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Definitions: Pain Management

Acute pain – Pain that occurs in response to tissue trauma.

Addiction – A psychological dependence on drugs characterized by compulsive and continued drug use regardless of harmful consequences, even death.

Adjuvant analgesics – Prescription drugs, such as antidepressants or anti-seizure medications, that have been found to be effective pain relievers.

Adverse effects – Opioid-induced nausea/vomiting, drowsiness or confusion that can be easily managed with medication and generally subside after a brief period of time as patients develop a tolerance to the opioid dosage.

Allodynia – Hypersensitivity to touch

Analgesics – Pain relievers

Non-opioid analgesics – Pain relievers that do not contain opioids/narcotics. Include acetaminophen and (NSAIDS) nonsteroidal anti-inflammatory drugs (including aspirin and ibuprofen).

Anti-seizure/anticonvulsants – Drugs used to treat seizures.

Antidepressants – Drugs used to treat depression.

Bolus effect – Syndrome in which the dose of an opioid changes in the bloodstream causing the patient to experience drowsiness for up to an hour after taking (high level) and followed by pain just before the next dose is due (low level).

Bone pain – Usually the result of changes in metastases, compression or pathologic fracture. It is constant at rest and worse with movement.

Breakthrough pain – A significant sudden increase in pain while taking ongoing pain medication.

Central pain – Associated with a lesion of the central nervous system.

Chronic pain – Pain that extends beyond the expected period of healing. A persistent pain that disrupts sleep and daily activities.

Codeine – An opioid pain reliever, not as strong as morphine. Sometimes combined with aspirin or acetaminophen.

Compression – The result of bone collapsing due to the growth of a tumor. In the spine, the collapse of vertebrae that puts pressure on the nerve roots exiting from the spinal column, causing pain, tingling sensations and weakness.

Corticosteroid – A synthetic steroid hormone that helps decrease inflammation.

Cross tolerance – Resistance to the effects of a medication as a result of continued use to a different but similar medication.

Drug diversion – The use of a prescription medication by someone other than the patient.

Fentanyl – A narcotic analgesic that is used in a patch for continuous long-acting pain relief or as a sub-lingual tablet for fast acting pain relief (rescue medication).

Hepatic – Relating to the liver

Interventional pain management – Non-drug form of controlling pain through epidural or intrathecal catheters, implanted pump, nerve blocks, stimulations or ablations.

Lesion – Tumor cells localized in an organ or tissue.

Metastases – Cancer tumor cells that spread to other parts of the body from its original site to form secondary growths.

Methadone – Synthetic opioid very effective in the treatment of pain, especially neuropathy.

Morphine – Fast acting opioid pain reliever. The oral form is used to treat cancer pain.

Myoclonic – a sudden twitching of muscles without any rhythm or pattern. Can be a sign of opioid toxicity.

Narcotic – The legal term used by the U.S. Controlled Substance Act that includes opioids, marijuana, cocaine and heroin.

Naloxone – Medication that is used to counteract the effects of opioids, including overdose. Available as an injectable (like an Epi Pen) or as a mist that is sprayed into the nasal passages. Every home with someone taking an opioid, prescribed or not, should have one form of naloxone and be educated as to how and when to use it.

Neuropathic pain – Pain caused by an abnormality anywhere in the nerve pathway. Felt as a deep ache, or burning sensation.

Nociceptive pain – The result of direct mechanical or chemical stimulation of nociceptors and normal neural signaling to the brain. Described as aching, throbbing or cramping.

Non-pharmacologic interventions – Other therapies available for managing pain including TENS (transcutaneous electrical nerve stimulation), massage and body work, physical therapy, acupuncture, meditation, imagery, biofeedback, behavior therapy, psychotherapy, hypnosis and art or music therapy.

NSAID (non-steroidal anti-inflammatory drugs) – Pain relievers that include ibuprofen, naproxen and others, that also reduce inflammation.

Opiate – A drug derived from the opium poppy, including codeine and morphine.

Opioids – Synthetic and semisynthetic narcotic pain relievers, such as methadone and fentanyl.

Opioid allergy – A rare reaction to opioid medications that includes shortness of breath (seek immediate medical attention). Also, severe itching (pruritus) or hives (urticarial) which can be controlled by long-acting, non-drowsy antihistamines.

Opioid – induced constipation – Difficult, incomplete or infrequent evacuation of the bowels due to reduced activity in the intestines caused by opioid use. Dehydration, poor food intake, and other medications may make the problem worse. Management requires a constant regime: stimulant laxatives with softeners and milk of magnesia are most often recommended. An oral form of an IV medication that quickly stimulates movement in the intestines has become available. One side effect of this oral medication is that it can interfere with any opioid medication being taken.

Opioid rotation – Several opioids may need to be tried before one is found to provide good pain relief with minimal adverse effects.

Opioid use disorder – Addiction

Oxycodone – Opioid pain reliever usually combined with aspirin or acetaminophen

Pain – An unpleasant sensation signaling that the body has sustained damage through disease or injury.

Pain assessment – Evaluation of the aspects of pain including description, location, duration, intensity, frequency and response.

Pain management – Seeks to reduce symptoms of pain.

Pain threshold – The least stimulus intensity at which someone perceives pain.

Pain tolerance level – The greatest stimulus intensity causing pain that someone is prepared to tolerate.

Pathologic fracture – Caused when a cancer tumor grows into and weakens the bone.

Pseudo-addiction – False addiction. Patients with unrelieved pain due to under-medicating may exhibit addiction-like behaviors.

Physical dependence – The body adapts and develops a tolerance or dependence to the drug being used and withdrawal symptoms will occur when drug use is stopped.

Referred pain – Pain that is experienced someplace other than where the actual pain occurs.

Sedation – The inability to fully wake up after taking opioid medication. This is different from exhaustion due to sleep deprivation (sleeps a lot but is able to wake fully between sleeps).

Somatic – Related to the body (soma) as opposed to the mind (psyche). Also refers to the body wall in contrast to the internal organs (viscera).

Tolerance – The reduced effectiveness of a given dose of medication over time. In order to produce the same effect of the original dose, subsequent dosage must be increased.

Total pain – A concept that emphasizes that there may also be non-physical factors, including psychological (depression), social (family problems) or spiritual (loss of hope), that exacerbate pain.

Transdermal opioids – Fentanyl in a patch form that allows the medication to be absorbed through the skin for continuous pain relief.

Trigger point – An a particular area, usually located in muscle tissue, which, when pressure is applied, results in pain.

Tumor – An abnormal mass caused by increased cell production that may invade surrounding tissue.

Under-medicating – Providing inadequate pain medication to a patient in need of pain relief.

Visceral – Feeling that is intense or deep.

Withdrawal – Symptoms such as rapid breathing, headache, diarrhea or shaking that occur when a drug that has been used over a period of time is stopped abruptly.

Sources

The Merck Manual of Medical Information – Home Edition. Merck Research Laboratories, 1997

Harrison’s Principles of Internal Medicine – 16th Edition. McGraw-Hill, Medical Publishing Division, 2005

The American Medical Association Encyclopedia of Medicine. Random House New York, 1989

Stedman’s Medical Dictionary – 27th Edition. Lippincott Williams & Wilkins, 2000

The American Heritage Dictionary of the English Language – Fourth Edition. Houghton Mifflin Company, 2000

EPEC -O (Education in Palliative and End-of-Life Care – Oncology), Cancer Pain Management, EPEC Project, Northwestern University Feinberg School of Medicine, Chicago, IL., 2005

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