecological surgery. These women were more likely to have experienced previous significant psychosexual trauma.


The pain associated with CIPP should be treated symptomatically and sympathetically. The participation of pain management specialists, complementary medical providers, and the primary health care provider should be integrated. Realistic goals (e.g., the reduction of pain rather than its elimination) should be set. Medroxyprogesterone acetate, oral contraceptives, presacral neurectomy, hypnosis, and hysterectomy have been tried with varying degrees of success.

chronic pain

1. Long-lasting discomfort, with episodic exacerbations, that may be felt in the back, one or more joints, the pelvis, or other parts of the body.
2. Pain that lasts more than 3–6 months.
3. Pain that lasts more than a month longer than the usual or expected course of an illness.
4. Pain that returns periodically every few weeks or months for many years. Chronic pain is often described by sufferers as being debilitating, intolerable, disabling, or alienating and may occur without an easily identifiable cause. Studies have shown a high correlation between chronic pain and depression or dysphoria, but it is unclear whether the psychological aspects of chronic pain precede or develop as a result of a person's subjective suffering. Chronic pain is the leading cause of disability in the U.S.acute pain;

Patient care

The management of chronic, nonmalignant pain is often difficult and may be frustrating for both sufferer and caregiver. The best results are usually obtained through multimodal therapy that combines sympathetic guidance that encourages patients to recover functional abilities, by combinations of drugs (e.g., nonsteroidal anti-inflammatories, narcotic analgesics, and/or antidepressants), physical therapy and regular exercise, occupational therapy, physiatry, psychological or social counseling, and alternative medical therapies (e.g., acupuncture, massage, or relaxation techniques). Placebos, although rarely employed clinically, effectively treat chronic pain in about a third of all patients. Surgery and other invasive strategies are occasionally employed, with variable effectiveness.

cramplike pain


dental pain

Pain in the oral area, which, in general, may be of two origins. Soft tissue pain may be acute or chronic, and a burning pain is due to surface lesions and usually can be discretely localized; pulpal pain or tooth pain varies according to whether it is acute or chronic, but it is often difficult to localize.

dilating pain

Discomfort accompanying rhythmic uterine contractions during the first stage of labor.

diskogenic pain

Low back pain resulting from degeneration of an intervertebral disk. Discogenic pain differs from neuropathic pain in that it does not radiate into the extremities or torso.

dull pain

A mild discomfort, often difficult to describe, that may be associated with some musculoskeletal injuries or some diseases of the visceral organs.

eccentric pain

Pain occurring in peripheral structures owing to a lesion involving the posterior roots of the spinal nerves.

epigastric pain

Pain located between the xiphoid process and the umbilicus. It may suggest a problem in one of many different organs, including the stomach, pancreas, gallbladder, small or large bowel, pleura, or heart.
Synonym: gastralgic pain See: cardialgia

expulsive pains

Discomfort during the second stage of labor, associated with bearing-down efforts to expel the fetus. Women may experience a similar pain during delivery of the placenta.

false pain

Abdominal discomfort associated with Braxton Hicks contractions, which occur during the last trimester of pregnancy. Characteristically, the woman complains of irregular, lower abdominal pains, which are relieved by walking. Vaginal examination shows no change in cervical effacement or dilation.
See: Braxton Hicks contractions

fast pain

Acute pain.

fulgurant pain

Lightning pain.

gallbladder pain

Biliary colic.

gas pain

Pain in the intestines caused by an accumulation of gas therein.

gastralgic pain

Epigastric pain.

girdle pain


growing pains

An imprecise term indicating ill-defined pain, usually in the shin or other areas of the legs, typically occurring after bedtime in children age 5 to 12. There is no evidence that the pain is related to rapid growth or to emotional problems. If these symptoms occur during the daytime, are accompanied by other symptoms, or become progressively more severe, evaluation for infection, cancer, and other diseases of muscle and bone should be undertaken. In the majority of cases, this evaluation is not necessary.


