Pain

Question 1

What is the 2020 IASP definition of pain?

Answer 1

“An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”

Question 2

What six key notes accompany the 2020 IASP definition of pain? (P/LRAV)

Answer 2

1) Pain is always personal, shaped by bio-psycho-social factors.
2) Pain (subjective experience) ≠ nociception (biological experience).
3) Learned through life experience.
4) Report of pain should be respected.
5) Pain is adaptive but can harm well-being.
6) Pain can exist without verbal expression.

Question 3

What are the typical duration and causes of acute pain?

Answer 3

Onset is sudden, lasts <1 month, usually from injury, surgery, or trauma, and resolves with healing.

Question 4

What are the duration and causes of chronic pain, and how is it classified functionally? What percent of acute pain transitions to chronic?

Answer 4

Persists >3 months, may lack clear cause, reflects nervous system dysfunction, considered maladaptive (vs acute, which is adaptive). About 20% of acute pain transitions to chronic.

Question 5

Why is the biomedical model inadequate for chronic pain?

Answer 5

It only addresses biological mechanisms and misses psychological, social, and functional influences, leading to incomplete care.

Question 6

What model replaces the biomedical model for chronic pain, and what social factors influence prevalence?

Answer 6

The biopsychosocial model; prevalence is higher in poverty, rural residents, unemployed, and lower with higher education.

Question 7

What 7 psychological consequences are associated with chronic pain?

Answer 7

Anxiety, depression, anger, helplessness, suicidal ideation/behavior, substance use, and pain catastrophizing.

Question 8

What 7 social/functional consequences are associated with chronic pain?

Answer 8

Disrupted employment, financial strain, relationship problems, and in children: functional impairment, school absence, isolation, and long-term risk of mood disorders.

Question 9

What does the mnemonic PQRSTU stand for in pain evaluation?

Answer 9

P = Provoking/palliating, Q = Quality, R = Region/Radiation, S = Severity, T = Time course, U = “You” (impact on life).

Question 10

Why is it important to ask “U” (You) in the PQRSTU pain assessment?

Answer 10

It identifies how pain affects function and quality of life, guiding comprehensive management.

Question 11

What do patients with pain want (5) and fear (4) in the physician–patient relationship?

Answer 11

They want respect, belief, explanations, relief, and restored function; they fear dismissal, serious illness, worsening pain, or addiction.

Question 12

What physician behaviors support successful chronic pain management?

Answer 12

Multimodal strategies (meds, procedures, PT/OT, psychology, lifestyle), focus on function, and building a strong, supportive relationship that improves adherence and outcomes.

Question 13

How is pain assessed in children of different ages?

Answer 13

Toddlers use words like “owie,” ages 5–7 can rate pain, older children explain causes; FLACC scale is used in neonates/preverbal children (e.g., facial expression, how they’re laying in bed)

Question 14

How is pain assessed in older adults, cognitively impaired, and critically ill patients?

Answer 14

Older adults may say “aches/soreness/discomfort” (instead of “pain”). Cognitively impaired/nonverbal: facial expressions, movements, vocalizations, mental status change.
Critically ill/intubated: facial expression, body movement, ventilator compliance.