Pain

Pain
Pain is a distressing feeling often caused

by intense or damaging stimuli. The Pain
International Association for the Study of
Pain defines pain as "an unpleasant
sensory and emotional experience
associated with, or resembling that
associated with, actual or potential tissue
damage."[1]
Pain motivates organisms to withdraw

from damaging situations, to protect a
damaged body part while it heals, and to
avoid similar experiences in the future.[2]
Most pain resolves once the noxious An illustration of wrist pain
stimulus is removed and the body has
Specialty Neurology
healed, but it may persist despite removal
Pain medicine
of the stimulus and apparent healing of the
body. Sometimes pain arises in the absence Symptoms Unpleasant sensory and emotional
of any detectable stimulus, damage or sensations[1]
disease.[3] Duration Typically depends on the cause
Pain is the most common reason for Types Physical, psychological,

physician consultation in most developed psychogenic
countries.[4][5] It is a major symptom in Medication Analgesic
many medical conditions, and can interfere
with a person's quality of life and general functioning.[6] People in pain experience
impaired concentration, working memory, mental flexibility, problem solving and
information processing speed, and are more likely to experience irritability, depression
and anxiety.
Simple pain medications are useful in 20% to 70% of cases.[7] Psychological factors such
as social support, cognitive behavioral therapy, excitement, or distraction can affect pain's
intensity or unpleasantness.[8][9]
Etymology
First attested in English in 1297, the word peyn comes from the Old French peine, in turn
from Latin poena meaning "punishment, penalty"[10][11] (also meaning "torment,
hardship, suffering" in Late Latin) and that from Greek ποινή (poine), generally meaning
"price paid, penalty, punishment".[12][13]
Classification
The International Association for the Study of Pain recommends using specific features to
describe a patient's pain:
1. region of the body involved (e.g. abdomen, lower limbs),

2. system whose dysfunction may be causing the pain (e.g., nervous, gastrointestinal),
3. duration and pattern of occurrence,
4. intensity, and
5. cause[14]
Chronic versus acute

Pain is usually transitory, lasting only until the noxious stimulus is removed or the
underlying damage or pathology has healed, but some painful conditions, such as
rheumatoid arthritis, peripheral neuropathy, cancer and idiopathic pain, may persist for
years. Pain that lasts a long time is called "chronic" or "persistent", and pain that resolves
quickly is called "acute". Traditionally, the distinction between acute and chronic pain has
relied upon an arbitrary interval of time between onset and resolution; the two most
commonly used markers being 3 months and 6 months since the onset of pain,[15] though
some theorists and researchers have placed the transition from acute to chronic pain at 12
months.[16]: 93 Others apply "acute" to pain that lasts less than 30 days, "chronic" to pain
of more than six months' duration, and "subacute" to pain that lasts from one to six
months.[17] A popular alternative definition of "chronic pain", involving no arbitrarily
fixed duration, is "pain that extends beyond the expected period of healing".[15] Chronic
pain may be classified as "cancer-related" or "benign."[17]
Allodynia
Allodynia is pain experienced in response to a normally painless stimulus.[18] It has no

biological function and is classified by stimuli into dynamic mechanical, punctate and
static.[18][19]
Phantom
Phantom pain is pain felt in a part of the body that has been amputated, or from which
the brain no longer receives signals. It is a type of neuropathic pain.[20]
The prevalence of phantom pain in upper limb amputees is nearly 82%, and in lower limb
amputees is 54%.[20] One study found that eight days after amputation, 72% of patients
had phantom limb pain, and six months later, 67% reported it.[21][22] Some amputees
experience continuous pain that varies in intensity or quality; others experience several
bouts of pain per day, or it may reoccur less often. It is often described as shooting,
crushing, burning or cramping. If the pain is continuous for a long period, parts of the
intact body may become sensitized, so that touching them evokes pain in the phantom
limb. Phantom limb pain may accompany urination or defecation.[23]: 61–69
Local anesthetic injections into the nerves or sensitive areas of the stump may relieve
pain for days, weeks, or sometimes permanently, despite the drug wearing off in a matter
of hours; and small injections of hypertonic saline into the soft tissue between vertebrae
produces local pain that radiates into the phantom limb for ten minutes or so and may be
followed by hours, weeks or even longer of partial or total relief from phantom pain.
Vigorous vibration or electrical stimulation of the stump, or current from electrodes
surgically implanted onto the spinal cord, all produce relief in some patients.[23]: 61–69
Mirror box therapy produces the illusion of movement and touch in a phantom limb
which in turn may cause a reduction in pain.[24]
Paraplegia, the loss of sensation and voluntary motor control after serious spinal cord
damage, may be accompanied by girdle pain at the level of the spinal cord damage,
visceral pain evoked by a filling bladder or bowel, or, in five to ten per cent of paraplegics,
phantom body pain in areas of complete sensory loss. This phantom body pain is initially
described as burning or tingling but may evolve into severe crushing or pinching pain, or
the sensation of fire running down the legs or of a knife twisting in the flesh. Onset may
be immediate or may not occur until years after the disabling injury. Surgical treatment
rarely provides lasting relief.[23]: 61–69
Breakthrough
Breakthrough pain is transitory pain that comes on suddenly and is not alleviated by the
patient's regular pain management. It is common in cancer patients who often have
background pain that is generally well-controlled by medications, but who also
sometimes experience bouts of severe pain that from time to time "breaks through" the
medication. The characteristics of breakthrough cancer pain vary from person to person
and according to the cause. Management of breakthrough pain can entail intensive use of
opioids, including fentanyl.[25][26]
Asymbolia and insensitivity

The ability to experience pain is essential for protection from injury, and recognition of
the presence of injury. Episodic analgesia may occur under special circumstances, such as
in the excitement of sport or war: a soldier on the
battlefield may feel no pain for many hours from a
traumatic amputation or other severe injury.[27]
Although unpleasantness is an essential part of the

IASP definition of pain,[28] it is possible to induce a
state described as intense pain devoid of
unpleasantness in some patients, with morphine A patient and doctor discuss
[29]
injection or psychosurgery. Such patients report congenital insensitivity to pain.
that they have pain but are not bothered by it; they
recognize the sensation of pain but suffer little, or not
at all.[30] Indifference to pain can also rarely be present from birth; these people have
normal nerves on medical investigations, and find pain unpleasant, but do not avoid
repetition of the pain stimulus.[31]
Insensitivity to pain may also result from abnormalities in the nervous system. This is
usually the result of acquired damage to the nerves, such as spinal cord injury, diabetes
mellitus (diabetic neuropathy), or leprosy in countries where that disease is prevalent.[32]
These individuals are at risk of tissue damage and infection due to undiscovered injuries.
People with diabetes-related nerve damage, for instance, sustain poorly-healing foot
ulcers as a result of decreased sensation.[33]
A much smaller number of people are insensitive to pain due to an inborn abnormality of
the nervous system, known as "congenital insensitivity to pain".[31] Children with this
condition incur carelessly-repeated damage to their tongues, eyes, joints, skin, and
muscles. Some die before adulthood, and others have a reduced life expectancy. Most
people with congenital insensitivity to pain have one of five hereditary sensory and
autonomic neuropathies (which includes familial dysautonomia and congenital
insensitivity to pain with anhidrosis).[34] These conditions feature decreased sensitivity to
pain together with other neurological abnormalities, particularly of the autonomic
nervous system.[31][34] A very rare syndrome with isolated congenital insensitivity to pain
has been linked with mutations in the SCN9A gene, which codes for a sodium channel
(Nav1.7) necessary in conducting pain nerve stimuli.[35]
Functional effects
Experimental subjects challenged by acute pain and patients in chronic pain experience
impairments in attention control, working memory, mental flexibility, problem solving,
and information processing speed.[36] Acute and chronic pain are also associated with
increased depression, anxiety, fear, and anger.[37]
If I have matters right, the consequences of pain will include direct physical
distress, unemployment, financial difficulties, marital disharmony, and
difficulties in concentration and attention…
— Harold Merskey 2000[38]
On subsequent negative emotion
Although pain is considered to be aversive and unpleasant and is therefore usually

avoided, a meta-analysis which summarized and evaluated numerous studies from
various psychological disciplines, found a reduction in negative affect. Across studies,
participants that were subjected to acute physical pain in the laboratory subsequently
reported feeling better than those in non-painful control conditions, a finding which was
also reflected in physiological parameters.[39] A potential mechanism to explain this
effect is provided by the opponent-process theory.
Theory
Historical
Before the relatively recent discovery of neurons and their role in pain, various different
body functions were proposed to account for pain. There were several competing early
theories of pain among the ancient Greeks: Hippocrates believed that it was due to an
imbalance in vital fluids.[40] In the 11th century, Avicenna theorized that there were a
number of feeling senses including touch, pain and titillation.[41]
In 1644, René Descartes theorized that pain was a

disturbance that passed along nerve fibers until the
disturbance reached the brain.[40][42] Descartes's
work, along with Avicenna's, prefigured the 19th-
century development of specificity theory. Specificity
theory saw pain as "a specific sensation, with its own
sensory apparatus independent of touch and other
senses".[43] Another theory that came to prominence
in the 18th and 19th centuries was intensive theory,
which conceived of pain not as a unique sensory
modality, but an emotional state produced by stronger
than normal stimuli such as intense light, pressure or
temperature.[44] By the mid-1890s, specificity was
backed mostly by physiologists and physicians, and
Portrait of René Descartes by Jan
the intensive theory was mostly backed by Baptist Weenix, 1647–1649
psychologists. However, after a series of clinical
observations by Henry Head and experiments by Max
von Frey, the psychologists migrated to specificity almost en masse, and by century's end,
most textbooks on physiology and psychology were presenting pain specificity as
fact.[41][43]
Modern
Some sensory fibers do not differentiate between

noxious and non-noxious stimuli, while others,
nociceptors, respond only to noxious, high intensity
stimuli. At the peripheral end of the nociceptor,
noxious stimuli generate currents that, above a given
threshold, send signals along the nerve fiber to the
spinal cord. The "specificity" (whether it responds to
thermal, chemical or mechanical features of its
environment) of a nociceptor is determined by which
ion channels it expresses at its peripheral end. Dozens
of different types of nociceptor ion channels have so
far been identified, and their exact functions are still
being determined.[45]
Regions of the cerebral cortex
The pain signal travels from the periphery to the associated with pain
spinal cord along A-delta and C fibers. Because the A-
delta fiber is thicker than the C fiber, and is thinly
sheathed in an electrically insulating material (myelin), it carries its signal faster (5–
30 m/s) than the unmyelinated C fiber (0.5–2 m/s).[46] Pain evoked by the A-delta fibers
is described as sharp and is felt first. This is followed by a duller pain, often described as
burning, carried by the C fibers.[47] These A-delta and C fibers enter the spinal cord via
Lissauer's tract and connect with spinal cord nerve fibers in the central gelatinous
substance of the spinal cord. These spinal cord fibers then cross the cord via the anterior
white commissure and ascend in the spinothalamic tract. Before reaching the brain, the
spinothalamic tract splits into the lateral, neospinothalamic tract and the medial,
paleospinothalamic tract. The neospinothalamic tract carries the fast, sharp A-delta
signal to the ventral posterolateral nucleus of the thalamus. The paleospinothalamic tract
carries the slow, dull, C-fiber pain signal. Some of the paleospinothalamic fibers peel off
in the brain stem, connecting with the reticular formation or midbrain periaqueductal
gray, and the remainder terminate in the intralaminar nuclei of the thalamus.[48]
Pain-related activity in the thalamus spreads to the insular cortex (thought to embody,
among other things, the feeling that distinguishes pain from other homeostatic emotions
such as itch and nausea) and anterior cingulate cortex (thought to embody, among other
things, the affective/motivational element, the unpleasantness of pain),[49] and pain that
is distinctly located also activates primary and secondary somatosensory cortex.[50]
Spinal cord fibers dedicated to carrying A-delta fiber pain signals, and others that carry
both A-delta and C fiber pain signals to the thalamus have been identified. Other spinal
cord fibers, known as wide dynamic range neurons, respond to A-delta and C fibers, but
also to the much larger, more heavily myelinated A-beta fibers that carry touch, pressure
and vibration signals.[46]
Ronald Melzack and Patrick Wall introduced their gate control theory in the 1965 Science
article "Pain Mechanisms: A New Theory".[51] The authors proposed that the thin C and
A-delta (pain) and large diameter A-beta (touch, pressure, vibration) nerve fibers carry
information from the site of injury to two destinations in the dorsal horn of the spinal
cord, and that A-beta fiber signals acting on inhibitory cells in the dorsal horn can reduce
the intensity of pain signals sent to the brain.[42]
Three dimensions of pain
In 1968 Ronald Melzack and Kenneth Casey described chronic pain in terms of its three
dimensions:
"sensory-discriminative" (sense of the intensity, location, quality and duration of the

