This document summarizes pain by defining it, classifying types of pain, and describing pain scales. It defines pain as an unpleasant sensation caused by damage or described in terms of damage. There are three main types of pain: nociceptive from tissue damage, neuropathic from nervous system damage, and psychogenic from mental factors. Nociceptive pain is further divided. Pain scales like faces scales and visual analog scales are used to measure pain intensity in patients and help with diagnosis and treatment.

1. PAIN
Prepared by Syed Basheeruddin

2. CONTENTS
 Pain
 Classification of pain
 Pain scale

3. PAIN
 Pain is a distressing feeling often caused by
intense or damaging stimuli. The International
Association for the Study of Pain's widely used
definition defines pain as "an unpleasant
sensory and emotional experience associated
with actual or potential tissue damage, or
described in terms of such damage“. however,
due to it being a complex, subjective
phenomenon, defining pain has been a
challenge. In medical diagnosis, pain is
regarded as a symptom of an underlying

4. CLASSIFICATION OF PAIN
 The 3 Basic Types of Pain
 There are two main classifications of
pain: the common sensical sort that
arises from damaged
tissue (nociceptive pain), and the more
exotic kind that comes from damage to
the system that reports and interprets
damage, the nervous
system (neuropathic pain), and other
pain

6.  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 a
cut or chemicals released during inflammation).
Some nociceptors respond to more than one of
these modalities and are consequently
designated polymodal.

7. Nociceptive pain may also be divided into
"visceral", "deep somatic" and "superficial
somatic" pain. Visceral structures 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 as distant,
usually superficial, structure. It may be
accompanied by nausea and vomiting and may be
described as sickening, deep, squeezing, and
dull. 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

8. Superficial 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.

9.  Neuropathic
 Neuropathic pain
 Neuropathic pain is caused by damage or
disease affecting any part of the nervous
system involved in bodily feelings
(the somatosensory system).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". Bumping the
"funny bone" elicits acute peripheral neuropathic
pain.

10.  Allodynia
 Allodynia is pain experienced in response to a
normally painless stimulus. It has no biological
function and is classified by stimuli into dynamic
mechanical, punctate and static. In
osteoarthritis, NGF has been identified as being
involved in allodynia.The extent and intensity of
sensation can be assessed through locating
trigger points and the region of sensation, as
well as utilising phantom maps.

11.  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.
 The prevalence of phantom pain in upper limb
amputees is nearly 82%, and in lower limb amputees
is 54%.One study found that eight days after
amputation, 72% of patients had phantom limb pain,
and six months later, 67% reported it. 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.

12.  Psychogenic
 Psychogenic pain
 Psychogenic pain also
called psychalgia or somatoform pain, is pain
caused, increased, or prolonged by mental,
emotional, or behavioral factors. Headache,
back pain, and stomach pain are sometimes
diagnosed as psychogenic.Sufferers 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.

13. PAIN SCALE
 A pain scale measures a patient's pain intensity
or other features. Pain scales are based on trust,
cartoons (behavioral), or imaginary data. Self-
report is considered primary and should be
obtained if possible. Pain measurements help
determine the severity, type, and duration of the
pain, and are used to make an accurate diagnosis,
determine a treatment plan, and evaluate the
effectiveness of treatment. Pain scales are
available for neonates, infants, children,
adolescents, adults, seniors, and persons whose
communication is impaired. Pain assessments are
often regarded as "the 5th Vital Sign".

14.  In children the pain is measured by faces pain
scale and color analog scale
 "These faces show how much something can
hurt. This face [point to left-most face] shows no
pain. The faces show more and more
pain [point to each from left to right] up
to this one. [point to right-most face] It shows
very much pain. Point to the face that shows
how much you hurt [right now]."
 Score the chosen face 0, 2, 4, 6, 8, or 10, counting
left to right, so "0" equals "No pain" and "10"
equals "Very much pain." Do not use words like
"happy" and '"sad." This scale is intended to
measure how children feel inside, not how their
face looks.

