TAYSIDE PAIN SERVICE
STUDENT INDUCTION AND
INFORMATION PACK
Student:
Mentor:
Associate Mentor:
Starting date:
Developed 2006
Reviewed 2008
Next Review 2010
WELCOME TO THE TAYSIDE PAIN SERVICE
We hope that you will enjoy your placement here and that you will quickly feel part of
the team. We will assign you a mentor who will support and guide you through your
placement.
On your first day, your mentor will discuss your learning objectives with you. A
learning contract will then be negotiated between you and your mentor within 48
hours of starting your placement (The Development of Quality Standards for Practice
Placements, NHS Scotland). Times will be arranged by your mentor for regular
progress meetings. We will aim for you to work with your mentor(s) on as many
occasions as possible.
Please do not hesitate to ask questions. We will always try to answer them. The staff
within the Pain Service are keen to facilitate your learning but will expect you to assist
with your own learning by developing a questioning approach. We look forward to
hearing your views and suggestions about our service and how we can improve the
experience for students.
On your first day please report to the reception desk, Pain Services, Level 6, South
Block, Ninewells Hospital at 8.30 a.m. You are not required to wear uniform but
please wear a name badge and come appropriately dressed for seeing patients in the
clinical area.
We look forward to meeting you.
THE PAIN TEAM
STUDENT WORK PATTERNS AND ATTENDANCE

Student Work Patterns are 8.30 a.m. to 4.30 p.m. 5 days per week – Monday to
Friday

Uniform is not required but please wear a name badge and come appropriately
dressed for seeing patients in the clinical area

In order for you to fulfil your personal learning objectives and meet your
competencies for this placement, you need to regularly attend work whilst in the
clinical area
There may be times when absence is unavoidable. If reporting in absent, please
telephone 01382 425612 after 8.30 a.m. and ask to speak to a Pain Specialist Nurse.
Returning to work: please telephone 01382 425612 and ask to speak to a Pain Specialist
Nurse. You should telephone the department no later than 4 p.m. on the day before you
intend to return to work. The University of Dundee will be notified by the department, of
student sick absences.
INFORMATION ABOUT THE TAYSIDE PAIN SERVICE
What is the Tayside Pain Service
We are a multi-disciplinary team of Doctors, Nurses and Psychologists providing a wide
range of treatments/therapies for patients with chronic pain. We also provide information,
education and support for patients, their families and carers.
Location
The Pain Service is located on three sites.
Ninewells Hospital, Dundee (Level 6, South Block)
Perth Royal Infirmary, Perth (Outpatient Annexe)
Stracathro Hospital, Brechin (Physiotherapy Department)
The Team
 Ninewells Hospital
Consultants in Anaesthesia and Pain Management
Dr W Macrae
Dr J Bannister
Dr D Hartmann
Dr P Lacoux
Dr G Gillespie
Lead Nurse, Tayside Pain Service
Judith Rafferty (Bleep 4456)
Pain Specialist Nurse
Judith Linskell (Bleep 4456)
Pain Management Nurses
Susan Clark
Mike Nicholas
Clinical Psychologists
Ms P Fraser (Consultant)
Dr T Spencer
Secretary
Gillian Shepherd
Contact telephone number (01382) 660111 Ext 35612
Or (01382) 425612

Perth Royal Infirmary
Consultants in Anaesthesia and Pain Management
Dr W Macrae
Dr J Bannister
Pain Specialist Nurses
Moira Gibson (Bleep 5163)
Betty Little (Bleep 5180)
Secretary
Linda Westwood
Contact telephone number (01738) 473492