pain),
"affective-motivational" (unpleasantness and urge to escape the unpleasantness),
and
"cognitive-evaluative" (cognitions such as appraisal, cultural values, distraction and
hypnotic suggestion).
They theorized that pain intensity (the sensory discriminative dimension) and
unpleasantness (the affective-motivational dimension) are not simply determined by the
magnitude of the painful stimulus, but "higher" cognitive activities can influence
perceived intensity and unpleasantness. Cognitive activities may affect both sensory and
affective experience or they may modify primarily the affective-motivational dimension.
Thus, excitement in games or war appears to block both the sensory-discriminative and
affective-motivational dimensions of pain, while suggestion and placebos may modulate
only the affective-motivational dimension and leave the sensory-discriminative
dimension relatively undisturbed.[52] (p. 432)
The paper ends with a call to action: "Pain can be treated not only by trying to cut down
the sensory input by anesthetic block, surgical intervention and the like, but also by
influencing the motivational-affective and cognitive factors as well."[52] (p. 435)
Evolutionary and behavioral role

Pain is part of the body's defense system, producing a reflexive retraction from the painful
stimulus, and tendencies to protect the affected body part while it heals, and avoid that
harmful situation in the future.[53][54] It is an important part of animal life, vital to
healthy survival. People with congenital insensitivity to pain have reduced life
expectancy.[31]
In The Greatest Show on Earth: The Evidence for Evolution, biologist Richard Dawkins
addresses the question of why pain should have the quality of being painful. He describes
the alternative as a mental raising of a "red flag". To argue why that red flag might be
insufficient, Dawkins argues that drives must compete with one other within living
beings. The most "fit" creature would be the one whose pains are well balanced. Those
pains which mean certain death when ignored will become the most powerfully felt. The
relative intensities of pain, then, may resemble the relative importance of that risk to our
ancestors.[a] This resemblance will not be perfect, however, because natural selection can
be a poor designer. This may have maladaptive results such as supernormal stimuli.[55]
Pain, however, does not only wave a "red flag" within living beings but may also act as a
warning sign and a call for help to other living beings. Especially in humans who readily
helped each other in case of sickness or injury throughout their evolutionary history, pain
might be shaped by natural selection to be a credible and convincing signal of need for
relief, help, and care.[56]
Idiopathic pain (pain that persists after the trauma or pathology has healed, or that arises
without any apparent cause) may be an exception to the idea that pain is helpful to
survival, although some psychodynamic psychologists argue that such pain is
psychogenic, enlisted as a protective distraction to keep dangerous emotions
unconscious.[57]
Thresholds
In pain science, thresholds are measured by gradually increasing the intensity of a
stimulus in a procedure called quantitative sensory testing which involves such stimuli as
electric current, thermal (heat or cold), mechanical (pressure, touch, vibration), ischemic,
or chemical stimuli applied to the subject to evoke a response.[58] The "pain perception
threshold" is the point at which the subject begins to feel pain, and the "pain threshold
intensity" is the stimulus intensity at which the stimulus begins to hurt. The "pain
tolerance threshold" is reached when the subject acts to stop the pain.[58]
Assessment
A person's self-report is the most reliable measure of pain.[59][60][61] Some health care
professionals may underestimate pain severity.[62] A definition of pain widely employed
in nursing, emphasizing its subjective nature and the importance of believing patient
reports, was introduced by Margo McCaffery in 1968: "Pain is whatever the experiencing
person says it is, existing whenever he says it does".[63] To assess intensity, the patient
may be asked to locate their pain on a scale of 0 to 10, with 0 being no pain at all, and 10
the worst pain they have ever felt. Quality can be established by having the patient
complete the McGill Pain Questionnaire indicating which words best describe their
pain.[6]
Visual analogue scale
The visual analogue scale is a common, reproducible tool in the assessment of pain and
pain relief.[64] The scale is a continuous line anchored by verbal descriptors, one for each
extreme of pain where a higher score indicates greater pain intensity. It is usually 10 cm
in length with no intermediate descriptors as to avoid marking of scores around a
preferred numeric value. When applied as a pain descriptor, these anchors are often 'no
pain' and 'worst imaginable pain". Cut-offs for pain classification have been
recommended as no pain (0–4mm), mild pain (5–44mm), moderate pain (45–74mm)
and severe pain (75–100mm).[65]
Multidimensional pain inventory
The Multidimensional Pain Inventory (MPI) is a questionnaire designed to assess the

psychosocial state of a person with chronic pain. Combining the MPI characterization of
the person with their IASP five-category pain profile is recommended for deriving the
most useful case description.[15]
Assessment in non-verbal people
Non-verbal people cannot use words to tell others that they are experiencing pain.
However, they may be able to communicate through other means, such as blinking,
pointing, or nodding.[66]
With a non-communicative person, observation becomes critical, and specific behaviors

can be monitored as pain indicators. Behaviors such as facial grimacing and guarding
(trying to protect part of the body from being bumped or touched) indicate pain, as well
as an increase or decrease in vocalizations, changes in routine behavior patterns and
mental status changes. Patients experiencing pain may exhibit withdrawn social behavior
and possibly experience a decreased appetite and decreased nutritional intake. A change
in condition that deviates from baseline, such as moaning with movement or when
manipulating a body part, and limited range of motion are also potential pain indicators.
In patients who possess language but are incapable of expressing themselves effectively,
such as those with dementia, an increase in confusion or display of aggressive behaviors
or agitation may signal that discomfort exists, and further assessment is necessary.
Changes in behavior may be noticed by caregivers who are familiar with the person's
normal behavior.[66]
Infants do feel pain, but lack the language needed to report it, and so communicate
distress by crying. A non-verbal pain assessment should be conducted involving the
parents, who will notice changes in the infant which may not be obvious to the health care
provider. Pre-term babies are more sensitive to painful stimuli than those carried to full
term.[67]
Another approach, when pain is suspected, is to give the person treatment for pain, and
then watch to see whether the suspected indicators of pain subside.[66]
Other reporting barriers
The way in which one experiences and responds to pain is related to sociocultural
characteristics, such as gender, ethnicity, and age.[68][69] An aging adult may not respond
to pain in the same way that a younger person might. Their ability to recognize pain may
be blunted by illness or the use of medication. Depression may also keep older adult from
reporting they are in pain. Decline in self-care may also indicate the older adult is
experiencing pain. They may be reluctant to report pain because they do not want to be
perceived as weak, or may feel it is impolite or shameful to complain, or they may feel the
pain is a form of deserved punishment.[70][71]
Cultural barriers may also affect the likelihood of reporting pain. Patients may feel that
certain treatments go against their religious beliefs. They may not report pain because
they feel it is a sign that death is near. Many people fear the stigma of addiction, and
avoid pain treatment so as not to be prescribed potentially addicting drugs. Many Asians
do not want to lose respect in society by admitting they are in pain and need help,
believing the pain should be borne in silence, while other cultures feel they should report
pain immediately to receive immediate relief.[67]
Gender can also be a perceived factor in reporting pain. Gender differences can be the
result of social and cultural expectations, with women expected to be more emotional and
show pain, and men more stoic.[67] As a result, female pain is often stigmatized, leading
to less urgent treatment of women based on social expectations of their ability to
accurately report it.[72] This leads to extended emergency room wait times for women and
frequent dismissal of their ability to accurately report pain.[73][74]
Diagnostic aid
Pain is a symptom of many medical conditions. Knowing the time of onset, location,
intensity, pattern of occurrence (continuous, intermittent, etc.), exacerbating and
relieving factors, and quality (burning, sharp, etc.) of the pain will help the examining
physician to accurately diagnose the problem. For example, chest pain described as
extreme heaviness may indicate myocardial infarction, while chest pain described as
tearing may indicate aortic dissection.[75][76]
Physiological measurement
Functional magnetic resonance imaging brain scanning has been used to measure pain,
and correlates well with self-reported pain.[77][78][79]
Mechanisms
Nociceptive
Nociceptive pain is caused by stimulation of

sensory nerve fibers that respond to stimuli
approaching or exceeding harmful intensity
(nociceptors), and may be classified
according to the mode of noxious
stimulation. The most common categories
are "thermal" (e.g. heat or cold),
"mechanical" (e.g. crushing, tearing,
shearing, etc.) and "chemical" (e.g. iodine in Mechanism of nociceptive pain
a cut or chemicals released during
inflammation). Some nociceptors respond to
more than one of these modalities and are consequently designated polymodal.
Nociceptive pain may also be classed according to the site of origin and divided into
"visceral", "deep somatic" and "superficial somatic" pain. Visceral structures (e.g., the
heart, liver and intestines) are highly sensitive to stretch, ischemia and inflammation, but
relatively insensitive to other stimuli that normally evoke pain in other structures, such as
burning and cutting. Visceral pain is diffuse, difficult to locate and often referred to a
distant, usually superficial, structure. It may be accompanied by nausea and vomiting and
may be described as sickening, deep, squeezing, and dull.[80] Deep somatic pain is
initiated by stimulation of nociceptors in ligaments, tendons, bones, blood vessels, fasciae
and muscles, and is dull, aching, poorly-localized pain. Examples include sprains and
broken bones. Superficial somatic pain is initiated by activation of nociceptors in the skin
or other superficial tissue, and is sharp, well-defined and clearly located. Examples of
injuries that produce superficial somatic pain include minor wounds and minor (first
degree) burns.[16]
Neuropathic
Neuropathic pain is caused by damage or disease affecting any part of the nervous system
involved in bodily feelings (the somatosensory system).[81] Neuropathic pain may be
divided into peripheral, central, or mixed (peripheral and central) neuropathic pain.
Peripheral neuropathic pain is often described as "burning", "tingling", "electrical",
"stabbing", or "pins and needles".[82] Bumping the "funny bone" elicits acute peripheral
neuropathic pain.
Some manifestations of neuropathic pain include: traumatic neuropathy, tic douloureux,

painful diabetic neuropathy, and postherpetic neuralgia.[83]
Nociplastic
Nociplastic pain is pain characterized by a changed nociception (but without evidence of
real or threatened tissue damage, or without disease or damage in the somatosensory
system).[9]
Psychogenic
Psychogenic pain, also called psychalgia or somatoform pain, is pain caused, increased
or prolonged by mental, emotional or behavioral factors.[84] Headache, back pain and
stomach pain are sometimes diagnosed as psychogenic.[84] Those affected are often
stigmatized, because both medical professionals and the general public tend to think that
pain from a psychological source is not "real". However, specialists consider that it is no
less actual or hurtful than pain from any other source.[29]
People with long-term pain frequently display psychological disturbance, with elevated
scores on the Minnesota Multiphasic Personality Inventory scales of hysteria, depression
and hypochondriasis (the "neurotic triad"). Some investigators have argued that it is this
neuroticism that causes acute pain to turn chronic, but clinical evidence points the other
direction, to chronic pain causing neuroticism. When long-term pain is relieved by
therapeutic intervention, scores on the neurotic triad and anxiety fall, often to normal
levels. Self-esteem, often low in chronic pain patients, also shows improvement once pain
has resolved.[23]: 31–32
Management
Pain can be treated through a variety of methods. The most appropriate method depends
upon the situation. Management of chronic pain can be difficult and may require the
coordinated efforts of a pain management team, which typically includes medical
practitioners, clinical pharmacists, clinical psychologists, physiotherapists, occupational
therapists, physician assistants, and nurse practitioners.[85]
Inadequate treatment of pain is widespread throughout surgical wards, intensive care

