ABPN Pain Medicine key terms

Pain arising from activation of nociceptors in somatic or visceral tissue by actual or threatened damage. It is typically aching, throbbing, or cramping and generally responds to non-opioid analgesics or opioids.

Pain caused by a lesion or disease of the somatosensory nervous system. It is often burning, shooting, or electric-shock-like, with sensory loss or gain, and requires a plausible neuroanatomic distribution plus confirmatory testing.

Increased responsiveness of nociceptive neurons in the central nervous system to normal or subthreshold input. It produces hyperalgesia, allodynia, and spreading pain and is prominent in chronic widespread and neuropathic pain states.

Standardized psychophysical tests measuring detection thresholds and pain responses to calibrated thermal, mechanical, and vibration stimuli. They characterize sensory gain or loss and are used mainly in research and selected clinical assessments.

A descending inhibitory phenomenon in which a painful conditioning stimulus reduces pain evoked by a separate test stimulus. Reduced conditioned pain modulation efficiency is associated with chronic pain and central sensitization.

A ten-item clinician-administered questionnaire with seven symptom and three examination items scoring neuropathic pain features. A total score of four or more out of ten suggests a neuropathic pain component.

An eleven-point self-report scale anchored at zero for no pain and ten for worst imaginable pain. It is simple and widely used but unidimensional and vulnerable to recall bias.

Eight nonorganic physical findings grouped as tenderness, simulation, distraction, regional disturbance, and overreaction. They suggest psychosocial distress rather than prove malingering and should not alone be used to deny care.

Intentional production or exaggeration of symptoms for external gain, such as financial compensation or avoiding work. It differs from factitious disorder and from legitimate symptom amplification caused by distress or misunderstanding.

A state of adaptation in which opioid exposure diminishes one or more drug effects over time, so higher doses are needed for the same analgesia. It is not synonymous with addiction or physical dependence.

A paradoxical increase in pain sensitivity and worsening pain during escalating opioid doses, distinct from tolerance and withdrawal. Mechanisms involve central sensitization, and management usually requires dose reduction or opioid rotation.

A physiologic adaptation manifested by withdrawal when an opioid is abruptly stopped, reduced, or antagonized. It can occur with legitimate prescribing and does not by itself indicate addiction.

The dose of one analgesic that produces approximately the same pain relief as another. Conversions guide opioid switching, but incomplete cross-tolerance usually prompts a twenty-five to fifty percent dose reduction.

Switching from one opioid to another to improve analgesia or reduce adverse effects when tolerance or toxicity develops. It uses equianalgesic tables and accounts for incomplete cross-tolerance by reducing the calculated dose.

Gabapentin and pregabalin bind alpha-2-delta subunits of voltage-gated calcium channels, reducing excitatory neurotransmitter release. They are first-line for neuropathic pain but cause sedation, edema, and have misuse potential.

A potentially life-threatening toxidrome from serotonergic excess, marked by mental status change, autonomic instability, and neuromuscular hyperactivity such as clonus and hyperreflexia. Risk rises with tramadol, meperidine, and serotonergic antidepressants.

A short-acting opioid receptor antagonist used to reverse opioid-induced respiratory depression. Repeated doses or an infusion may be needed because its duration is shorter than many opioids.

A partial mu-opioid agonist and kappa antagonist with high receptor affinity and a ceiling effect on respiratory depression. It treats chronic pain and opioid use disorder and can precipitate withdrawal in dependent patients.

A Risk Evaluation and Mitigation Strategy is an FDA-required plan for selected drugs, including long-acting opioids, to ensure benefits outweigh risks through prescriber training, patient education, and controlled distribution.

Injection of local anesthetic, sometimes with steroid, around medial branches of dorsal rami that innervate facet joints. It is used diagnostically to identify facet-mediated pain before radiofrequency ablation.

A procedure using heat from radiofrequency current to lesion nerves, commonly medial branches, for longer-term relief of facet-mediated or sacroiliac pain. It is not routine treatment for generalized neuropathic pain.

Delivery of corticosteroid, often with local anesthetic, into the epidural space to reduce radicular inflammation and pain. It offers modest short-term benefit for radiculopathy and carries risks including infection and dural puncture.

Injection of local anesthetic around the stellate ganglion at the sixth cervical level to block sympathetic outflow to the head, neck, and upper limb. Uses include complex regional pain syndrome and sympathetically maintained pain.

Delivery of low-voltage electrical pulses to the dorsal columns through implanted epidural electrodes to modulate pain transmission. It is used for persistent radicular or neuropathic pain after conservative and less invasive options fail.

Implantation of a pump and catheter to deliver small analgesic doses, such as morphine or ziconotide, directly into cerebrospinal fluid. It is reserved for refractory severe pain and requires careful trialing and monitoring.

Injection of local anesthetic or saline into a palpable taut band with a hypersensitive nodule to relieve myofascial pain. Evidence is modest, and technique must avoid nerves and vessels.

A structured, time-limited psychotherapy that identifies and changes maladaptive thoughts and behaviors about pain and teaches coping skills such as relaxation, pacing, and activity scheduling. It is supported for chronic pain and disability reduction.

A mindfulness-based behavioral therapy fostering psychological flexibility, acceptance of unavoidable pain, and engagement in valued activities rather than symptom control. It is increasingly used for chronic pain and associated distress.

A sequential rehabilitation approach using laterality recognition, imagined movements, and mirror therapy to desensitize altered cortical representations. It is used mainly for complex regional pain syndrome and phantom limb pain.

Structured education explaining the biology of pain, central sensitization, and the difference between tissue damage and pain experience. It reduces fear and catastrophizing and supports active coping and rehabilitation.

A cognitive-behavioral model in which catastrophic interpretation of pain leads to fear, avoidance, disuse, and depression, perpetuating chronic pain and disability. It is a target for exposure-based treatment.

Coordinated care by clinicians from different disciplines, such as medicine, psychology, and physical therapy, working in parallel and each addressing pain within their own scope. Communication is important, but team integration may vary.

A team of professionals from different disciplines collaborating on shared goals, treatment plans, and coordinated interventions, typically with regular team meetings. It is considered the gold standard for complex chronic pain.

A framework understanding pain and disability as resulting from interacting biological, psychological, and social factors rather than solely tissue pathology. It underpins comprehensive assessment and multimodal treatment.

A collaborative process in which clinician and patient discuss evidence, benefits, harms, and patient values to reach an informed choice. It is central to ethical chronic pain management and opioid decisions.

Voluntary authorization for a procedure or treatment after disclosure of diagnosis, nature and purpose, risks, benefits, alternatives, and consequences of refusal, with assessment of patient understanding.

A state-run electronic database tracking controlled substance prescriptions. It identifies multiple prescribers, overlapping opioids and benzodiazepines, and possible misuse while supporting safer prescribing decisions.

An administrative process assessing whether and how far a person's impairment limits work or function. Clinicians document objective findings and functional capacity, not merely reported pain.