Stracathro Hospital
Consultant in Anaesthesia and Pain Management
Dr D Hartmann
Pain Specialist Nurse
Joyce Lind (Bleep 2445)
Secretary
Mrs E McLaggan
Contact telephone number (01356) 647291 Ext 65389
Tayside Pain Service Philosophy of Care
The purpose of the chronic pain team is to facilitate safe and effective pain management
for referred patients in outpatient clinics and within the hospital.
The service provided is evidence-based and underpinned by an ethos of continuous
quality improvement.
This will be achieved through collaborative working with multidisciplinary team members
and effective working partnerships with the acute pain team, palliative care team and
clinical pharmacists.
All patients, relatives and staff will be treated with respect and politeness ensuring
privacy, dignity and confidentiality of our patients at all times.
We will :  Treat patients as individuals acknowledging their needs and encouraging their
participation in formulating pain management plans.
 Ensure documented evidence of ongoing pain management involving the patient, with
regular reviews of treatment, thus ensuring changes are made to treatment and
interventions on the bases of individual’s pain experience.
 Assist and direct healthcare professionals to make the correct decisions regarding pain
management treatment/interventions.
 Recognise and value the contribution of all staff in the pain management process and
assist them to achieve/maintain knowledge and skills in order to provide safe and
effective pain management.
Patient Pathway
PRIMARY CARE REFERRALS
SECONDARY CARE REFERRALS
Referral for
SCS/Intrathecal
pumps
General
Practitioner
CHRONIC PAIN CLINIC
Multi-disciplinary triage of
referral (consultant and
senior nurse undertaken
once per week)
Physiotherapy
Nurse led Clinics
TENS/Acupuncture
New Patient
Consultation
with Specialist
Nurse
Nurse
review
clinics
Pain
Association
Scotland
Active for life
In-patient referrals from
within secondary care
(e.g. renal/surgical etc)
for outpatient
consultations.
Referrals from
Fife/Highlands
other Regions
Discharge back
to G.P
Acute Pain
Service
led
Out-patient referrals from
other specialist e.g. Combined
orthopaedic /spinal clinic
Out patient referrals from other
secondary care regions
Procedures
P.A.M.S e.g.
psychology, O.T
New patient Multidisciplinary
Consultation with
Consultant and nurse
specialist
Discharged
Back to G.P
Consultants
review
clinics
Physiotherapy
Psychology
Palliative care
Other Specialists
Pain
Management
Programmes
WHAT CAN YOU EXPECT FROM YOUR
PRACTICE PLACEMENT
There are many opportunities for students to develop and increase their knowledge of the
management of pain, in both the inpatient and outpatient setting.
Learning opportunities include :

Management of chronic pain

Management of acute-on-chronic pain

Management of patients with pain and dependency problems

Management of acute post-operative pain

Management challenges of acute and chronic pain

Management of patients receiving palliative care
Aims of your practice placement
You will develop clinical, managerial and personal skills, utilising research skills to
demonstrate how they can be used to provide evidence-based care to patients with a
variety of pain problems.
Objectives
Your mentor will meet with you to discuss your learning needs, set objectives, plan how
these will be achieved and what evidence will be required to show that learning has
occurred. A learning contract will be used for this purpose. In addition to your own
learning needs, you should aim, in conjunction with your mentor, to achieve some, if not
all of the following learning objectives :

Understand the meaning of the terms ‘chronic pain’, ‘acute pain’ and ‘acute-onchronic pain’ and the differences between them

Develop an understanding of pain as a biopsychosocial experience

Possess a clear understanding of the role of the Pain Specialist Nurse

Demonstrate knowledge of the patients journey within the Pain Service

Recognise and understand the features of Nociceptive Pain and Neuropathic Pain

Identify the fundamental principles of acute post-operative pain management

Develop a basic understanding of the assessment of patients receiving palliative
care
During your practice placement, the majority of your time will be spent at Ninewells
Hospital, however, you will also spend time at Perth Royal infirmary and Stracathro
Hospital. You will spend approximately two weeks with the Acute Pain Team at Ninewells
Hospital and we hope to provide you with the opportunity to spend some time with the
Palliative Care Team.
PLEASE LIST YOUR PERSONAL LEARNING AIMS AND OBJECTIVES
Specific Learning Opportunities

Nurse Led Clinics – New and Review Patients
TENS
Acupuncture

Consultant/Nurse Led Clinics -

Pain Service Procedures in Day Surgery Unit

Psychologists Clinics

Pain Association Scotland Meetings

Spinal Surgery in Neuro Theatre

Ward visits – chronic pain/acute-on-chronic pain problems

Ward rounds with Acute Pain Specialist Nurse

Sessions with Hospital Palliative Care Team

Personal Project Work -

Lunchtime Pain Meeting – Tuesday/Wednesday at 1.00 p.m. in lunch room, Pain
Clinic. Cases/papers, etc are discussed or pain related subjects presented.
New and Review Patients
Pain and Dependency Clinic
Spinal Cord Stimulator Clinic
Pump Clinic
Hypnotherapy Assessment & treatment clinic
A short project on a particular pain condition or
area of pain management that interests you.
The Pain Meetings are held on Tuesdays or Wednesdays at
13.00 hrs in the lunch room for half an hour.
This is a forum where cases are discussed, papers discussed, meetings reported back
upon or pain related subjects presented.
Features of meetings










Relaxed meetings open to all – medical, nursing, psychology, students, secretarial,
ward.
Weekly, initially on Tuesdays for three months and then changing to Wednesdays.
Time 13.00 hours for half an hour – we should try to keep to time.
Chair or “lets get started” person – whoever is presenting that week supported by
us all.
Set-up, mostly round table discussions, if you need Power point you should arrange
this.
Confidentiality – the normal rules apply.
Advertising by me on paper and email.
Subject, anything but hopefully half are case discussions – e.g. your difficult cases,
your interesting cases.
Lunch – eat it at the same time.
Quorum – I suggest that if there are three people or less we should probably
cancel and re-schedule.
Questions, comments and offers of presentations to me.
Phil Lacoux
Diary of Achievements
Week 1:
Monday
Tuesday
AM
AM
AM
PM
PM
PM
Wednesday
AM
PM
Thursday
AM
PM
Friday
Diary of Achievements
Week 2:
Monday
Tuesday
AM
AM
AM
PM
PM
PM
Wednesday
AM
PM
Thursday
AM
PM
Friday
Diary of Achievements
Week 3:
Monday
Tuesday
AM
AM
AM
PM
PM
PM
Wednesday
AM
PM
Thursday
AM
PM
Friday
Diary of Achievements
Week 4:
Monday
Tuesday
AM
AM
AM
PM
PM
PM
Wednesday
AM
PM
Thursday
AM
PM
Friday
Diary of Achievements
Week 5:
Monday
Tuesday
AM
AM
AM
PM
PM
PM
Wednesday
AM
PM
Thursday
AM
PM
Friday
Diary of Achievements
Week 6:
Monday
Tuesday
AM
AM
AM
PM
PM
PM
Wednesday
AM
PM
Thursday
AM
PM
Friday
USEFUL TELEPHONE NUMBERS
NAME/AREA
Pain Clinic Ninewells Hospital
 Reception/Secretaries
 Nurses
J Rafferty
J Linskell

Consultants
TELEPHONE NUMBER
01382 425612
35489
35116
S Clark
35116
35489
W Macrae
J Bannister
D Hartmann
P Lacoux
G Gillespie
Ext 35133
Ext 36262
Ext 35711
Pain Clinic Perth Royal Infirmary 01738 473379
 Nurses
M Gibson
Ext 13492
B Little
Ext 13492
Pain Clinic Stracathro Hospital
 Nurse
J Lind
Acute Pain Service, Ninewells
 Nurse
V Shepherd
BLEEP NUMBER
4456
4006
4309
4748
4003
5163
5180
65389
32175
4311
Ninewells Hospital
Outpatients Area 3A
 Reception
 Nurses
35710
35203
Day Surgery Unit
 Reception
 Nurses
32914/32119
36750
MS Specialist Nurses
S Flucker
M Abercrombie
P Reilly
Porters
36033
32730/32753
4765
Money advice Support Team
Welfare Rights
Dundee – Tel 01382 432452
Fife – Tel 01592 416379
Angus – Tel 01575 575800
Perth – Tel 01738 476700
Angus – Tel 01307 461460
Dundee – Tel 01382 431167
Princess Trust
Aileen Goodwin
Tel 01382 200422
Citizen’s Advice Bureau
Dundee – Tel 01382 227171
Forfar – Tel 01307 467097
Perth – Tel 01738 624301
Montrose – 01674 673263
Arbroath – Tel 01241 870661
Cupar – Tel 01334 412485
For help and advice with benefits forms, etc
Call for an appointment
Call for an appointment
Dundee North Law Centre
Tel 01382 432458
If you have any legal problems or worries and
would like to obtain advice or assistance – we
can help!
Call for an appointment
D.I.S.I.P.
Disability Information Service in
Perthshire
Tel 01738 440099/Fax 01738 687546
Email: disip@disip.org.uk
Website: www.disip.org.uk
Benefits Agency
Dundee Area
- Tel 01382 313419
Angus Area
- Tel 01241 446099
Montrose Area
- Tel 01674 6776605
Perth Area
- Tel 01738 412000
TABLE OF PAIN CLINICS FOR TAYSIDE INTEGRATED PAIN SERVICE
NINEWELLS HOSPITAL
MONDAY
A.M.
P.M.
8.30 – 9.30 Telephone reviews
8.45 – 12.00 Dr. Hartmann (1 nurse)
acupuncture clinic – DSU
1.30 – 5.00 Dr Hartmann OP clinic at
3A
2.00 – 4.30 Nurse clinic J Linskell
10.30 – 12.30 Dr Hartmann
procedures DSU
1.45 – 3.30 Dr Spencer – Psychology
9.30 – 12.30 Dr Spencer –
Psychology
TUESDAY
8.30 – 9.30 Telephone reviews
8.45 – 12.30 Acupuncture clinic (2
nurses) DSU
2.00 – 4.30 Nurse clinic J Linskell
2.00 – 4.30 Nurse clinic S Clark/M
Nicholas
9.00 – 12.15 Dr Gillespie (1 nurse)
OP clinic at office
9.30 – 12.30 (ad hoc)Dr Bannister
Combined Pain/Dependency OP
clinic at Pain office – or OP clinic at
PRI
1.30 – 4.10 Dr McQueen acupuncture
clinic DSU
1.30 – 3.30 Dr Vickers - Psychology
9.30 – 12.00 Miss Fraser –
Psychology
10.00 – 12.00 Dr Vickers Psychology
WEDNESDAY
THURSDAY
8.30 – 9.30 Telephone reviews
2.00 – 4.00 Nurse clinic J Linskell
9.30 – 12.30 Dr Bannister (1 nurse)
OP clinic at office
9.30 – 11.00 (alternate weeks) Dr
Bannister procedures DSU
9.00 – 13.00 Dr Macrae (1 nurse) OP
Clinic at 3A
2.00 – 4.00 Dr Bannister (1 nurse)
OP clinic at Pain office
8.30 – 9.30 Telephone reviews
9.30 – 12.30 Nurse clinic J Rafferty
2.00 – 4.00 Nurse clinic Group
TENS/Routine News S Clark/M
Nicholas
9.00 – 1.00 Pain Fellow (1 nurse) OP
Clinic at Pain office
9.00 Dr Hartmann OP clinic
Stracathro
2.00 Dr Macrae procedures DSU
2.00 – 4.30 Dr Gillespie at Pain office
(1 nurse)
1.45 – 3.30 Dr Spencer – Psychology
FRIDAY
8.30 – 9.30 Telephone reviews
9.30 – 12.30 Nurse clinic S Clark/M
Nicholas
9.00 (Apr – Sept) Dr Lacoux OP clinic
at 3A
TABLE OF CLINICS FOR TAYSIDE INTEGRATED PAIN SERVICE
PERTH ROYAL INFIRMARY
Monday am
In patient pain issues
Tuesday am
0.800-08.45 In Patent pain issues
Respond to voice mail
0.900-12.45 Every week Dr Macrae clinic
Monday pm
Teaching
Practice development
16.00hrs finish
Tuesday pm
14.00hrs-15.45 Double nurse clinic
16.00hrs finish
0.900-12.45 Every second week Dr
Bannister’s clinic
Single or no nurse clinic
Can be contacted by wards/ out patients for
telephone advice throughout
Wednesday am
Can be contacted by wards/ out patients for
telephone advice throughout
Wednesday pm
0.800hrs-08.45 In patient pain issues
Respond to voice mail
0.900-12.45 Double nurse clinic
14.00hrs-15.45 Double nurse clinic
16.00hrs finish
Can be contacted by wards/ out patients for
telephone advice throughout
Can be contacted by wards/ out patients for
telephone advice throughout
Thursday am
0.800-0.900hrs Respond to voice mail
Admin issues
0.900hrs-12.00rs Consultant ward round
Acute pain admin
Development with
consultant
Teaching
Admin
Practice development
Ward respond
16.00hrs Finish
Can be contacted by wards/ out patients for
telephone advice throughout
Can be contacted by wards/ out patients for
telephone advice throughout
Friday am
0.800hrs-08.45 In patient pain issues
Respond to voice mail
0.900 12.45hrs Double nurse clinic
Can be contacted by wards/ out patients for
telephone advice throughout
Thursday pm
Friday pm
Admin
Practice development
Respond to ward requests for pain issues
Teaching
16.00hrs finish
Can be contacted by wards/ out patients for
telephone advice throughout
TABLE OF CLINICS FOR TAYSIDE INTEGRATED PAIN SERVICE
STRACATHRO HOSPITAL
Monday am (Day Hospital)
9.00 Virtual Clinic – Telephone consultations
and administration for clinic
9.30 – 12.00 Nurse-led Clinic (new and return
patients) (Care of the Elderly)
12.00 – 12.30 - Lunch
Tuesday am (Pain Clinic office)
9.00 – 9.30 Check and respond to voice mail,
email and other administration
9.30 – 12.00 Clinic
12.00 – 12.30 – Lunch
Monday pm
12.30 – 1.30 – Check and respond to voice
mail, email and other administration
1.30 – 3.00 – Clinic/meetings/admin/project
work/teaching
Tuesday pm (OPD)
12.30 – 2.30 – Acupuncture nurse-led clinic
2.30 – 3.00 – Check and respond to voice mail,
email and other administration
Wednesday am (Pain Clinic office)
Wednesday pm (OPD)
9.00 – 9.30 – Check and respond to voice mail,
email and other administration
9.30 – 12.00 – Clinic
12.00 – 12.30 – Lunch
12.30 – 3.00 – Acupuncture nurse-led clinic
2.30 – 3.00 – Check and respond to voice mail,
email and other administration
Thursday am (OPD)
Thursday pm (Pain Clinic office)
9.00 – 12.00 – Consultant led clinic
12.00 – 12.30 – Lunch
12.30 – 1.00 – Check and respond to voice
mail, email and other administration
1.00 – 3.00 – Acupuncture nurse-led Clinic
Friday am (Pain Clinic office)
9.00 – 12.00 – Virtual clinic – Telephone
consultations and administration for clinic
Respond to voice mail, email and see 1 new
patient
12.00 – 12.30 - Lunch
Friday pm (Pain Clinic office)
12.30 – 2.15 – Administration, meetings,
project work, teaching, study session,
audit/research
2.15 – 3.00 – 1 patient
STRUCTURED PERSONAL STUDY
Identify a specific topic or area of pain management that has interested you during your
placement. Write a short information package, to be used to develop other students
understanding of the topic or area of pain management. The Package should include:
An overview of the topic
Treatment/therapies used
Research evidence that underpins treatment
LEARNING CONTRACT
During your stay we suggest that you write a learning contract in conjunction with your
mentor.
Learning Need(s):
Learning Outcome(s):
Learning Strategies: i.e. reading, attending other areas etc.
Resources: e.g. mentor, specialist nurses etc.
Assessment and evaluation: i.e. did you achieve your aims?
Date of Contract:
Date to be Completed:
Student signature:……………………………..
Mentor signature:……………………………..
Commonly used terms in the
Pain Service
Pain
An unpleasant sensory and emotional experience associated with actual or
potential tissue damage, or described in terms of such damage.
Note: The inability to communicate verbally does not negate the possibility
that an individual is experiencing pain and is in need of appropriate painrelieving treatment.
Notes: Pain is always subjective. Each individual learns the application of the word
through experiences related to injury in early life. Biologists recognize that those
stimuli which cause pain are liable to damage tissue. Accordingly, pain is that
experience we associate with actual or potential tissue damage. It is
unquestionably a sensation in a part or parts of the body, but it is also always
unpleasant and therefore also an emotional experience. Experiences which
resemble pain but are not unpleasant, e.g., pricking, should not be called pain.
Unpleasant abnormal experiences (dysesthesias) may also be pain but are not
necessarily so because, subjectively, they may not have the usual sensory qualities
of pain.
Many people report pain in the absence of tissue damage or any likely
pathophysiological cause; usually this happens for psychological reasons. There is
usually no way to distinguish their experience from that due to tissue damage if we
take the subjective report. If they regard their experience as pain and if they report
it in the same ways as pain caused by tissue damage, it should be accepted as
pain. This definition avoids tying pain to the stimulus. Activity induced in the
nociceptor and nociceptive pathways by a noxious stimulus is not pain, which is
always a psychological state, even though we may well appreciate that pain most
often has a proximate physical cause.
Allodynia
Pain due to a stimulus which does not normally provoke pain.
Note: The term allodynia was originally introduced to separate from hyperalgesia
and hyperesthesia, the conditions seen in patients with lesions of the nervous
system where touch, light pressure, or moderate cold or warmth evoke pain when
applied to apparently normal skin. Allo means "other" in Greek and is a common
prefix for medical conditions that diverge from the expected. Odynia is derived from
the Greek word "odune" or "odyne," which is used in "pleurodynia" and
"coccydynia" and is similar in meaning to the root from which we derive words with algia or -algesia in them. Allodynia was suggested following discussions with
Professor Paul Potter of the Department of the History of Medicine and Science at
The University of Western Ontario.
The words "to normal skin" were used in the original definition but later were
omitted in order to remove any suggestion that allodynia applied only to referred
pain. Originally, also, the pain-provoking stimulus was described as "non-noxious."
However, a stimulus may be noxious at some times and not at others, for example,
with intact skin and sunburned skin, and also, the boundaries of noxious stimulation
may be hard to delimit. Since the Committee aimed at providing terms for clinical
use, it did not wish to define them by reference to the specific physical
characteristics of the stimulation, e.g., pressure in kilopascals per square
centimeter. Moreover, even in intact skin there is little evidence one way or the
other that a strong painful pinch to a normal person does or does not damage
tissue. Accordingly, it was considered to be preferable to define allodynia in terms
of the response to clinical stimuli and to point out that the normal response to the
stimulus could almost always be tested elsewhere in the body, usually in a
corresponding part. Further, allodynia is taken to apply to conditions which may
give rise to sensitization of the skin, e.g., sunburn, inflammation, trauma.
It is important to recognize that allodynia involves a change in the quality of a
sensation, whether tactile, thermal, or of any other sort. The original modality is
normally non-painful, but the response is painful. There is thus a loss of specificity
of a sensory modality. By contrast, hyperalgesia (q.v.) represents an augmented
response in a specific mode, viz., pain. With other cutaneous modalities,
hyperesthesia is the term which corresponds to hyperalgesia, and as with
hyperalgesia, the quality is not altered. In allodynia the stimulus mode and the
response mode differ, unlike the situation with hyperalgesia. This distinction should
not be confused by the fact that allodynia and hyperalgesia can be plotted with
overlap along the same continuum of physical intensity in certain circumstances, for
example, with pressure or temperature.
See also the notes on hyperalgesia and hyperpathia.
Analgesia
Absence of pain in response to stimulation which would normally be painful.
Note: As with allodynia (q.v.), the stimulus is defined by its usual subjective effects.
Anesthesia dolorosa
Pain in an area or region which is anesthetic.
Causalgia
A syndrome of sustained burning pain, allodynia, and hyperpathia after a traumatic
nerve lesion, often combined with vasomotor and sudomotor dysfunction and later
trophic changes.
Central pain
Pain initiated or caused by a primary lesion or dysfunction in the central nervous
system.
Dysesthesia
An unpleasant abnormal sensation, whether spontaneous or evoked.
Note: Compare with pain and with paresthesia. Special cases of dysesthesia
include hyperalgesia and allodynia. A dysesthesia should always be unpleasant
and a paresthesia should not be unpleasant, although it is recognized that the
borderline may present some difficulties when it comes to deciding as to whether a
sensation is pleasant or unpleasant. It should always be specified whether the
sensations are spontaneous or evoked.
Hyperalgesia
An increased response to a stimulus which is normally painful.
Note: Hyperalgesia reflects increased pain on suprathreshold stimulation. For pain
evoked by stimuli that usually are not painful, the term allodynia is preferred, while
hyperalgesia is more appropriately used for cases with an increased response at a
normal threshold, or at an increased threshold, e.g., in patients with neuropathy. It
should also be recognized that with allodynia the stimulus and the response are in
different modes, whereas with hyperalgesia they are in the same mode. Current
evidence suggests that hyperalgesia is a consequence of perturbation of the
nociceptive system with peripheral or central sensitization, or both, but it is
important to distinguish between the clinical phenomena, which this definition
emphasizes, and the interpretation, which may well change as knowledge
advances.
Hyperesthesia
Increased sensitivity to stimulation, excluding the special senses.
Note: The stimulus and locus should be specified. Hyperesthesia may refer to
various modes of cutaneous sensibility including touch and thermal sensation
without pain, as well as to pain. The word is used to indicate both diminished
threshold to any stimulus and an increased response to stimuli that are normally
recognized.
Allodynia is suggested for pain after stimulation which is not normally painful.
Hyperesthesia includes both allodynia and hyperalgesia, but the more specific
terms should be used wherever they are applicable.
Hyperpathia
A painful syndrome characterized by an abnormally painful reaction to a stimulus,
especially a repetitive stimulus, as well as an increased threshold.
Note: It may occur with allodynia, hyperesthesia, hyperalgesia, or dysesthesia.
Faulty identification and localization of the stimulus, delay, radiating sensation, and
after-sensation may be present, and the pain is often explosive in character. The
changes in this note are the specification of allodynia and the inclusion of
hyperalgesia explicitly. Previously hyperalgesia was implied, since hyperesthesia
was mentioned in the previous note and hyperalgesia is a special case of
hyperesthesia.
Hypoalgesia
Diminished pain in response to a normally painful stimulus.
Note: Hypoalgesia was formerly defined as diminished sensitivity to noxious
stimulation, making it a particular case of hypoesthesia (q.v.). However, it now
refers only to the occurrence of relatively less pain in response to stimulation that
produces pain. Hypoesthesia covers the case of diminished sensitivity to
stimulation that is normally painful.
The implications of some of the above definitions may be summarized for
convenience as follows:

Allodynia: lowered threshold: stimulus and response mode differ
Hyperalgesia: increased response: stimulus and response mode are
the same
Hyperpathia: raised threshold: stimulus and response mode may be
the increased response: same or different
Hypoalgesia: raised threshold: stimulus and response mode are the
same lowered response:
The above essentials of the definitions do not have to be symmetrical
and are not symmetrical at present. Lowered threshold may occur
with allodynia but is not required. Also, there is no category for
lowered threshold and lowered response - if it ever occurs.
Hypoesthesia
Decreased sensitivity to stimulation, excluding the special senses.
Note: Stimulation and locus to be specified.
Neuralgia
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.
Neuritis
Inflammation of a nerve or nerves.
Note: Not to be used unless inflammation is thought to be present.
Neurogenic pain
Pain initiated or caused by a primary lesion, dysfunction, or transitory
perturbation in the peripheral or central nervous system.
Neuropathic pain
Pain initiated or caused by a primary lesion or dysfunction in the nervous
system.
Note: See also Neurogenic Pain and Central Pain. Peripheral neuropathic
pain occurs when the lesion or dysfunction affects the peripheral nervous
system. Central pain may be retained as the term when the lesion or
dysfunction affects the central nervous system.
Neuropathy
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. Neuropathy is not intended to
cover cases like neurapraxia, neurotmesis, section of a nerve, or transitory
impact like a blow, stretching, or an epileptic discharge. The term neurogenic
applies to pain due to such temporary
perturbations.
Nociceptor
A receptor preferentially sensitive to a noxious stimulus or to a stimulus
which would become noxious if prolonged.
Note: Avoid use of terms like pain receptor, pain pathway, etc.
Noxious stimulus
A noxious stimulus is one which is damaging to normal tissues.
Note: Although the definition of a noxious stimulus has been retained, the
term is not used in this list to define other terms.
Pain threshold
The least experience of pain which a subject can recognize.
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.
Pain tolerance level
The greatest level of pain which a subject is prepared to tolerate.
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.
Paresthesia
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 which are
unpleasant.
Peripheral neurogenic pain
Pain initiated or caused by a primary lesion or dysfunction or transitory
perturbation in the peripheral nervous system.
Peripheral neuropathic pain
Pain initiated or caused by a primary lesion or dysfunction in the peripheral
nervous system.
For additional information:
IASP Secretariat
909 NE 43rd St., Suite 306
Seattle, WA 98105-6020, USA
Tel: 206-547-6409
Fax: 206-547-1703
Email: iaspdesk@iasp-pain.org
WWW: http://www.iasp-pain.org and www.painbooks.org
USEFUL WEBSITE ADDRESSES
The oxford pain Internet site www.jr2.ox.ac.uk/bandolier/booth/painpag/index.html
The Wellcome Trust
www.wellcome.ac.uk/en/pain/microsite/medicine3.html
Pain Talk
www.paintalk.co.uk/
British Pain Society
www.britishpainsociety.org
Pain Concern
www.painconcern.org.uk
Pain Relief Foundation
www.painrelieffoundation.org.uk
Pain Research Institute
www.liv.ac.uk/pri/html/chronicpain.html
Pain Association Scotland
www.painassociation.com
Bandolier
www.ebandolier.com
Acute Pain Management – Scientific Evidence 2nd Edition
www.anzca.edu.au
NHS Tayside Pain Management Guidelines Book
Internet Home Page/E-Health/Clinical Systems/Acute Pain Guidelines
SUGGESTED READING
ALLEN, S., 2005. Pharmacotherapy of neuropathic pain. Continuing Education in Anaesthesia,
Critical Care & Pain, 5(4), pp.134-137.
BRENNAN, F., CARR, D.B. and COUSINS, M. 2007. Pain management: a fundamental human
right. Pain Medicine. 105(1). pp.205-221.
BRIGGS, M., 1995. Principles of acute pain assessment. Nursing Standard, 9(19), pp.23-27.
CARR, E.C.J. and MANN, E.M., 2000. Pain: Creative approaches to effective management.
Bournemouth: Bournemouth University.
HORGAS, A.L. 2003. Pain management in elderly adults. Journal of Infusion Nursing. 26(3),
pp.161-165.
KEHLET, H., WERNER, M. and PERKINS, F., 1999. Balanced analgesia: What is it and what are
its advantages in postoperative pain? Drugs. 58(5). pp. 793-797.
McCREADIE, M. and DAVISON, S. 2002. Pain management in drug users. Nursing Standard.
16(19), pp.45-51, 53, 55.
McQUAY, H. 1999. Opioids in pain management. The Lancet. 353(9171). pp. 2229-2232.
RYDER, S. and STANNARD, C.F. 2005. Treatment of chronic pain: antidepressant, antiepileptic
and antiarrhythmic drugs. Continuing Educaion in Anaesthesia, Critical Care & Pain. 5(1). pp.1821.
SERPELL, M. 2006. Anatomy, physiology and pharmacology of pain. Surgery. 24(10). pp.350353.
SHAW, S.M. 2006. Nursing and supporting patients with chronic pain. Nursing Standard.
20(19). Pp.60-65.