units, and accident and emergency departments, in general practice, in the management
of all forms of chronic pain including cancer pain, and in end of life
care.[86][87][88][89][90][91][92] This neglect extends to all ages, from newborns to medically
frail elderly.[93][94] In the US, African and Hispanic Americans are more likely than
others to suffer unnecessarily while in the care of a physician;[95][96] and women's pain is
more likely to be undertreated than men's.[97]
The International Association for the Study of Pain advocates that the relief of pain
should be recognized as a human right, that chronic pain should be considered a disease
in its own right, and that pain medicine should have the full status of a medical
specialty.[98] It is a specialty only in China and Australia at this time.[99] Elsewhere, pain
medicine is a subspecialty under disciplines such as anesthesiology, physiatry, neurology,
palliative medicine and psychiatry.[100] In 2011, Human Rights Watch alerted that tens of
millions of people worldwide are still denied access to inexpensive medications for severe
pain.[101]
Medication
Acute pain is usually managed with medications such as analgesics and anesthetics.[102]
Caffeine when added to pain medications such as ibuprofen, may provide some additional
benefit.[103][104] Ketamine can be used instead of opioids for short-term pain.[105] Pain
medications can cause paradoxical side effects, such as opioid-induced hyperalgesia
(severe generalized pain caused by long-term opioid use).[106][107]
Sugar (sucrose) when taken by mouth reduces pain in newborn babies undergoing some
medical procedures (a lancing of the heel, venipuncture, and intramuscular injections).
Sugar does not remove pain from circumcision, and it is unknown if sugar reduces pain
for other procedures.[108] Sugar did not affect pain-related electrical activity in the brains
of newborns one second after the heel lance procedure.[109] Sweet liquid by mouth
moderately reduces the rate and duration of crying caused by immunization injection in
children between one and twelve months of age.[110]
Psychological
Individuals with more social support experience less cancer pain, take less pain
medication, report less labor pain and are less likely to use epidural anesthesia during
childbirth, or suffer from chest pain after coronary artery bypass surgery.[8]
Suggestion can significantly affect pain intensity. About 35% of people report marked
relief after receiving a saline injection they believed to be morphine. This placebo effect is
more pronounced in people who are prone to anxiety, and so anxiety reduction may
account for some of the effect, but it does not account for all of it. Placebos are more
effective for intense pain than mild pain; and they produce progressively weaker effects
with repeated administration.[23]: 26–28 It is possible for many with chronic pain to
become so absorbed in an activity or entertainment that the pain is no longer felt, or is
greatly diminished.[23]: 22–23
A number of meta-analyses have found clinical hypnosis to be effective in controlling pain

associated with diagnostic and surgical procedures in both adults and children, as well as
pain associated with cancer and childbirth.[111] A 2007 review of 13 studies found
evidence for the efficacy of hypnosis in the reduction of chronic pain under some
conditions, though the number of patients enrolled in the studies was low, raising issues
related to the statistical power to detect group differences, and most lacked credible
controls for placebo or expectation. The authors concluded that "although the findings
provide support for the general applicability of hypnosis in the treatment of chronic pain,
considerably more research will be needed to fully determine the effects of hypnosis for
different chronic-pain conditions."[112]
Alternative medicine
An analysis of the 13 highest quality studies of pain treatment with acupuncture,

published in January 2009, concluded there was little difference in the effect of real,
faked and no acupuncture.[113] However, more recent reviews have found some
benefit.[114][115][116] Additionally, there is tentative evidence for a few herbal
medicines.[117] There has been some interest in the relationship between vitamin D and
pain, but the evidence so far from controlled trials for such a relationship, other than in
osteomalacia, is inconclusive.[118]
For chronic (long-term) lower back pain, spinal manipulation produces tiny, clinically
insignificant, short-term improvements in pain and function, compared with sham
therapy and other interventions.[119] Spinal manipulation produces the same outcome as
other treatments, such as general practitioner care, pain-relief drugs, physical therapy,
and exercise, for acute (short-term) lower back pain.[119]
Epidemiology
Pain is the main reason for visiting an emergency department in more than 50% of
cases,[120] and is present in 30% of family practice visits.[121] Several epidemiological
studies have reported widely varying prevalence rates for chronic pain, ranging from 12 to
80% of the population.[122] It becomes more common as people approach death. A study
of 4,703 patients found that 26% had pain in the last two years of life, increasing to 46%
in the last month.[123]
A survey of 6,636 children (0–18 years of age) found that, of the 5,424 respondents, 54%
had experienced pain in the preceding three months. A quarter reported having
experienced recurrent or continuous pain for three months or more, and a third of these
reported frequent and intense pain. The intensity of chronic pain was higher for girls, and
girls' reports of chronic pain increased markedly between ages 12 and 14.[124]
Society and culture

Physical pain is a universal experience, and a strong motivator of human and animal
behavior. As such, physical pain is used politically in relation to various issues such as
pain management policy, drug control, animal rights or animal welfare, torture, and pain
compliance. The deliberate infliction of pain and the medical management of pain are
both important aspects of biopower, a concept that encompasses the "set of mechanisms
through which the basic biological features of the human species became the object of a
political strategy".[125]
In various contexts, the deliberate infliction of pain in the form of corporal punishment is
used as retribution for an offence, for the purpose of disciplining or reforming a
wrongdoer, or to deter attitudes or behaviour deemed unacceptable. In Western societies,
the intentional infliction of severe pain (torture) was principally used to extract
confession prior to its abolition in the latter part of the 19th century. Torture as a means
to punish the citizen has been reserved for offences posing severe threat to the social
fabric (for example, treason).[126]
The administration of torture on bodies othered by the cultural narrative, those observed
as not 'full members of society' [126]: 101–121[AD1] met a resurgence in the 20th century,
possibly due to the heightened warfare.[126]: 101–121 [AD2]
Many cultures use painful ritual practices as a catalyst for psychological

