El texto a continuación utiliza muchos términos relativos a tipo de dolor y precepción del dolor.

Es
importante que busquen los conceptos desconocidos al igual que el vocabulario pertinente.

Overview of Pain

Pain is the most common reason patients seek medical care.

Pain has sensory and emotional components and is often classified as acute or
chronic. Acute pain is frequently associated with anxiety and hyperactivity of the
sympathetic nervous system (eg, tachycardia, increased respiratory rate and BP,
diaphoresis, dilated pupils). Chronic pain does not involve sympathetic hyperactivity
but may be associated with vegetative signs (eg, fatigue, loss of libido, loss of
appetite) and depressed mood. People vary considerably in their tolerance for pain.

Pathophysiology

Acute pain, which usually occurs in response to tissue injury, results from activation
of peripheral pain receptors and their specific A delta and C sensory nerve fibers
(nociceptors).
Chronic pain related to ongoing tissue injury is presumably caused by persistent
activation of these fibers. However, the severity of tissue injury does not always
predict the severity of chronic or acute pain. Chronic pain may also result from
ongoing damage to or dysfunction of the peripheral or central nervous system (which
causes neuropathic pain).
Nociceptive pain may be somatic or visceral. Somatic pain receptors are located in
skin, subcutaneous tissues, fascia, other connective tissues, periosteum, endosteum,
and joint capsules. Stimulation of these receptors usually produces sharp or dull
localized pain, but burning is not uncommon if the skin or subcutaneous tissues are
involved. Visceral pain receptors are located in most viscera and the surrounding
connective tissue. Visceral pain due to injury of organ capsules or other deep
connective tissues may be more localized and sharp.
Psychologic factors modulate pain intensity to a highly variable degree. Thoughts and
emotions have an important role in the perception of pain. Many patients who have
chronic pain also have psychologic distress, especially depression and anxiety.
Because certain syndromes characterized as psychiatric disorders (eg, some somatic
symptom disorders) are defined by self-reported pain, patients with poorly explained
pain are often mischaracterized as having a psychiatric disorder and are thus
deprived of appropriate care.
Pain impairs multiple cognitive domains including attention, memory, concentration,
and content of thought, possibly by demanding cognitive resources.

Many pain syndromes are multifactorial. For example, chronic low back pain and
most cancer pain syndromes have a prominent nociceptive component but may also
involve neuropathic pain (due to nerve damage).

Evaluation of Pain

Clinicians should evaluate the cause, severity, and nature of the pain and its effect on
activities, mood, cognition, and sleep. Evaluation of the cause of acute pain (eg, back
pain, chest pain) differs from that of chronic pain.

The history should include the following information about the pain:

 Quality (eg, burning, cramping, aching, deep, superficial, boring, shooting)

 Severity
 Location
 Radiation pattern
 Duration
 Timing (including pattern and degree of fluctuation and frequency of
remissions)
 Exacerbating and relieving factors

The patient’s level of function should be assessed, focusing on activities of daily living
(eg, dressing, bathing), employment, and personal relationships (including sexual).

The patient's perception of pain can represent more than the disorder's intrinsic
physiologic processes. What pain means to the patient should be determined, with
emphasis on psychologic issues, depression, and anxiety. Reporting pain is more
socially acceptable than reporting anxiety or depression, and appropriate therapy
often depends on sorting out these divergent perceptions. Pain and suffering should
also be distinguished, especially in cancer patients; suffering may be due as much to
loss of function and fear of death as to pain.

Taken from Mayo Clinic, Feb 2023