The child should be reassured and given acetaminophen or ibuprofen; heat and massage can be applied locally. Children with growing pains benefit from concern and reassurance from their parents and health care providers.

heterotopic pain

Referred pain.

homotopic pain

Pain felt at the point of injury.

hunger pain

Pain in the epigastrum that occurs before meals.

incident pain

Pain due to a sudden, forceful, unanticipated, or unusual body movement or posture.

inflammatory pain

Pain in the presence of inflammation that is increased by pressure.

intermenstrual pain

Episodic, localized pelvic discomfort that occurs between menstrual periods, possibly accompanying ovulation.
Synonym: midpain See: mittelschmerz

intractable pain

Chronic pain that is difficult or impossible to manage with standard interventions. Common causes include metastatic cancer, chronic pancreatitis, radiculopathy, spinal cord transection, or peripheral neuropathy. Intractable pain may also accompany somatoform disorders, depression, fibromyalgia, irritable bowel syndrome, and opiate dependence. Various combinations of the following management strategies are often used to treat intractable pain: antidepressant medications, counseling, deep brain stimulation, injected anesthetics, narcotic analgesics, neurological surgery, and pain clinic consultations.

labor pains

Uncomfortable, intermittent, rhythmic, girdling sensations associated with uterine contractions during childbearing. The frequency, duration, and intensity of the events increase, climaxing with the delivery of the fetus.

lancinating pain

Acute pain.

lightning pain

A sudden brief pain that may be repetitive, usually in the legs but may be at any location. It is associated with tabes dorsalis and other neurological disorders. Synonym: fulgurant pain

lingual pain

Pain in the tongue that may be due to local lesions, glossitis, fissures, or pernicious anemia. Synonym: tongue pain

lung pain

Sharp pain in the region of the lungs.

menstrual pain


mental pain

Psychogenic pain.

middle pain

Intermenstrual pain.

mobile pain

Pain that moves from one area to another.

movement pain


neuropathic pain

Pain that originates in peripheral nerves or the central nervous system rather than in other damaged organs or tissues. A hallmark of neuropathic pain is its localization to specific dermatomes or nerve distributions. Some examples of neuropathic pain are the pain of shingles (herpes zoster), diabetic neuropathy, radiculopathy, and phantom limb pain.


Drugs like gabapentin or pregabalin provide effective relief of neuropathic pain for some patients. Other treatments include (but are not limited to) regional nerve blocks, selective serotonin and norepinephrine reuptake inhibitors, psychological counseling, acupuncture, transcutaneous electrical nerve stimulation, and physical therapy.

night pain

Pain that awakens the patient at night or interferes with sleep; may be due to infection, inflammation, neurovascular compromise, or severe structural damage.

noise pain


objective pain

Pain induced by some external or internal irritant, by inflammation, or by injury to nerves, organs, or other tissues that interferes with the function, nutrition, or circulation of the affected part. It is usually traceable to a definite pathologic process.

paresthesic pain

A stinging or tingling sensation manifested in central and peripheral nerve lesions.
See: paresthesia

periodontal pain

A discrete, well-localized pain caused by inflammation of tissues surrounding a tooth. This may be contrasted with the throbbing, nonlocalized pain typical of a toothache or pulpal pain.

phantom limb pain

The sensation of pain felt in the nerve distribution of a body part that has been amputated. Phantom pain can lead to difficulties in prosthetic training. Synonym: phantom sensation

Patient care

Phantom limb pain or nonpainful sensations are reported by most amputees. A multimodal or combination approach to management is appropriate. Drugs used to treat neuropathic pain may be helpful, including some anticonvulsant drugs, tricyclic antidepressants, selective serotonin inhibitors, and muscle relaxants. Nerve blockade and/or transcutaneous electrical stimulation may also be helpful. Health care professionals should encourage amputees to move the affected extremity, seek counseling or group therapy, engage in physical and occupational therapy, and use distraction techniques.

postprandial pain

Abdominal pain after eating.

precordial pain

Pain felt in the center of the chest (e.g., below the sternum) or in the left side of the chest.

premonitory pain

Ineffective contractions of the uterus before the beginning of true labor.
See: false pain

pseudomyelic pain

The false sensation of movement in a paralyzed limb or of no movement in a moving limb; not a true pain.

psychogenic pain

Pain having mental, as opposed to organic, origin.

radicular pain

Pain that radiates away from the spinal column through an extremity or the torso resulting from the compression or irritation of a spinal nerve root or large paraspinal nerve. It may be accompanied by numbness or tingling.
Enlarge picture

referred pain

Pain that arises in one body part or location but is perceived in another. For example, pain caused by inflammation of the diaphragm often is felt in the shoulder; pain caused by myocardial ischemia may be referred to the neck or jaw; and pain caused by appendicitis may first be felt near the umbilicus rather than in the right lower quadrant, where the appendix lies. See: table
Synonym: heterotopic pain; sympathetic pain See: illustration

remittent pain

Pain with temporary abatements in severity; characteristic of neuralgia and colic.

rest pain

Pain due to ischemia that comes on when sitting or lying.

root pain

Cutaneous pain caused by disease of the sensory nerve roots.