transformation.[127] The use of pain to transition to a 'cleansed and purified' state is seen
in Catholic self-flagellation practices, or personal catharsis in neo-primitive body
suspension experiences.[128]
Beliefs about pain play an important role in sporting cultures. Pain may be viewed
positively, exemplified by the 'no pain, no gain' attitude, with pain seen as an essential
part of training. Sporting culture tends to normalise experiences of pain and injury and
celebrate athletes who 'play hurt'.[129]
Pain has psychological, social, and physical dimensions, and is greatly influenced by
cultural factors.[130]
Non-humans
René Descartes argued that animals lack consciousness and therefore do not experience
pain and suffering in the way that humans do.[131] Bernard Rollin of Colorado State
University, the principal author of two U.S. federal laws regulating pain relief for
animals,[b] wrote that researchers remained unsure into the 1980s as to whether animals
experience pain, and that veterinarians trained in the U.S. before 1989 were simply
taught to ignore animal pain.[133][134] The ability of invertebrate species of animals, such
as insects, to feel pain and suffering is unclear.[135][136][137]
Specialists believe that all vertebrates can feel pain, and that certain invertebrates, like
the octopus, may also.[135][138][139] The presence of pain in animals is unknown, but can
be inferred through physical and behavioral reactions,[140] such as paw withdrawal from
various noxious mechanical stimuli in rodents.[141]
While plants, as living beings, can perceive and communicate physical stimuli and
damage, they do not feel pain simply because of the lack of any pain receptors, nerves, or
a brain,[142] and, by extension, lack of consciousness.[143] Many plants are known to
perceive and respond to mechanical stimuli at a cellular level, and some plants such as
the venus flytrap or touch-me-not, are known for their "obvious sensory abilities".[142]
Nevertheless, the plant kingdom as a whole do not feel pain notwithstanding their
abilities to respond to sunlight, gravity, wind, and any external stimuli such as insect
bites, since they lack any nervous system. The primary reason for this is that, unlike the
members of the animal kingdom whose evolutionary successes and failures are shaped by
suffering, the evolution of plants are simply shaped by life and death.[142]
See also
Feeling, a perceptual state of conscious experience.
Hedonic adaptation, the tendency to quickly return to a relatively stable level of
happiness despite major positive or negative events
Pain (philosophy), the branch of philosophy concerned with suffering and physical
pain
Pain and suffering, the legal term for the physical and emotional stress caused from
an injury
Explanatory notes
a. For example, lack of food, extreme cold, or serious injuries are felt as exceptionally
painful, whereas minor damage is felt as mere discomfort.
b. Rollin drafted the 1985 Health Research Extension Act and an animal welfare
amendment to the 1985 Food Security Act.[132]
References
1. Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. (September 2020).
"The revised International Association for the Study of Pain definition of pain:
concepts, challenges, and compromises" (https://www.ncbi.nlm.nih.gov/pmc/articles/P
MC7680716). Pain. 161 (9): 1976–1982. doi:10.1097/j.pain.0000000000001939 (http
s://doi.org/10.1097%2Fj.pain.0000000000001939). PMC 7680716 (https://www.ncbi.n
lm.nih.gov/pmc/articles/PMC7680716). PMID 32694387 (https://pubmed.ncbi.nlm.nih.
gov/32694387).
2. Cervero F (2012). Understanding Pain : Exploring the Perception of Pain. Cambridge,
Mass.: MIT Press. pp. Chapter 1. ISBN 9780262305433. OCLC 809043366 (https://w
ww.worldcat.org/oclc/809043366).
3. Raj PP (2007). "Taxonomy and classification of pain" (https://books.google.com/books
?id=ZG4Svh_UL3UC&pg=PA41). In: The Handbook of Chronic Pain. Nova
Biomedical Books. ISBN 9781600210440. Archived (https://web.archive.org/web/202
10330014627/https://books.google.com/books?id=ZG4Svh_UL3UC&pg=PA41) from
the original on 30 March 2021. Retrieved 3 February 2016.
4. Debono DJ, Hoeksema LJ, Hobbs RD (August 2013). "Caring for patients with
chronic pain: pearls and pitfalls" (https://doi.org/10.7556%2Fjaoa.2013.023). The
Journal of the American Osteopathic Association. 113 (8): 620–7.
doi:10.7556/jaoa.2013.023 (https://doi.org/10.7556%2Fjaoa.2013.023).
PMID 23918913 (https://pubmed.ncbi.nlm.nih.gov/23918913).
5. Turk DC, Dworkin RH (2004). "What should be the core outcomes in chronic pain
5. Turk DC, Dworkin RH (2004). "What should be the core outcomes in chronic pain
clinical trials?" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC464897). Arthritis
Research & Therapy. 6 (4): 151–4. doi:10.1186/ar1196 (https://doi.org/10.1186%2Far
1196). PMC 464897 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC464897).
6. Breivik H, Borchgrevink PC, Allen SM, Rosseland LA, Romundstad L, Hals EK,
Kvarstein G, Stubhaug A (July 2008). "Assessment of pain" (https://doi.org/10.1093%
2Fbja%2Faen103). British Journal of Anaesthesia. 101 (1): 17–24.
doi:10.1093/bja/aen103 (https://doi.org/10.1093%2Fbja%2Faen103). PMID 18487245
(https://pubmed.ncbi.nlm.nih.gov/18487245).
7. Moore RA, Wiffen PJ, Derry S, Maguire T, Roy YM, Tyrrell L (November 2015). "Non-
prescription (OTC) oral analgesics for acute pain – an overview of Cochrane reviews"
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6485506). The Cochrane Database of
Systematic Reviews. 11 (11): CD010794. doi:10.1002/14651858.CD010794.pub2 (htt
ps://doi.org/10.1002%2F14651858.CD010794.pub2). PMC 6485506 (https://www.ncbi
.nlm.nih.gov/pmc/articles/PMC6485506). PMID 26544675 (https://pubmed.ncbi.nlm.ni
h.gov/26544675).
8. Eisenberger NI, Lieberman M (2005). "Why it hurts to be left out: The neurocognitive
overlap between physical and social pain" (https://webscript.princeton.edu/psych/psyc
hology/related/socneuconf/pdf/eisenberger-lieberman2.pdf) (PDF). In Williams KD
(ed.). The Social Outcast: Ostracism, Social Exclusion, Rejection, & Bullying (Sydney
Symposium of Social Psychology). East Sussex: Psychology Press. p. 210.
ISBN 9781841694245.
9. Garland EL, Brintz CE, Hanley AW, Roseen EJ, Atchley RM, Gaylord SA, et al.
(January 2020). "Mind-Body Therapies for Opioid-Treated Pain: A Systematic Review
and Meta-analysis" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6830441). JAMA
Internal Medicine. 180 (1): 91–105. doi:10.1001/jamainternmed.2019.4917 (https://doi
.org/10.1001%2Fjamainternmed.2019.4917). PMC 6830441 (https://www.ncbi.nlm.nih
.gov/pmc/articles/PMC6830441). PMID 31682676 (https://pubmed.ncbi.nlm.nih.gov/3
1682676).
10. Lewis CT, Short C. "Poena" (https://web.archive.org/web/20110513202944/https://ww
w.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.04.0059%3Aentry%
3Dpoena). A Latin Dictionary. Archived from the original (https://www.perseus.tufts.ed
u/hopper/text?doc=Perseus%3Atext%3A1999.04.0059%3Aentry%3Dpoena) on 13
May 2011 – via Perseus Digital Library.
11. Lavoie, Anne; Toledo, Paloma (1 September 2013). "Multimodal Postcesarean
Delivery Analgesia" (https://www.sciencedirect.com/science/article/pii/S00955108130
00638). Clinics in Perinatology. Pain Management in the Peripartum Period. 40 (3):
443–455. doi:10.1016/j.clp.2013.05.008 (https://doi.org/10.1016%2Fj.clp.2013.05.008
). ISSN 0095-5108 (https://www.worldcat.org/issn/0095-5108). PMID 23972750 (https:
//pubmed.ncbi.nlm.nih.gov/23972750).
12. Liddell HG, Scott R. "ποινή" (https://web.archive.org/web/20110513202951/https://ww
w.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%
3Dpoinh%2F). A Greek-English Lexicon. Archived from the original (https://www.perse
us.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%3Dpoinh
%2F) on 13 May 2011 – via Perseus Digital Library.
13. "Pain" (https://web.archive.org/web/20110728085534/https://www.etymonline.com/ind
ex.php?term=pain). Archived from the original (https://www.etymonline.com/index.php
?term=pain) on 28 July 2011 – via Online Etymology Dictionary.
?term=pain) on 28 July 2011 – via Online Etymology Dictionary.
14. Merskey H, Bogduk N (1994). Classification of Chronic Pain (https://archive.org/detail
s/classificationof0000unse_o5f1/page/3) (2 nd ed.). Seattle: International Association
for the Study of Pain. pp. 3 & 4 (https://archive.org/details/classificationof0000unse_o
5f1/page/3). ISBN 978-0931092053.
15. Turk DC, Okifuji A (2001). "Pain terms and taxonomies of pain". In Bonica JJ, Loeser
JD, Chapman CR, Turk DC (eds.). Bonica's management of pain. Hagerstwon, MD:
Lippincott Williams & Wilkins. ISBN 978-0781768276.
16. Coda BA, Bonica JJ (2000). "General considerations of acute pain" (https://archive.or
g/details/painmanagementin0000main). In Panswick CC, Main CJ (eds.). Pain
management: an interdisciplinary approach. Edinburgh: Churchill Livingstone.
ISBN 978-0443056833.
17. Thienhaus O, Cole BE (2002). "Classification of pain". In Weiner R (ed.). Pain
management: a practical guide for clinicians (https://archive.org/details/painmanagem
entpr00wein). Boca Raton: CRC Press. pp. 28 (https://archive.org/details/painmanage
mentpr00wein/page/n60). ISBN 978-0849322624.
18. Jensen TS, Finnerup NB (September 2014). "Allodynia and hyperalgesia in
neuropathic pain: clinical manifestations and mechanisms". The Lancet. Neurology.
13 (9): 924–935. doi:10.1016/s1474-4422(14)70102-4 (https://doi.org/10.1016%2Fs1
474-4422%2814%2970102-4). PMID 25142459 (https://pubmed.ncbi.nlm.nih.gov/251
42459). S2CID 25011309 (https://api.semanticscholar.org/CorpusID:25011309).
19. Lolignier S, Eijkelkamp N, Wood JN (January 2015). "Mechanical allodynia" (https://w
ww.ncbi.nlm.nih.gov/pmc/articles/PMC4281368). Pflügers Archiv. 467 (1): 133–139.
doi:10.1007/s00424-014-1532-0 (https://doi.org/10.1007%2Fs00424-014-1532-0).
PMC 4281368 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4281368).
20. Kooijman CM, Dijkstra PU, Geertzen JH, Elzinga A, van der Schans CP (July 2000).
"Phantom pain and phantom sensations in upper limb amputees: an epidemiological
study" (https://research.rug.nl/en/publications/phantom-pain-and-phantom-sensations
-in-upper-limb-amputees(8dd1fc12-cc0d-400b-aef1-72ed0443f9ad).html). Pain. 87
(1): 33–41. doi:10.1016/S0304-3959(00)00264-5 (https://doi.org/10.1016%2FS0304-3
959%2800%2900264-5). PMID 10863043 (https://pubmed.ncbi.nlm.nih.gov/1086304
21. Jensen TS, Krebs B, Nielsen J, Rasmussen P (November 1983). "Phantom limb,
phantom pain and stump pain in amputees during the first 6 months following limb
amputation". Pain. 17 (3): 243–256. doi:10.1016/0304-3959(83)90097-0 (https://doi.or
g/10.1016%2F0304-3959%2883%2990097-0). PMID 6657285 (https://pubmed.ncbi.n
lm.nih.gov/6657285). S2CID 10304696 (https://api.semanticscholar.org/CorpusID:103
04696).
22. Jensen TS, Krebs B, Nielsen J, Rasmussen P (March 1985). "Immediate and long-
term phantom limb pain in amputees: incidence, clinical characteristics and
relationship to pre-amputation limb pain". Pain. 21 (3): 267–278. doi:10.1016/0304-
3959(85)90090-9 (https://doi.org/10.1016%2F0304-3959%2885%2990090-9).
PMID 3991231 (https://pubmed.ncbi.nlm.nih.gov/3991231). S2CID 24358789 (https://
api.semanticscholar.org/CorpusID:24358789).
23. Wall PD, Melzack R (1996). The challenge of pain (2nd ed.). New York: Penguin
Books. ISBN 978-0140256703.
24. Ramachandran VS, Rogers-Ramachandran D (April 1996). "Synaesthesia in phantom
limbs induced with mirrors". Proceedings. Biological Sciences. 263 (1369): 377–386.
limbs induced with mirrors". Proceedings. Biological Sciences. 263 (1369): 377–386.
Bibcode:1996RSPSB.263..377R (https://ui.adsabs.harvard.edu/abs/1996RSPSB.263.
.377R). doi:10.1098/rspb.1996.0058 (https://doi.org/10.1098%2Frspb.1996.0058).
PMID 8637922 (https://pubmed.ncbi.nlm.nih.gov/8637922). S2CID 4819370 (https://a
pi.semanticscholar.org/CorpusID:4819370).
25. Mishra S, Bhatnagar S, Chaudhary P, Rana SP (January 2009). "Breakthrough
cancer pain: review of prevalence, characteristics and management" (https://www.ncb
i.nlm.nih.gov/pmc/articles/PMC2886208). Indian Journal of Palliative Care. 15 (1): 14–
18. doi:10.4103/0973-1075.53506 (https://doi.org/10.4103%2F0973-1075.53506).
26. Caraceni A, Hanks G, Kaasa S, Bennett MI, Brunelli C, Cherny N, Dale O, De Conno
F, Fallon M, Hanna M, Haugen DF, Juhl G, King S, Klepstad P, Laugsand EA, Maltoni
M, Mercadante S, Nabal M, Pigni A, Radbruch L, Reid C, Sjogren P, Stone PC,
Tassinari D, Zeppetella G (February 2012). "Use of opioid analgesics in the treatment
of cancer pain: evidence-based recommendations from the EAPC" (https://web.archiv
e.org/web/20141019205001/https://www.fadin.org/Documenti/164/Recommendations
_EAPC_2012.pdf) (PDF). The Lancet. Oncology. 13 (2): e58–68. doi:10.1016/S1470-
2045(12)70040-2 (https://doi.org/10.1016%2FS1470-2045%2812%2970040-2).
PMID 22300860 (https://pubmed.ncbi.nlm.nih.gov/22300860). Archived from the
original (https://www.fadin.org/Documenti/164/Recommendations_EAPC_2012.pdf)
(PDF) on 19 October 2014.
27. Beecher HK (1959). Measurement of subjective responses (https://archive.org/details/
measurementofsub0000beec). New York: Oxford University Press. cited in Melzack
R, Wall PD (1996). The challenge of pain (2nd ed.). London: Penguin. p. 7. ISBN 978-
0140256703.
28. "International Association for the Study of Pain: Pain Definitions" (https://web.archive.
