Terminology

Decreased sensitivity to stimulation, excluding the special senses.

Note: Stimulation and locus to be specified.

Integrative pain care is coordinated and evidence-based management applying both conventional and traditional/complementary approaches by a team that includes the person being treated.

Notes

1. As defined by the World Health Organization, 1) “complementary medicine refers to a broad set of health care practices that are not part of that country’s own tradition or conventional medicine and may not be fully integrated into the dominant health-care system; and 2) “Traditional medicine is the sum total of the knowledge, skill, and practices based on the theories, beliefs, and experiences indigenous to different cultures”
2. Integrative pain care operates in a biopsychosocial framework and emphasizes multimodal¹ interventions from both conventional and traditional/complementary health approaches in various combinations.

¹“multimodal”: concurrent use of separate therapeutic interventions with different mechanisms of action (within one discipline)

Multimodal treatment provided by a multidisciplinary team collaborating in assessment and treatment using a shared biopsychosocial model and goals. For example: the prescription of an anti-depressant by a physician alongside exercise treatment from a physiotherapist, and cognitive behavioral treatment by a psychologist, all working closely together with regular team meetings (face to face or online), agreement on diagnosis, therapeutic aims and plans for treatment and review.

Multimodal treatment provided by practitioners from different disciplines. For example: the prescription of an anti-depressant by a physician alongside exercise treatment from a physiotherapist, and cognitive behavioral treatment by a psychologist, all the professions working separately with their own therapeutic aim for the patient and not necessarily communicating with each other.

The concurrent use of separate therapeutic interventions with different mechanisms of action within one discipline aimed at different pain mechanisms. For example: the use of pregabalin and opioids for pain control by a physician; the use of NSAID and orthosis for pain control by a physician.

Pain in the distribution of a nerve or nerves.

Note: Common usage, especially in Europe, often implies a paroxysmal quality, but neuralgia should not be reserved for paroxysmal pains.

Inflammation of a nerve or nerves.

Note: Not to be used unless inflammation is thought to be present.

Pain caused by a lesion or disease of the somatosensory nervous system.

Note: Neuropathic pain is a clinical description (and not a diagnosis) which requires a demonstrable lesion or a disease that satisfies established neurological diagnostic criteria. The term lesion is commonly used when diagnostic investigations (e.g. imaging, neurophysiology, biopsies, lab tests) reveal an abnormality or when there was obvious trauma. The term disease is commonly used when the underlying cause of the lesion is known (e.g. stroke, vasculitis, diabetes mellitus, genetic abnormality).

Somatosensory refers to information about the body per se including visceral organs, rather than information about the external world (e.g., vision, hearing, or olfaction). The presence of symptoms or signs (e.g., touch-evoked pain) alone does not justify the use of the term neuropathic. Some disease entities, such as trigeminal neuralgia, are currently defined by their clinical presentation rather than by objective diagnostic testing. Other diagnoses such as postherpetic neuralgia are normally based upon the history. It is common when investigating neuropathic pain that diagnostic testing may yield inconclusive or even inconsistent data. In such instances, clinical judgment is required to reduce the totality of findings in a patient into one putative diagnosis or concise group of diagnoses.

Pain caused by a lesion or disease of the central somatosensory nervous system. See neuropathic pain note.

Pain caused by a lesion or disease of the peripheral somatosensory nervous system. See neuropathic pain note.

A disturbance of function or pathological change in a nerve: in one nerve, mononeuropathy; in several nerves, mononeuropathy multiplex; if diffuse and bilateral, polyneuropathy.

Note: Neuritis (q.v.) is a special case of neuropathy and is now reserved for inflammatory processes affecting nerves.

The neural process of encoding noxious stimuli.

Note: Consequences of encoding may be autonomic (e. g. elevated blood pressure) or behavioral (motor withdrawal reflex or more complex nocifensive behavior). Pain sensation is not necessarily implied.

A central or peripheral neuron of the somatosensory nervous system that is capable of encoding noxious stimuli.

Pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors.

Note: This term is designed to contrast with neuropathic pain. The term is used to describe pain occurring with a normally functioning somatosensory nervous system to contrast with the abnormal function seen in neuropathic pain.

An actually or potentially tissue-damaging event transduced and encoded by nociceptors.

A high-threshold sensory receptor of the peripheral somatosensory nervous system that is capable of transducing and encoding noxious stimuli.

Pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain.

Note: Patients can have a combination of nociceptive and nociplastic pain

A stimulus that is damaging or threatens damage to normal tissues.

The minimum intensity of a stimulus that is perceived as painful.

Note: Traditionally the threshold has often been defined, as we defined it formerly, as the least stimulus intensity at which a subject perceives pain. Properly defined, the threshold is really the experience of the patient, whereas the intensity measured is an external event. It has been common usage for most pain research workers to define the threshold in terms of the stimulus, and that should be avoided. However, the threshold stimulus can be recognized as such and measured. In psychophysics, thresholds are defined as the level at which 50% of stimuli are recognized. In that case, the pain threshold would be the level at which 50% of stimuli would be recognized as painful. The stimulus is not pain (q.v.) and cannot be a measure of pain.

The maximum intensity of a pain-producing stimulus that a subject is willing to accept in a given situation.

Note: As with pain threshold, the pain tolerance level is the subjective experience of the individual. The stimuli which are normally measured in relation to its production are the pain tolerance level stimuli and not the level itself. Thus, the same argument applies to pain tolerance level as to pain threshold, and it is not defined in terms of the external stimulation as such.

An abnormal sensation, whether spontaneous or evoked.

Note: Compare with dysesthesia. After much discussion, it has been agreed to recommend that paresthesia be used to describe an abnormal sensation that is not unpleasant while dysesthesia be used preferentially for an abnormal sensation that is considered to be unpleasant. The use of one term (paresthesia) to indicate spontaneous sensations and the other to refer to evoked sensations is not favored. There is a sense in which, since paresthesia refers to abnormal sensations in general, it might include dysesthesia, but the reverse is not true. Dysesthesia does not include all abnormal sensations, but only those that are unpleasant.

Increased responsiveness of nociceptive neurons to their normal input, and/or recruitment of a response to normally subthreshold inputs.

Note: Sensitization can include a drop in threshold and an increase in suprathreshold response. Spontaneous discharges and increases in receptive field size may also occur. This is a neurophysiological term that can only be applied when both input and output of the neural system under study are known, e.g., by controlling the stimulus and measuring the neural event. Clinically, sensitization may only be inferred indirectly from phenomena such as hyperalgesia or allodynia.

Increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input.

Note: See note for sensitization and nociceptive neuron above. This may include increased responsiveness due to dysfunction of endogenous pain control systems. Peripheral neurons are functioning normally; changes in function occur in central neurons only.

Increased responsiveness and reduced threshold of nociceptive neurons in the periphery to the stimulation of their receptive fields.

Note: See note for sensitization above.

Single therapeutic intervention directed at a specific pain mechanism or pain diagnosis. For example: the application of exercise treatment by a physiotherapist.