shooting pain

Pain that seems to travel like lightning from one place to another.

slow pain

Pain that is perceived a second or more after a stimulus. It is transmitted to the central nervous system by C (nerve) fibers, which are not myelinated, and therefore conduct sensations more slowly than A delta fibers. Slow pain lasts longer than sudden pain. It is usually perceived by patients as burning, cramping, dull, itchy, or warm.

standards for pain relief

Standards for the Relief of Acute Pain and Cancer Pain developed by the American Pain Society. These are summarized as follows:

1. In order to increase the clinician's responsiveness to complaints of pain, it is now considered by some health care professionals to be the fifth vital sign.2. Acute pain and cancer pain are recognized and effectively treated. Essential to this process is the development of a clinically useful and easy-to-use scale for rating pain and its relief. Patients will be evaluated according to the scales and the results recorded as frequently as needed.3. Information about analgesics is readily available. This includes data concerning the effectiveness of various agents in controlling pain and the availability of equianalgesic charts wherever drugs are used for pain.4. Patients are informed on admission of the availability of methods of relieving pain, and that they must communicate the presence and persistence of pain to the health care staff.5. Explicit policies for use of advanced analgesic technologies are defined. These advances include patient-controlled analgesia, epidural analgesia, and regional analgesia. Specific instructions concerning use of these techniques must be available for the health care staff.6. Adherence to standards is monitored by an interdisciplinary committee. The committee is responsible for overseeing the activities related to implementing and evaluating the effectiveness of these pain standards.

starting pain

A pain accompanied by muscular spasm during the early stages of sleep.

subdiaphragmatic pain

A sharp stitchlike pain occurring during breathing caused, for example, by an abscess or tumor beneath the diaphragm. When the breath is held, the pain ceases. Pressure against the lower rib cage eases the pain.

subjective pain

Psychogenic pain.

sympathetic pain

Referred pain.

tenesmic pain


terebrant pain

A boring or piercing type of pain.

thalamic pain

See: thalamic syndrome

thermalgesic pain

Pain caused by heat.

thoracic pain

Chest pain.

throbbing pain

Pain found in dental caries, headache, and localized inflammation. The pain is often thought to be caused by arterial pulsations.

tongue pain

Lingual pain.

tracheal pain


vascular pain

Pain that throbs or pulses, such as the pain of a migraine headache.

wandering pain

Pain that changes its location repeatedly.
* By mouth unless indicated otherwise.PO—by mouth only.SOURCE: Adapted from Isselbacher, K.J., et al.: Harrison's Principles of Internal Medicine, ed 13. McGraw-Hill, New York, 1994.
Nonopioid Analgesics
Generic NameDose, mg *IntervalComments
Acetylsalicylic acid325–6504–24 hrEnteric-coated preparations available
Acetaminophen6504 hrAvoid in liver failure
Ibuprofen400–8004–8 hrAvailable without prescription
Indomethacin25–758 hrGastrointestinal and kidney side effects common
Naproxen250–50012 hrDelayed effects may be due to long half-life
Ketorolac15–60 IM4–6 hrSimilar to ibuprofen but more potent
Opioid Analgesics
Generic NameParenteral Dose (mg)PO Dose (mg)Comments
Codeine30–60 every 4 hr30–60 every 4 hrNausea common
Hydromorphone1–2 every 4 hr2–4 every 4 hrShorter acting than morphine sulfate
Levorphanol2 every 6–8 hr4 every 6 hrLonger acting than morphine sulfate; absorbed well PO
Methadone10–1006–24 hrDelayed sedation due to long half-life
Meperidine25–100300 every 4 hrPoorly absorbed PO; normeperidine is a toxic metabolite
Morphine10 every 4 hr60 every 4 hr
Morphine, sustained release30–9060–180 2 or 3 times daily
Oxycodone5–10 every 4–6 hrUsually available with acetaminophen or aspirin
NOTE: L = left; R = right.
Organ of OriginLocation Felt
HeadExternal or middle ear
Nose & sinuses
Teeth, gums, tongue
Throat, tonsils
Parotid gland, TMJ joint
DiaphragmShoulder, upper abdomen
HeartUpper chest, L shoulder, inside L arm, L jaw
Stomach & spleenL upper abdomen
DuodenumUpper abdomen, R shoulder
Stomach & spleenL upper abdomen
Stomach & spleenL upper abdomen
Stomach & spleenL upper abdomen
ColonLower abdomen
AppendixPeriumbilical and R lower abdomen
AppendixPeriumbilical and R lower abdomen
Medical Dictionary, © 2009 Farlex and Partners
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