org/web/20150113000208/https://www.iasp-pain.org/Taxonomy). Archived from the
original (https://www.iasp-pain.org/Taxonomy) on 13 January 2015. Retrieved
12 January 2015. "Pain is an unpleasant sensory and emotional experience
associated with actual or potential tissue damage, or described in terms of such
damage" Alt URL (https://etc.ch/ZTKs) Derived from Bonica JJ (June 1979). "The
need of a taxonomy". Pain. 6 (3): 247–248. doi:10.1016/0304-3959(79)90046-0 (https
://doi.org/10.1016%2F0304-3959%2879%2990046-0). PMID 460931 (https://pubmed.
ncbi.nlm.nih.gov/460931). S2CID 53161389 (https://api.semanticscholar.org/CorpusID
:53161389).
29. "International Association for the Study of Pain | Pain Definitions". (https://web.archive
.org/web/20080512061229/https://www.iasp-pain.org/AM/Template.cfm?Section=Gen
eral_Resource_Links&Template=%2FCM%2FHTMLDisplay.cfm&ContentID=3058#Pa
in). Retrieved 12 October 2010.
30. Grahek N (2007). Feeling pain and being in pain (https://web.archive.org/web/200809
27042509/https://docserver.bis.uni-oldenburg.de/publikationen/bisverlag/2001/grafee
01/grafee01.html) (2nd ed.). Cambridge, Mass.: MIT Press. ISBN 978-0262517324.
Archived from the original (https://docserver.bis.uni-oldenburg.de/publikationen/bisverl
ag/2001/grafee01/grafee01.html) on 27 September 2008.
31. Nagasako EM, Oaklander AL, Dworkin RH (February 2003). "Congenital insensitivity
to pain: an update". Pain. 101 (3): 213–219. doi:10.1016/S0304-3959(02)00482-7 (htt
ps://doi.org/10.1016%2FS0304-3959%2802%2900482-7). PMID 12583863 (https://pu
bmed.ncbi.nlm.nih.gov/12583863). S2CID 206055264 (https://api.semanticscholar.org
/CorpusID:206055264).
/CorpusID:206055264).
32. Brand PW, Yancey P (1997). The gift of pain: why we hurt & what we can do about it.
Grand Rapids, Mich: Zondervan Publ. ISBN 978-0310221449.
33. Lipsky BA, Berendt AR, Deery HG, Embil JM, Joseph WS, Karchmer AW, LeFrock JL,
Lew DP, Mader JT, Norden C, Tan JS (October 2004). "Diagnosis and treatment of
diabetic foot infections" (https://doi.org/10.1086%2F424846). Clinical Infectious
Diseases. 39 (7): 885–910. doi:10.1086/424846 (https://doi.org/10.1086%2F424846).
34. Axelrod FB, Hilz MJ (December 2003). "Inherited autonomic neuropathies". Seminars
in Neurology. 23 (4): 381–390. doi:10.1055/s-2004-817722 (https://doi.org/10.1055%
2Fs-2004-817722). PMID 15088259 (https://pubmed.ncbi.nlm.nih.gov/15088259).
35. Raouf R, Quick K, Wood JN (November 2010). "Pain as a channelopathy" (https://ww
w.ncbi.nlm.nih.gov/pmc/articles/PMC2965577). The Journal of Clinical Investigation.
120 (11): 3745–3752. doi:10.1172/JCI43158 (https://doi.org/10.1172%2FJCI43158).
36. Hart RP, Wade JB, Martelli MF (April 2003). "Cognitive impairment in patients with
chronic pain: the significance of stress". Current Pain and Headache Reports. 7 (2):
116–126. doi:10.1007/s11916-003-0021-5 (https://doi.org/10.1007%2Fs11916-003-00
21-5). PMID 12628053 (https://pubmed.ncbi.nlm.nih.gov/12628053).
S2CID 14104974 (https://api.semanticscholar.org/CorpusID:14104974).
37. Bruehl S, Burns JW, Chung OY, Chont M (March 2009). "Pain-related effects of trait
anger expression: neural substrates and the role of endogenous opioid mechanisms"
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2756489). Neuroscience and
Biobehavioral Reviews. 33 (3): 475–491. doi:10.1016/j.neubiorev.2008.12.003 (https:/
/doi.org/10.1016%2Fj.neubiorev.2008.12.003). PMC 2756489 (https://www.ncbi.nlm.ni
h.gov/pmc/articles/PMC2756489). PMID 19146872 (https://pubmed.ncbi.nlm.nih.gov/
19146872).
38. Merskey H (2000). "The History of Psychoanalytic Ideas Concerning Pain" (https://arc
hive.org/details/personalitychara0000unse). In Weisberg JN, Gatchel RJ (eds.).
Personality Characteristics of Patients With Pain. American Psychological Association
(APA). ISBN 978-1557986467.
39. Bresin K, Kling L, Verona E (2018). "The effect of acute physical pain on subsequent
negative emotional affect: A meta-analysis" (https://www.ncbi.nlm.nih.gov/pmc/articles
/PMC5624817). Personality Disorders: Theory, Research, and Treatment. 9 (3): 273–
283. doi:10.1037/per0000248 (https://doi.org/10.1037%2Fper0000248).
40. Linton. Models of Pain Perception. Elsevier Health, 2005. Print.
41. Dallenbach KM (July 1939). "Pain: History and present status". American Journal of
Psychology. 52 (3): 331–347. doi:10.2307/1416740 (https://doi.org/10.2307%2F1416
740). JSTOR 1416740 (https://www.jstor.org/stable/1416740).
42. Melzack R, Katz J (2004). "The Gate Control Theory: Reaching for the Brain". In
Craig KD, Hadjistavropoulos T (eds.). Pain: psychological perspectives. Mahwah, N.J:
Lawrence Erlbaum Associates, Publishers. ISBN 978-0415650618.
43. Bonica JJ (1990). "History of pain concepts and therapies". The management of pain.
Vol. 1 (2 ed.). London: Lea & Febiger. p. 7. ISBN 978-0812111224.
44. Finger S (2001). Origins of neuroscience: a history of explorations into brain function.
US: Oxford University Press. p. 149. ISBN 978-0195146943.
US: Oxford University Press. p. 149. ISBN 978-0195146943.
45. Woolf CJ, Ma Q (August 2007). "Nociceptors – noxious stimulus detectors" (https://doi
.org/10.1016%2Fj.neuron.2007.07.016). Neuron. 55 (3): 353–364.
doi:10.1016/j.neuron.2007.07.016 (https://doi.org/10.1016%2Fj.neuron.2007.07.016).
PMID 17678850 (https://pubmed.ncbi.nlm.nih.gov/17678850). S2CID 13576368 (https
://api.semanticscholar.org/CorpusID:13576368).
46. Marchand S (2010). "Applied pain neurophysiology". In Beaulieu P, Lussier D,
Porreca F, Dickenson A (eds.). Pharmacology of pain. Seattle: International
Association for the Study of Pain Press. pp. 3–26. ISBN 978-0931092787.
47. Skevington S (1995). Psychology of pain (https://archive.org/details/psychologyofpain
0000skev/page/9). New York: Wiley. p. 9 (https://archive.org/details/psychologyofpain
0000skev/page/9). ISBN 978-0471957737.
48. Skevington SM (1995). Psychology of pain (https://archive.org/details/psychologyofpai
n0000skev/page/18). Chichester, UK: Wiley. p. 18 (https://archive.org/details/psycholo
gyofpain0000skev/page/18). ISBN 978-0471957737.
49. Craig AD (2003). "Pain mechanisms: labeled lines versus convergence in central
processing" (https://semanticscholar.org/paper/a4938adad8552540e2b594c2f58c927
54fea4d00). Annual Review of Neuroscience. 26: 1–30.
doi:10.1146/annurev.neuro.26.041002.131022 (https://doi.org/10.1146%2Fannurev.ne
uro.26.041002.131022). PMID 12651967
(https://pubmed.ncbi.nlm.nih.gov/12651967). S2CID 12387848 (https://api.semanticsc
holar.org/CorpusID:12387848). Archived (https://web.archive.org/web/202103300147
29/https://www.semanticscholar.org/paper/Pain-mechanisms%3A-labeled-lines-versu
s-convergence-Craig/a4938adad8552540e2b594c2f58c92754fea4d00) from the
original on 30 March 2021. Retrieved 24 January 2020.
50. Romanelli P, Esposito V (July 2004). "The functional anatomy of neuropathic pain".
Neurosurgery Clinics of North America. 15 (3): 257–268.
doi:10.1016/j.nec.2004.02.010 (https://doi.org/10.1016%2Fj.nec.2004.02.010).
51. Melzack R, Wall PD (November 1965). "Pain mechanisms: a new theory" (https://web.
archive.org/web/20120114141747/https://www.hnehealth.nsw.gov.au/__data/assets/p
df_file/0012/70122/pain_mechanisms_20100315013844.pdf) (PDF). Science. 150
(3699): 971–979. Bibcode:1965Sci...150..971M (https://ui.adsabs.harvard.edu/abs/19
65Sci...150..971M). doi:10.1126/science.150.3699.971 (https://doi.org/10.1126%2Fsci
ence.150.3699.971). PMID 5320816 (https://pubmed.ncbi.nlm.nih.gov/5320816).
Archived from the original (https://www.hnehealth.nsw.gov.au/__data/assets/pdf_file/0
012/70122/pain_mechanisms_20100315013844.pdf) (PDF) on 14 January 2012.
52. Melzack, Ronald; Casey, Kenneth (1968). "Sensory, Motivational, and Central Control
Determinants of Pain". In Kenshalo, Dan (ed.). The Skin Senses (https://www.researc
hgate.net/publication/233801589_Sensory_Motivational_and_Central_Control_Deter
minants_of_Pain). Springfield, Illinois: Charles C Thomas.
53. Lynn B (1984). "Cutaneous nociceptors" (https://books.google.com/books?id=S7rnAA
AAIAAJ&pg=PA106). In Winlow W, Holden AV (eds.). The neurobiology of pain:
Symposium of the Northern Neurobiology Group, held at Leeds on 18 April 1983.
Manchester: Manchester University Press. p. 106. ISBN 978-0719009969. Archived (
https://web.archive.org/web/20210330014628/https://books.google.com/books?id=S7
rnAAAAIAAJ&pg=PA106) from the original on 30 March 2021. Retrieved 3 February
2016.
54. Bernston GG, Cacioppo JT (2007). "The neuroevolution of motivation" (https://books.
54. Bernston GG, Cacioppo JT (2007). "The neuroevolution of motivation" (https://books.
google.com/books?id=iCxpZkZtDG8C&q=%22One+general+class+of+spinal+reflexes
+consists+of+the+flexor+(pain)+withdrawal%22&pg=PT209). In Gardner WL, Shah
JY (eds.). Handbook of Motivation Science. New York: The Guilford Press. p. 191.
ISBN 978-1593855680. Archived (https://web.archive.org/web/20210330014656/https
://books.google.com/books?id=iCxpZkZtDG8C&q=%22One+general+class+of+spinal
+reflexes+consists+of+the+flexor+%28pain%29+withdrawal%22&pg=PT209) from
the original on 30 March 2021. Retrieved 18 November 2020.
55. Dawkins R (2009). The Greatest Show on Earth (https://archive.org/details/greatestsh
owonea00dawk). Free Press. pp. 392–395 (https://archive.org/details/greatestshowon
ea00dawk/page/392). ISBN 978-1416594789.
56. Steinkopf L (June 2016). "An Evolutionary Perspective on Pain Communication" (http
s://doi.org/10.1177%2F1474704916653964). Evolutionary Psychology. 14 (2): 100.
doi:10.1177/1474704916653964 (https://doi.org/10.1177%2F1474704916653964).
57. Sarno JE (2006). The divided mind: the epidemic of mindbody disorders (https://archi
ve.org/details/dividedmindep00sarn). New York: ReganBooks. ISBN 978-
0061174308.
58. Fillingim RB, Loeser JD, Baron R, Edwards RR (September 2016). "Assessment of
Chronic Pain: Domains, Methods, and Mechanisms" (https://www.ncbi.nlm.nih.gov/pm
c/articles/PMC5010652). The Journal of Pain. 17 (9 Suppl): T10–20.
doi:10.1016/j.jpain.2015.08.010 (https://doi.org/10.1016%2Fj.jpain.2015.08.010).
59. Amico D (2016). Health & physical assessment in nursing. Boston: Pearson. p. 173.
ISBN 978-0133876406.
60. Taylor C (2015). Fundamentals of nursing : the art and science of person-centered
nursing care. Philadelphia: Wolters Kluwer Health. p. 241. ISBN 978-1451185614.
61. Venes D (2013). Taber's cyclopedic medical dictionary. Philadelphia: F.A. Davis.
p. 1716. ISBN 978-0803629776.
62. Prkachin KM, Solomon PE, Ross J (June 2007). "Underestimation of pain by health-
care providers: towards a model of the process of inferring pain in others". The
Canadian Journal of Nursing Research. 39 (2): 88–106. PMID 17679587 (https://pub
med.ncbi.nlm.nih.gov/17679587).
63. McCaffery M. (1968). Nursing practice theories related to cognition, bodily pain, and
man-environment interactions. Los Angeles: UCLA Students Store.
More recently, McCaffery defined pain as "whatever the experiencing person says it
is, existing whenever the experiencing person says it does." Pasero C, McCaffery M
(1999). Pain: clinical manual. St. Louis: Mosby. ISBN 978-0815156093.
64. Kelly AM (May 2001). "The minimum clinically significant difference in visual analogue
scale pain score does not differ with severity of pain" (https://www.ncbi.nlm.nih.gov/p
mc/articles/PMC1725574). Emergency Medicine Journal. 18 (3): 205–207.
doi:10.1136/emj.18.3.205 (https://doi.org/10.1136%2Femj.18.3.205). PMC 1725574 (h
ttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1725574). PMID 11354213 (https://pub
med.ncbi.nlm.nih.gov/11354213).
65. Hawker GA, Mian S, Kendzerska T, French M (November 2011). "Measures of adult
pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS
Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-
MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36
BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP)".
BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP)".
Arthritis Care & Research. 63 (S11): S240–252. doi:10.1002/acr.20543 (https://doi.org
/10.1002%2Facr.20543). PMID 22588748 (https://pubmed.ncbi.nlm.nih.gov/22588748
).
66. Lewis SM, Bucher L, Heitkemper MM, Harding M (2017). Medical-surgical nursing:
Assessment and management of clinical problems (10th ed.). St. Louis, Missouri:
Elsevier. p. 126. ISBN 978-0323328524. OCLC 944472408 (https://www.worldcat.org/
oclc/944472408).
67. Jarvis C (2007). Physical examination & health assessment. St. Louis, Mo: Elsevier
Saunders. pp. 180–192. ISBN 978-1455728107.
68. Encandela JA (March 1993). "Social science and the study of pain since Zborowski: a
need for a new agenda". Social Science & Medicine. 36 (6): 783–791.
doi:10.1016/0277-9536(93)90039-7 (https://doi.org/10.1016%2F0277-9536%2893%2
990039-7). PMID 8480223 (https://pubmed.ncbi.nlm.nih.gov/8480223).
69. Zborowski M. People in Pain. 1969, San Francisco, CA:Josey-Bass
70. Encandela JA (1997). "Social Construction of pain and aging: Individual artfulness
within interpretive structures". Symbolic Interaction. 20 (3): 251–273.
doi:10.1525/si.1997.20.3.251 (https://doi.org/10.1525%2Fsi.1997.20.3.251).
71. Lawhorne L, Passerini J (1999). Chronic Pain Management in the Long Term Care
Setting: Clinical Practice Guidelines. Baltimore, Maryland: American Medical Directors
Association. pp. 1–27.
72. Epstein R (19 March 2018). "When Doctors Don't Listen to Women" (https://www.nyti
