A Glossary of Pain Terminology in Hospice

Acute Pain
Pain that arises quickly often following an injury; has well defined onset.

Addiction
A primary, chronic, neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. Addiction is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued despite harm, and cravings.

Adjuvant Analgesic
A medication with analgesic properties but whose primary indication is something other than analgesia. Adjuvant analgesics are also referred to as co-analgesic medications.

Allodynia
A state when a normally non-harmful, non-noxious stimulus induces pain. The stimulus leads to an unexpectedly painful response.

Central Pain
Pain initiated or caused by a primary lesion or dysfunction in the central nervous system.

Chronic Pain
Persistent pain often with a poorly defined onset that lasts for greater than 3 months.

Chronic Lower Respiratory Disease
A term which encompasses diseases that include chronic obstructive pulmonary disease, chronic pulmonary fibrosis, emphysema cystic fibrosis and asthma.

Dysesthesia
Condition of abnormal sensation.

Equianalgesia
The equivalent dose potency between opioids resulting in comparable analgesia.

Hyperalgesia
Exaggerated pain response to painful stimuli.

Latrogenesis
Literally means “brought forth by a healer” (iatros means healer in Greek); as such, it can refer to good or bad effects, but it is almost exclusively used to refer to a state of ill health or adverse effect or complication caused by or resulting from medical treatment.

Miosis
The constriction of the pupil of the eye.

Modulation
Modulation refers to the attenuation of dorsal horn transmission by descending inhibitory input from the brain or the facilitation of impulses via the descending pain pathway.

Neuralgia
Pain in the distribution of a nerve or nerves.

Neuritis
Inflammation of a nerve or nerve.

Neuropathic Pain
Pain resulting from or thought to be resulting from a disturbance of the central or peripheral nervous system. It is caused by aberrant signal processing in the peripheral or central nervous system. Neuropathic pain often seems disproportionate to the stimulus, or may occur without an identifiable stimulus.

Neuropathy
A disturbance of function or pathological change in a nerve; in one nerve called mononeuropathy; in several nerves called mononeuropathy multiplex; if diffuse and bilateral called polyneuropathy.

Nociceptive Pain
Pain arising from nerve ending of nociceptors in somatic tissue (bones, joints, and connective tissue) and visceral (organ) tissue.

Nociception
The neurological process of decoding noxious stimuli. Nociception refers to activation of peripheral nerve fibers (nociceptors), causing transmission of a pain impulse from the site of injury to the central nervous center (CNS). Pain sensation is not necessarily implied.

Nociceptor
A sensory receptor of the peripheral nervous system that is capable of transducing and transmitting noxious stimuli resulting in pain perception.

Noxious
Injurious, dangerous or harmful to physical health.

Pain Threshold
The least experience of pain which a subject can recognize. Pain threshold is the subjective experience of the individual.

Pain Tolerance
The greatest level of pain which a subject is prepared to tolerate. Pain tolerance is the subjective experience of the individual.

Palliative Care
“Comprehensive specialized care provided by an interdisciplinary team to patients and families living with a life-threatening or severe advanced illness expected to progress toward dying and where care is particularly focused on alleviating suffering and promoting quality of life”. (AAHPM)

Paresthesia
Abnormal sensation that occurs spontaneously; it is usually used to describe a sensation that is non-painful and may arise from a lesion in the peripheral and/or central nervous systems.

Perception
The process of developing pain into a subjective emotional experience. Cortical and limbic system structures are involved in this process. Social and environmental factors, as well as past experience and cultural factors can influence perception.

Peripheral Sensitization
A process whereby nociceptors are activated at very low thresholds or begin to fire spontaneously in the absence of a painful stimulus. Peripheral sensitization may result from repetitive stimulation of nociceptors. Nociceptors respond more readily after repeated stimulation.

Physical Dependence
In pain management this refers to the physiological adaptation of the body to the use of a drug; symptoms of withdrawal occur when the drug is abruptly stopped, reduced, or an antagonist is administered.

Pseudoaddiction
Latrogenic syndrome of drug-seeking behaviors resulting from inadequate analgesic regimens.

Psychological Dependence
Behavioral pattern of preoccupation with drug use and acquisition.

Sensitization
Nociceptors may undergo a process called sensitization where they are activated at very low thresholds or begin to fire spontaneously in the absence of a painful stimulus. This is seen in patients with chronic unrelieved pain.

Somatic Pain
A type of nociceptive pain originating musculoskeletal or cutaneous tissues.

Tolerance
A physiologic adaptation to drug effects requiring higher doses to maintain the same effect after chronic use.

Transduction
The mechanism in which the nociceptors transform external noxious stimuli into electrical energy (nerve impulses). Pain stimulus occurs I the periphery when a noxious stimulus causes tissue damage, releasing sensitizing substances that activate or sensitize nociceptors (increasing their excitability and discharge frequency) leading to pain.

Transmission
The mechanism by which the pain signal generated in the periphery is transmitted to the spinal cord and the brain. Pain signals travel via axons of primary afferent neurons to the dorsal horn of the spinal cord (spinal cord neurons), then to the brainstem and thalamus regions via the spinothalamic tract. The thalamus acts as a relay station sending pain impulses to central structures where pain is processed.

Visceral Pain
A type of nociceptive pain arising from damage to the viscera or organs. Pain may be from the stretching or distention of the internal organs (pelvic, thoracic, abdominal viscera) their capsular coverings or from obstruction of hollow organs.

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