15.  Faces pain scale

16.  Visual color analog scale
 A Visual Analogue Scale (VAS) is a
measurement instrument that tries to measure
a characteristic or attitude that is believed to
range across a continuum of values and cannot
easily be directly measured. It is often used in
epidemiologic and clinical research to measure
the intensity or frequency of various symptoms.
For example, the amount of pain that a patient
feels ranges across a continuum from none to
an extreme amount of pain. From the patient's
perspective, this spectrum appears continuous
± their pain does not take discrete jumps, as a
categorization of none, mild, moderate and
severe would suggest. It was to capture this
idea of an underlying continuum that the VAS
was devised.

17. VISUAL COLOR ANALOG SCALE

19. o Pain
Pain Level
0
No Pain
No pain at all, you feel perfectly normal.
Minor Pain Levels
Minor pain levels generally do not interfere with most day to day activities. Able to adapt to pain
psychologically and with medication or devices such as cushions.
Pain Level 1
Very Mild
Very light barely noticeable pain, like a mosquito
bite or a poison ivy itch. Most of the time you
never think about the pain.
Pain Level 2
Discomforting
Minor pain, like lightly pinching the fold of skin
between the thumb and first finger with the other
hand, using the fingernails. People can react
differently to this self-test.
Pain Level 3
Tolerable
Very noticeable pain, like an accidental cut, a
blow to the nose causing a bloody nose, or a
doctor giving you an injection. The pain is not so
strong that you cannot get used to it. Eventually,
most of the time you don't notice the pain, as
you have adapted to it.

20. Moderate Pain Levels
Moderate pain levels interfere with many daily activities. These pain
levels usually require some lifestyle changes but you can remain
independent, however, you are unable to adapt to the pain.
Pain Level 4
Distressing
Strong, deep pain, like an average
toothache, the initial pain from a
bee sting, or minor trauma to part of
the body, such as stubbing your toe
real hard. So strong you notice the
pain all the time and cannot
completely adapt. This pain level
can be simulated by pinching the
fold of skin between the thumb and
first finger with the other hand,
using the fingernails, and squeezing
real hard. Note how the simulated
pain is initially piercing but becomes
dull after that.

21. Pain Level 5
Very Distressing
Strong, deep, piercing pain, such as
a sprained ankle when you stand on
it wrong or mild back pain. Not only
do you notice the pain all the time,
you are now so preoccupied with
managing it that you normal lifestyle
is curtailed. Temporary personality
disorders are frequent.
Pain Level 6
Intense Pain
Strong, deep, piercing pain so strong
it seems to partially dominate your
senses, causing you to think
somewhat unclearly. At this point you
begin to have trouble holding a job or
maintaining normal social
relationships. Comparable to a bad
non-migraine headache combined
with several bee stings, or a bad
back pain

22. severe Pain Levels
Severe pain levels mean you are unable to engage in your normal
activities. The patient is considered disabled and unable to function
independently.
Pain Level 7
Very Intense Pain
Same as 6 except the pain
completely dominates your senses,
causing you to think unclearly about
half the time. At this point you are
effectively disabled and frequently
cannot live alone. Comparable to an
average migraine headache.
Pain Level 8
Horrible Pain
Pain so intense you can no longer
think clearly at all, and have often
undergone severe personality
change if the pain has been present
for a long time. Suicide is frequently
contemplated and sometimes tried.
Comparable to childbirth or a real
bad migraine headache.

23. Pain Level 9
Excruciating
Pain so intense you cannot tolerate
it and demand pain killers or
surgery, no matter what the side
effects or risk. If this doesn't work,
suicide is frequent since there is no
more joy in life whatsoever.
Comparable to throat cancer.
Pain Level 10
Unimaginable Pain
Pain so intense you will go
unconscious shortly. Most people
have never experienced this level of
pain. Those who have suffered a
severe accident, such as a crushed
hand, and lost consciousness as a
result of the pain and not blood loss,
have experienced level 10.

24. Thank you