mes.com/2018/03/19/books/review/abby-norman-ask-me-about-my-uterus.html). The
New York Times. Archived (https://web.archive.org/web/20190509110006/https://www
.nytimes.com/2018/03/19/books/review/abby-norman-ask-me-about-my-uterus.html)
from the original on 9 May 2019. Retrieved 20 July 2019.
73. Fasslet J (15 October 2015). "How Doctors Take Women's Pain Less Seriously" (https
://www.theatlantic.com/health/archive/2015/10/emergency-room-wait-times-sexism/41
0515/). The Atlantic. Archived (https://web.archive.org/web/20190717161732/https://w
ww.theatlantic.com/health/archive/2015/10/emergency-room-wait-times-sexism/41051
5/) from the original on 17 July 2019. Retrieved 20 July 2019.
74. "Stories of Misunderstanding Women's Pain" (https://www.theatlantic.com/notes/all/20
15/10/stories-of-misunderstood-womens-pain/411793/). The Atlantic. 15 March 2016.
Archived (https://web.archive.org/web/20190415114017/https://www.theatlantic.com/n
otes/all/2015/10/stories-of-misunderstood-womens-pain/411793/) from the original on
15 April 2019. Retrieved 20 July 2019.
75. Panju AA, Hemmelgarn BR, Guyatt GH, Simel DL (October 1998). "The rational
clinical examination. Is this patient having a myocardial infarction?". JAMA. 280 (14):
1256–1263. doi:10.1001/jama.280.14.1256 (https://doi.org/10.1001%2Fjama.280.14.
1256). PMID 9786377 (https://pubmed.ncbi.nlm.nih.gov/9786377).
76. Slater EE, DeSanctis RW (May 1976). "The clinical recognition of dissecting aortic
aneurysm". The American Journal of Medicine. 60 (5): 625–633. doi:10.1016/0002-
9343(76)90496-4 (https://doi.org/10.1016%2F0002-9343%2876%2990496-4).
77. Brown JE, Chatterjee N, Younger J, Mackey S (September 2011). "Towards a
physiology-based measure of pain: patterns of human brain activity distinguish painful
from non-painful thermal stimulation" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC
3172232). PLOS ONE. 6 (9): e24124. Bibcode:2011PLoSO...624124B (https://ui.adsa
bs.harvard.edu/abs/2011PLoSO...624124B). doi:10.1371/journal.pone.0024124 (https
bs.harvard.edu/abs/2011PLoSO...624124B). doi:10.1371/journal.pone.0024124 (https
://doi.org/10.1371%2Fjournal.pone.0024124). PMC 3172232 (https://www.ncbi.nlm.ni
h.gov/pmc/articles/PMC3172232). PMID 21931652 (https://pubmed.ncbi.nlm.nih.gov/
21931652).
78. Paddock C (15 September 2011). "Tool That Measures Pain Objectively Under Way" (
https://www.medicalnewstoday.com/articles/234450.php). Medical News Today.
Archived (https://web.archive.org/web/20170925230621/https://www.medicalnewstod
ay.com/articles/234450.php) from the original on 25 September 2017. Retrieved
25 September 2017.
79. "Feeling pain? The computer can tell" (https://www.reuters.com/article/us-pain-diagno
stic-idUSTRE78C81920110913). Reuters. 13 September 2011. Archived (https://web.
archive.org/web/20150617221847/https://www.reuters.com/article/2011/09/13/us-pain
-diagnostic-idUSTRE78C81920110913) from the original on 17 June 2015. Retrieved
25 September 2017. "Editorial"
80. Urch CE, Suzuki R (26 September 2008). "Pathophysiology of somatic, visceral, and
neuropathic cancer pain". In Sykes N, Bennett MI & Yuan C-S (ed.). Clinical pain
management: Cancer pain (2d ed.). London: Hodder Arnold. pp. 3–12. ISBN 978-
0340940075.
81. Treede RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, Hansson
P, Hughes R, Nurmikko T, Serra J (April 2008). "Neuropathic pain: redefinition and a
grading system for clinical and research purposes". Neurology. 70 (18): 1630–1635.
doi:10.1212/01.wnl.0000282763.29778.59 (https://doi.org/10.1212%2F01.wnl.000028
2763.29778.59). hdl:11573/97043 (https://hdl.handle.net/11573%2F97043).
82. Paice JA (2003). "Mechanisms and management of neuropathic pain in cancer" (https
://web.archive.org/web/20100107161021/https://www.supportiveoncology.net/journal/
articles/0102107.pdf) (PDF). The Journal of Supportive Oncology. 1 (2): 107–120.
PMID 15352654 (https://pubmed.ncbi.nlm.nih.gov/15352654). Archived from the
original (https://www.supportiveoncology.net/journal/articles/0102107.pdf) (PDF) on 7
January 2010. Retrieved 8 January 2010.
83. Campbell JN, Meyer RA (October 2006). "Mechanisms of neuropathic pain" (https://w
ww.ncbi.nlm.nih.gov/pmc/articles/PMC1810425). Neuron. 52 (1): 77–92.
doi:10.1016/j.neuron.2006.09.021 (https://doi.org/10.1016%2Fj.neuron.2006.09.021).
84. "Psychogenic Pain" (https://my.clevelandclinic.org/services/Pain_Management/hic_Ps
ychogenic_Pain.aspx). Cleveland Clinic. Archived (https://archive.wikiwix.com/cache/
20110714011822/https://my.clevelandclinic.org/services/Pain_Management/hic_Psyc
hogenic_Pain.aspx) from the original on 14 July 2011. Retrieved 25 September 2017.
85. Thienhaus O, Cole BE (2002). "The classification of pain". In Weiner RS (ed.). Pain
management: A practical guide for clinicians. American Academy of Pain
Management. p. 29. ISBN 978-0849322624.
Main CJ, Spanswick CC (2000). Pain management: an interdisciplinary approach
(https://archive.org/details/painmanagementin0000main). Churchill Livingstone.
ISBN 978-0443056833. "Pain management: an interdisciplinary approach."
86. Brown AK, Christo PJ, Wu CL (December 2004). "Strategies for postoperative pain
management". Best Practice & Research. Clinical Anaesthesiology. 18 (4): 703–717.
doi:10.1016/j.bpa.2004.05.004 (https://doi.org/10.1016%2Fj.bpa.2004.05.004).
doi:10.1016/j.bpa.2004.05.004 (https://doi.org/10.1016%2Fj.bpa.2004.05.004).
87. Cullen L, Greiner J, Titler MG (June 2001). "Pain management in the culture of critical
care". Critical Care Nursing Clinics of North America. 13 (2): 151–166.
doi:10.1016/S0899-5885(18)30046-7 (https://doi.org/10.1016%2FS0899-5885%2818
%2930046-7). PMID 11866399 (https://pubmed.ncbi.nlm.nih.gov/11866399).
88. Rupp T, Delaney KA (April 2004). "Inadequate analgesia in emergency medicine".
Annals of Emergency Medicine. 43 (4): 494–503.
doi:10.1016/j.annemergmed.2003.11.019 (https://doi.org/10.1016%2Fj.annemergmed
.2003.11.019). PMID 15039693 (https://pubmed.ncbi.nlm.nih.gov/15039693).
89. Smith GF, Toonen TR (April 2007). "Primary care of the patient with cancer".
American Family Physician. 75 (8): 1207–1214. PMID 17477104 (https://pubmed.ncbi
.nlm.nih.gov/17477104).
90. Jacobson PL, Mann JD (January 2003). "Evolving role of the neurologist in the
diagnosis and treatment of chronic noncancer pain". Mayo Clinic Proceedings. 78 (1):
80–84. doi:10.4065/78.1.80 (https://doi.org/10.4065%2F78.1.80). PMID 12528880 (htt
ps://pubmed.ncbi.nlm.nih.gov/12528880).
91. Deandrea S, Montanari M, Moja L, Apolone G (December 2008). "Prevalence of
undertreatment in cancer pain. A review of published literature" (https://www.ncbi.nlm.
nih.gov/pmc/articles/PMC2733110). Annals of Oncology. 19 (12): 1985–1991.
doi:10.1093/annonc/mdn419 (https://doi.org/10.1093%2Fannonc%2Fmdn419).
92. Perron V, Schonwetter RS (2001). "Assessment and management of pain in palliative
care patients" (https://doi.org/10.1177%2F107327480100800103). Cancer Control. 8
(1): 15–24. doi:10.1177/107327480100800103 (https://doi.org/10.1177%2F10732748
93. Selbst SM, Fein JA (2006). "Sedation and analgesia" (https://books.google.com/books
?id=oA7qSOvYZxUC&pg=PA63). In Henretig FM, Fleisher GR, Ludwig S (eds.).
Textbook of pediatric emergency medicine. Hagerstwon, MD: Lippincott Williams &
Wilkins. ISBN 978-1605471594. Archived (https://web.archive.org/web/201606111708
47/https://books.google.com/books?id=oA7qSOvYZxUC&pg=PA63) from the original
on 11 June 2016. Retrieved 3 February 2016.
94. Cleeland CS (June 1998). "Undertreatment of cancer pain in elderly patients". JAMA.
279 (23): 1914–1915. doi:10.1001/jama.279.23.1914 (https://doi.org/10.1001%2Fjam
a.279.23.1914). PMID 9634265 (https://pubmed.ncbi.nlm.nih.gov/9634265).
95. Bonham VL (2001). "Race, ethnicity, and pain treatment: striving to understand the
causes and solutions to the disparities in pain treatment" (https://www.painandthelaw.
org/aslme_content/29-1/bonham.pdf) (PDF). The Journal of Law, Medicine & Ethics.
29 (1): 52–68. doi:10.1111/j.1748-720X.2001.tb00039.x (https://doi.org/10.1111%2Fj.1
748-720X.2001.tb00039.x). PMID 11521272 (https://pubmed.ncbi.nlm.nih.gov/115212
72). S2CID 18257031 (https://api.semanticscholar.org/CorpusID:18257031). Archived
(https://web.archive.org/web/20110719132135/https://www.painandthelaw.org/aslme_
content/29-1/bonham.pdf) (PDF) from the original on 19 July 2011.
96. Green CR, Anderson KO, Baker TA, Campbell LC, Decker S, Fillingim RB,
Kalauokalani DA, Kaloukalani DA, Lasch KE, Myers C, Tait RC, Todd KH, Vallerand
AH (September 2003). "The unequal burden of pain: confronting racial and ethnic
disparities in pain" (https://deepblue.lib.umich.edu/bitstream/2027.42/73822/1/j.1526-
4637.2003.03034.x.pdf) (PDF). Pain Medicine. 4 (3): 277–294. doi:10.1046/j.1526-
4637.2003.03034.x.pdf) (PDF). Pain Medicine. 4 (3): 277–294. doi:10.1046/j.1526-
4637.2003.03034.x (https://doi.org/10.1046%2Fj.1526-4637.2003.03034.x).
hdl:2027.42/73822 (https://hdl.handle.net/2027.42%2F73822). PMID 12974827 (https
://pubmed.ncbi.nlm.nih.gov/12974827). Archived (https://web.archive.org/web/202103
30014611/https://deepblue.lib.umich.edu/bitstream/handle/2027.42/73822/j.1526-463
7.2003.03034.x.pdf;jsessionid=9D282F272A80BFE500C544F4D9C57617?sequence
=1) from the original on 30 March 2021. Retrieved 2 September 2019.
97. Hoffmann DE, Tarzian AJ (2001). "The girl who cried pain: a bias against women in
the treatment of pain" (https://digitalcommons.law.umaryland.edu/cgi/viewcontent.cgi?
article=1144&context=fac_pubs). The Journal of Law, Medicine & Ethics. 29 (1): 13–
27. doi:10.1111/j.1748-720X.2001.tb00037.x (https://doi.org/10.1111%2Fj.1748-720X.
2001.tb00037.x). PMID 11521267 (https://pubmed.ncbi.nlm.nih.gov/11521267).
S2CID 219952180 (https://api.semanticscholar.org/CorpusID:219952180). Archived (
https://web.archive.org/web/20191101132951/https://digitalcommons.law.umaryland.e
du/cgi/viewcontent.cgi?article=1144&context=fac_pubs) from the original on 1
November 2019. Retrieved 11 July 2019.
98. Delegates to the International Pain Summit of the International Association for the
Study of Pain (2010). "Declaration of Montreal" (https://web.archive.org/web/2011051
3203221/https://www.iasp-pain.org/AM/Template.cfm?Section=Declaration_of_Montra
ndNum233_al). Archived from the original (https://www.iasp-pain.org/AM/Template.cf
m?Section=Declaration_of_MontrandNum233_al) on 13 May 2011.
99. Horlocker TT, Cousins MJ, Bridenbaugh PO, Carr DL (2008). Cousins and
Bridenbaugh's Neural Blockade in Clinical Anesthesia and Pain Medicine.
Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 978-0781773881.
100. "Physical Medicine and Rehabilitation" (https://web.archive.org/web/20080516091310
/https://www.abms.org/Who_We_Help/Consumers/About_Physician_Specialties/physi
cal.aspx). Archived from the original (https://www.abms.org/Who_We_Help/Consumer
s/About_Physician_Specialties/physical.aspx) on 16 May 2008.
101. Human Rights Watch (2011). "Tens of Millions Face Death in Agony" (https://www.hrw
.org/news/2011/06/02/global-tens-millions-face-death-agony). Archived (https://web.ar
chive.org/web/20130901232156/https://www.hrw.org/news/2011/06/02/global-tens-mill
ions-face-death-agony) from the original on 1 September 2013. Retrieved 26 August
2013.
102. Mallinson TE (2017). "A review of ketorolac as a prehospital analgesic" (https://www.r
esearchgate.net/publication/321640488). Journal of Paramedic Practice. 9 (12): 522–
526. doi:10.12968/jpar.2017.9.12.522 (https://doi.org/10.12968%2Fjpar.2017.9.12.52
2). Archived (https://web.archive.org/web/20180605033254/https://www.researchgate.
net/publication/321640488_A_review_of_ketorolac_as_a_prehospital_analgesic) from
the original on 5 June 2018. Retrieved 2 June 2018.
103. Derry CJ, Derry S, Moore RA (December 2014). "Caffeine as an analgesic adjuvant
for acute pain in adults" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6485702).
The Cochrane Database of Systematic Reviews. 12 (12): CD009281.
doi:10.1002/14651858.CD009281.pub3 (https://doi.org/10.1002%2F14651858.CD009
281.pub3). PMC 6485702 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6485702).
104. Derry S, Wiffen PJ, Moore RA (July 2015). "Single dose oral ibuprofen plus caffeine
for acute postoperative pain in adults" (https://www.ncbi.nlm.nih.gov/pmc/articles/PM
C6481458). The Cochrane Database of Systematic Reviews. 2019 (7): CD011509.
509.pub2). PMC 6481458 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481458).
105. Karlow N, Schlaepfer CH, Stoll CR, Doering M, Carpenter CR, Colditz GA, et al.
(October 2018). "A Systematic Review and Meta-analysis of Ketamine as an
Alternative to Opioids for Acute Pain in the Emergency Department" (https://doi.org/1
0.1111%2Facem.13502). Academic Emergency Medicine. 25 (10): 1086–1097.
doi:10.1111/acem.13502 (https://doi.org/10.1111%2Facem.13502). PMID 30019434 (h
ttps://pubmed.ncbi.nlm.nih.gov/30019434).
106. Higgins C, Smith BH, Matthews K (June 2019). "Evidence of opioid-induced
hyperalgesia in clinical populations after chronic opioid exposure: a systematic review
and meta-analysis" (https://doi.org/10.1016%2Fj.bja.2018.09.019). British Journal of
Anaesthesia. 122 (6): e114–e126. doi:10.1016/j.bja.2018.09.019 (https://doi.org/10.10
16%2Fj.bja.2018.09.019). PMID 30915985 (https://pubmed.ncbi.nlm.nih.gov/3091598
5).
107. Fishbain DA, Pulikal A (November 2019). "Does Opioid Tapering in Chronic Pain
