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Pain (Principles/meds/comfort Care)

Pain (Principles/meds/comfort Care) is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

Unpleasant sensory and emotional experience that may be secondary to actual or perceived damage to tissue, the somatosensory system, or a psychogenic dysfunction.
  • It is an individual, subjective, multifactorial experience influenced by culture, medical history, beliefs, mood and ability to cope.

Epidemiology

Incidence and Prevalence Estimates
  • Most common reason for seeking health care
  • Up to 78% of visits to the emergency department.
  • Pain is severe for 2/3rds of patients presenting with pain.
  • Chronic pain is present in up to 35% of the population.
  • Prevalence of neuropathic pain is 21.4% in emergency departments.

Etiology

  • Different components of pain can be combined in a same patient.
  • Nociceptive pain:
    • Stimulation of peripheral nerve fibers (nociceptors) that arises from actual or threatened damage to non-neural tissue.
    • Visceral pain:
      • Stimulation of visceral nociceptors
      • Diffuse, difficult to locate, and often referred to a distant, usually superficial, structure.
      • Sickening, deep, squeezing, dull.
    • Deep somatic pain:
      • Stimulation of nociceptors in ligaments, tendons, bones, blood vessels, fasciae, and muscles
      • Dull, aching, poorly localized pain.
    • Superficial pain:
      • Stimulation of nociceptors in the skin or other superficial tissue.
      • Sharp, well defined, and clearly located.
  • Neuropathic pain:
    • Exacerbation of normally nonpainful stimuli (allodynia).
    • Paroxysmal episodes likened to electric shocks.
    • Continuous sensations include burning or coldness, “pins and needles” sensations, numbness and itching.
  • Psychogenic pain:
    • Pain caused, increased or prolonged by mental, emotional, or behavioral factors.

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Citation

Rosen, Peter, et al., editors. "Pain (Principles/meds/comfort Care)." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307670/all/Pain__Principles_meds_comfort_Care_.
Pain (Principles/meds/comfort Care). In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307670/all/Pain__Principles_meds_comfort_Care_. Accessed April 23, 2019.
Pain (Principles/meds/comfort Care). (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307670/all/Pain__Principles_meds_comfort_Care_
Pain (Principles/meds/comfort Care) [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307670/all/Pain__Principles_meds_comfort_Care_.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Pain (Principles/meds/comfort Care) ID - 307670 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307670/all/Pain__Principles_meds_comfort_Care_ PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -