Physical Pain Related to Terminal Illness
It is important to determine what exactly is causing the patient's pain so that appropriate treatments can be initiated. Because patients frequently experience several different types of pain simultaneously, the adjectives that they use can help identify each type of pain.
There are three main types of pain:
1. Nociceptive Pain (which is further divided into somatic and visceral pain)
2. Neuropathic Pain
3. Raised Intracranial Pressure Pain
The information below gives more detail on the types of pain, including examples of each type. Each category will be discussed in more detail in subsequent sections of this module.
Nociceptive Pain:
Nociceptors activated by actual or potential tissue damage; can be Somatic Pain or Visceral Pain
Somatic Pain: Nociceptors activated in body-surface or musculoskeletal tissues; can be superficial or deep
Well-localized
Deep pain is usually described as aching, stabbing, throbbing, or squeezing
Superficial pain is usually described as sharp or burning
Arthritis
Metastatic bone disease
Wounds
Soft tissue tumors
Visceral Pain: Nociceptors activated by compression, obstruction, infiltration, ischemia, stretching, or inflammation of thoracic, abdominal, or pelvic viscera
Not well-localized unless organ capsule is involved
Spastic, cramping, gnawing, squeezing, or pressure
May vary with eating and bowel movements
Bowel obstruction
Angina
Bulky liver metastases
Urinary retention
Neuropathic Pain:
Direct injury or dysfunction of peripheral or central nervous system tissues
Tingling, numbness, burning, shooting, stabbing, scalding, painful numbness
May have aberrant sensations, allodynia (pain from light touch) or hyperalgesia (increased response to pain)
Diabetic neuropathy
Postherpetic neuralgia
Compression radiculopathies
Post-mastectomy and post-thoracotomy pain syndromes
Phantom pain syndromes "Thalamic pain” after a cerebrovascular accident
Raised Intracranial Pressure Pain:
Caused by increased intracranial pressure
Generalized or posterior head pain
Usually accompanied by nausea
May have focal neurological deficits, confusion, or seizures
Brain tumors