Patients Result in Improved Pain or Same Pain vs Increased Pain at Taper
Completion? A Structured Evidence-Based Systematic Review" (https://pubmed.ncbi.
nlm.nih.gov/30597076). Pain Medicine. 20 (11): 2179–2197. doi:10.1093/pm/pny231 (
https://doi.org/10.1093%2Fpm%2Fpny231). PMID 30597076 (https://pubmed.ncbi.nl
m.nih.gov/30597076). Archived (https://web.archive.org/web/20210118010043/https://
pubmed.ncbi.nlm.nih.gov/30597076/) from the original on 18 January 2021. Retrieved
19 February 2021.
108. Stevens B, Yamada J, Ohlsson A, Haliburton S, Shorkey A (July 2016). "Sucrose for
analgesia in newborn infants undergoing painful procedures" (https://www.ncbi.nlm.ni
h.gov/pmc/articles/PMC6457867). The Cochrane Database of Systematic Reviews. 7
(2): CD001069. doi:10.1002/14651858.CD001069.pub5 (https://doi.org/10.1002%2F1
4651858.CD001069.pub5). PMC 6457867 (https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC6457867). PMID 27420164 (https://pubmed.ncbi.nlm.nih.gov/27420164).
109. Lasky RE, van Drongelen W (October 2010). "Is sucrose an effective analgesic for
newborn babies?". Lancet. 376 (9748): 1201–1203. doi:10.1016/S0140-
6736(10)61358-X (https://doi.org/10.1016%2FS0140-6736%2810%2961358-X).
110. Harrison D, Stevens B, Bueno M, Yamada J, Adams-Webber T, Beyene J, Ohlsson A
(June 2010). "Efficacy of sweet solutions for analgesia in infants between 1 and 12
months of age: a systematic review" (https://doi.org/10.1136%2Fadc.2009.174227).
Archives of Disease in Childhood. 95 (6): 406–413. doi:10.1136/adc.2009.174227 (htt
ps://doi.org/10.1136%2Fadc.2009.174227). PMID 20463370 (https://pubmed.ncbi.nlm
.nih.gov/20463370).
111. Wark DM (July 2008). "What we can do with hypnosis: a brief note". The American
Journal of Clinical Hypnosis. 51 (1): 29–36. doi:10.1080/00029157.2008.10401640 (ht
tps://doi.org/10.1080%2F00029157.2008.10401640). PMID 18714889 (https://pubme
d.ncbi.nlm.nih.gov/18714889). S2CID 12240662 (https://api.semanticscholar.org/Corp
usID:12240662).
112. Elkins G, Jensen MP, Patterson DR (July 2007). "Hypnotherapy for the management
of chronic pain" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2752362). The
International Journal of Clinical and Experimental Hypnosis. 55 (3): 275–287.
doi:10.1080/00207140701338621 (https://doi.org/10.1080%2F00207140701338621).
113. Madsen MV, Gøtzsche PC, Hróbjartsson A (January 2009). "Acupuncture treatment
for pain: systematic review of randomised clinical trials with acupuncture, placebo
acupuncture, and no acupuncture groups" (https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC2769056). BMJ. 338: a3115. doi:10.1136/bmj.a3115 (https://doi.org/10.1136%2F
bmj.a3115). PMC 2769056 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769056).
114. Chiu HY, Hsieh YJ, Tsai PS (March 2017). "Systematic review and meta-analysis of
acupuncture to reduce cancer-related pain". European Journal of Cancer Care. 26
(2): e12457. doi:10.1111/ecc.12457 (https://doi.org/10.1111%2Fecc.12457).
115. Chang SC, Hsu CH, Hsu CK, Yang SS, Chang SJ (February 2017). "The efficacy of
acupuncture in managing patients with chronic prostatitis/chronic pelvic pain
syndrome: A systemic review and meta-analysis". Neurourology and Urodynamics. 36
(2): 474–481. doi:10.1002/nau.22958 (https://doi.org/10.1002%2Fnau.22958).
116. Ji M, Wang X, Chen M, Shen Y, Zhang X, Yang J (2015). "The Efficacy of
Acupuncture for the Treatment of Sciatica: A Systematic Review and Meta-Analysis" (
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4575738). Evidence-Based
Complementary and Alternative Medicine. 2015: 192808. doi:10.1155/2015/192808 (h
ttps://doi.org/10.1155%2F2015%2F192808). PMC 4575738 (https://www.ncbi.nlm.nih.
gov/pmc/articles/PMC4575738). PMID 26425130 (https://pubmed.ncbi.nlm.nih.gov/26
425130).
117. Gagnier JJ, Oltean H, van Tulder MW, Berman BM, Bombardier C, Robbins CB
(January 2016). "Herbal Medicine for Low Back Pain: A Cochrane Review". Spine. 41
(2): 116–133. doi:10.1097/BRS.0000000000001310 (https://doi.org/10.1097%2FBRS.
118. Straube S, Andrew Moore R, Derry S, McQuay HJ (January 2009). "Vitamin D and
chronic pain". Pain. 141 (1–2): 10–13. doi:10.1016/j.pain.2008.11.010 (https://doi.org/
10.1016%2Fj.pain.2008.11.010). PMID 19084336 (https://pubmed.ncbi.nlm.nih.gov/1
119. Rubinstein SM, Terwee CB, Assendelft WJ, de Boer MR, van Tulder MW (September
2012). "Spinal manipulative therapy for acute low-back pain" (https://www.ncbi.nlm.nih
.gov/pmc/articles/PMC6885055). The Cochrane Database of Systematic Reviews.
2012 (9): CD008880. doi:10.1002/14651858.CD008880.pub2 (https://doi.org/10.1002
%2F14651858.CD008880.pub2). PMC 6885055 (https://www.ncbi.nlm.nih.gov/pmc/ar
ticles/PMC6885055). PMID 22972127 (https://pubmed.ncbi.nlm.nih.gov/22972127).
120. Cordell WH, Keene KK, Giles BK, Jones JB, Jones JH, Brizendine EJ (May 2002).
"The high prevalence of pain in emergency medical care". The American Journal of
Emergency Medicine. 20 (3): 165–169. doi:10.1053/ajem.2002.32643 (https://doi.org/
10.1053%2Fajem.2002.32643). PMID 11992334 (https://pubmed.ncbi.nlm.nih.gov/11
992334).
121. Hasselström J, Liu-Palmgren J, Rasjö-Wrååk G (2002). "Prevalence of pain in general
practice". European Journal of Pain. 6 (5): 375–385. doi:10.1016/S1090-
3801(02)00025-3 (https://doi.org/10.1016%2FS1090-3801%2802%2900025-3).
122. Abu-Saad Huijer H (2010). "Chronic pain: a review". Le Journal Medical Libanais. The
Lebanese Medical Journal. 58 (1): 21–27. PMID 20358856 (https://pubmed.ncbi.nlm.n
ih.gov/20358856).
123. Smith AK, Cenzer IS, Knight SJ, Puntillo KA, Widera E, Williams BA, Boscardin WJ,
Covinsky KE (November 2010). "The epidemiology of pain during the last 2 years of
life" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150170). Annals of Internal
Medicine. 153 (9): 563–569. doi:10.7326/0003-4819-153-9-201011020-00005 (https://
doi.org/10.7326%2F0003-4819-153-9-201011020-00005). PMC 3150170 (https://ww
w.ncbi.nlm.nih.gov/pmc/articles/PMC3150170). PMID 21041575 (https://pubmed.ncbi.
nlm.nih.gov/21041575).
124. Perquin CW, Hazebroek-Kampschreur AA, Hunfeld JA, Bohnen AM, van Suijlekom-
Smit LW, Passchier J, van der Wouden JC (July 2000). "Pain in children and
adolescents: a common experience". Pain. 87 (1): 51–58. doi:10.1016/S0304-
3959(00)00269-4 (https://doi.org/10.1016%2FS0304-3959%2800%2900269-4).
PMID 10863045 (https://pubmed.ncbi.nlm.nih.gov/10863045). S2CID 9813003 (https:/
/api.semanticscholar.org/CorpusID:9813003).
125. Foucault M (2007). Security, Territory, Population: Lectures at the College de France,
1977–78. Palgrave Macmillan. p. 1.
126. Einolf C (2007). "The Fall and Rise of Torture: A Comparative and Historical Analysis"
(https://works.bepress.com/cgi/viewcontent.cgi?article=1008&context=christopher_ein
olf). Social Theory. 25 (2): 101–121. doi:10.1111/j.1467-9558.2007.00300.x (https://do
i.org/10.1111%2Fj.1467-9558.2007.00300.x). JSTOR 20453071 (https://www.jstor.org/
stable/20453071). S2CID 53345959 (https://api.semanticscholar.org/CorpusID:53345
959).
127. Morinis A (1985). "The ritual experience: pain and the transformation of
consciousness in ordeals of initiation" (https://doi.org/10.1525%2Feth.1985.13.2.02a0
0040). Ethos. 13 (2): 150–174. doi:10.1525/eth.1985.13.2.02a00040 (https://doi.org/1
0.1525%2Feth.1985.13.2.02a00040). JSTOR 639985 (https://www.jstor.org/stable/63
9985).
128. Atkinson M, Young K (2001). "Flesh journeys: neo primitives and the contemporary
rediscovery of radical body modification". Deviant Behavior. 22 (2): 117–146.
doi:10.1080/016396201750065018 (https://doi.org/10.1080%2F01639620175006501
129. Loland S, Skirstad B, Waddington I, eds. (2006). Pain and injury in sport: Social and
ethical analysis. London and New York: Routledge. pp. 17–20. ISBN 978-
0415357043.
130. Narayan MC (April 2010). "Culture's effects on pain assessment and management" (h
ttps://doi.org/10.1097%2F01.NAJ.0000370157.33223.6d). The American Journal of
Nursing. 110 (4): 38–47. doi:10.1097/01.NAJ.0000370157.33223.6d (https://doi.org/1
0.1097%2F01.NAJ.0000370157.33223.6d). PMID 20335689 (https://pubmed.ncbi.nlm
.nih.gov/20335689).
131. Working party of the Nuffield Council on Bioethics (2005). "The ethics of research
involving animals. London: Nuffield Council on Bioethics." (https://web.archive.org/we
b/20080625033250/https://www.nuffieldbioethics.org/fileLibrary/pdf/RIA_Report_FINA
L-opt.pdf) ISBN 978-1904384106. Archived from the original on 25 June 2008.
Retrieved 12 January 2010.
132. Rollin BE (June 2007). "Animal research: a moral science. Talking Point on the use of
animals in scientific research" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC200254
Rollin BE (June 2007). "Animal research: a moral science. Talking Point on the use of
animals in scientific research" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC200254
0). EMBO Reports. 8 (6): 521–525. doi:10.1038/sj.embor.7400996 (https://doi.org/10.
1038%2Fsj.embor.7400996). PMC 2002540 (https://www.ncbi.nlm.nih.gov/pmc/article
s/PMC2002540). PMID 17545990 (https://pubmed.ncbi.nlm.nih.gov/17545990).
133. Rollin B (1989). The Unheeded Cry: Animal Consciousness, Animal Pain, and
Science. New York: Oxford University Press. pp. 117–118. cited in Carbone L (2004).
What animals want: expertise and advocacy in laboratory animal welfare policy. US:
Oxford University Press. p. 150.
134. Griffin DR, Speck GB (January 2004). "New evidence of animal consciousness".
Animal Cognition. 7 (1): 5–18. doi:10.1007/s10071-003-0203-x (https://doi.org/10.100
7%2Fs10071-003-0203-x). PMID 14658059 (https://pubmed.ncbi.nlm.nih.gov/146580
135. Sherwin CM (February 2001). "Can invertebrates suffer? Or, how robust is argument-
by-analogy?" (https://www.ingentaconnect.com/contentone/ufaw/aw/2001/00000010/a
00101s1/art00010;jsessionid=1dtup2ob3at3b.x-ic-live-02). Animal Welfare. 10 (1):
103–118. doi:10.1017/S0962728600023551 (https://doi.org/10.1017%2FS096272860
Archived (https://web.archive.org/web/20220307174545/https://www.ingentaconnect.c
om/contentone/ufaw/aw/2001/00000010/a00101s1/art00010;jsessionid=1dtup2ob3at
3b.x-ic-live-02) from the original on 7 March 2022. Retrieved 22 December 2021.
136. Lockwood JA (1987). "The Moral Standing of Insects and the Ethics of Extinction".
The Florida Entomologist. 70 (1): 70–89. doi:10.2307/3495093 (https://doi.org/10.230
7%2F3495093). JSTOR 3495093 (https://www.jstor.org/stable/3495093).
137. DeGrazia D, Rowan A (September 1991). "Pain, suffering, and anxiety in animals and
humans". Theoretical Medicine. 12 (3): 193–211. doi:10.1007/BF00489606 (https://doi
.org/10.1007%2FBF00489606). PMID 1754965 (https://pubmed.ncbi.nlm.nih.gov/175
138. "Do Invertebrates Feel Pain?" (https://web.archive.org/web/20100106084119/https://s
encanada.ca/content/sen/committee/372/lega/witn/shelly-e.htm). The Senate
Standing Committee on Legal and Constitutional Affairs. The Parliament of Canada.
Archived from the original (https://sencanada.ca/content/sen/committee/372/lega/witn/
shelly-e.htm) on 6 January 2010. Retrieved 11 June 2008.
139. Smith JA (1991). "A Question of Pain in Invertebrates" (https://www.abolitionist.com/d
arwinian-life/invertebrate-pain.html). Institute for Laboratory Animal Research Journal.
33: 1–2. Archived (https://web.archive.org/web/20111008212237/https://www.abolition
ist.com/darwinian-life/invertebrate-pain.html) from the original on 8 October 2011.
140. Abbott FV, Franklin KB, Westbrook FR (January 1995). "The formalin test: scoring
properties of the first and second phases of the pain response in rats". Pain. 60 (1):
91–102. doi:10.1016/0304-3959(94)00095-V (https://doi.org/10.1016%2F0304-3959
%2894%2900095-V). PMID 7715946 (https://pubmed.ncbi.nlm.nih.gov/7715946).
S2CID 35448280 (https://api.semanticscholar.org/CorpusID:35448280).
141. Jones JM, Foster W, Twomey CR, Burdge J, Ahmed OM, Pereira TD, et al. (August
2020). "A machine-vision approach for automated pain measurement at millisecond
timescales" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7434442). eLife. 9:
e57258. doi:10.7554/eLife.57258 (https://doi.org/10.7554%2FeLife.57258).
142. Petruzzello, Melissa (2016). "Do Plants Feel Pain?" (https://www.britannica.com/story/
do-plants-feel-pain). Encyclopedia Britannica. Encyclopedia Britannica. Retrieved
do-plants-feel-pain). Encyclopedia Britannica. Encyclopedia Britannica. Retrieved
8 January 2023. "Given that plants do not have pain receptors, nerves, or a brain,
they do not feel pain as we members of the animal kingdom understand it. Uprooting
a carrot or trimming a hedge is not a form of botanical torture, and you can bite into
that apple without worry."
143. Draguhn, Andreas; Mallatt, Jon M.; Robinson, David G. (2021). "Anesthetics and
plants: no pain, no brain, and therefore no consciousness" (https://www.ncbi.nlm.nih.g
ov/pmc/articles/PMC7907021). Protoplasma. Springer. 258 (2): 239–248.
doi:10.1007/s00709-020-01550-9 (https://doi.org/10.1007%2Fs00709-020-01550-9).
PMID 32880005 (https://pubmed.ncbi.nlm.nih.gov/32880005). 32880005.
Casey K (2019). Chasing Pain: The Search for a Neurobiological Mechanism. New
York: Oxford University Press. ISBN 978-0190880231.
External links
Pain (https://curlie.org//Health/Senses/Touch_and_Sensation/Pain) at Curlie
"Pain" (https://plato.stanford.edu/entries/pain/), Stanford Encyclopedia of Philosophy
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Pain is a distressing feeling often caused

Pain motivates organisms to withdraw

Pain is the most common reason for Types Physical, psychological,

1. region of the body involved (e.g. abdomen, lower limbs),

Chronic versus acute

Allodynia is pain experienced in response to a normally painless stimulus.[18] It has no

Asymbolia and insensitivity

Although unpleasantness is an essential part of the

— Harold Merskey 2000[38]

On subsequent negative emotion

Although pain is considered to be aversive and unpleasant and is therefore usually

In 1644, René Descartes theorized that pain was a

Some sensory fibers do not differentiate between

Three dimensions of pain

"sensory-discriminative" (sense of the intensity, location, quality and duration of the

Evolutionary and behavioral role

Multidimensional pain inventory

The Multidimensional Pain Inventory (MPI) is a questionnaire designed to assess the

Assessment in non-verbal people

With a non-communicative person, observation becomes critical, and specific behaviors

Other reporting barriers

Nociceptive pain is caused by stimulation of

Some manifestations of neuropathic pain include: traumatic neuropathy, tic douloureux,

Inadequate treatment of pain is widespread throughout surgical wards, intensive care

A number of meta-analyses have found clinical hypnosis to be effective in controlling pain

An analysis of the 13 highest quality studies of pain treatment with acupuncture,

Society and culture

Many cultures use painful ritual practices as a catalyst for psychological

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