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After completion of this chapter, the physical therapist should be able to do the following:

  • Compare the various types of pain and appraise their positive and negative effects.

  • Choose a technique for assessing pain.

  • Analyze the characteristics of sensory receptors.

  • Examine how the nervous system relays information about painful stimuli.

  • Distinguish between the different neurophysiologic mechanisms for pain control for the therapeutic modalities used by clinicians.

  • Predict how pain perception can be modified by cognitive factors


Understanding Pain


The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”1 Pain is a subjective sensation, with more than 1 dimension and an abundance of descriptors of its qualities and characteristics. In spite of its universality, pain is composed of a variety of human discomforts, rather than being a single entity.2 The perception of pain can be subjectively modified by past experiences and expectations.37 Much of what we do to treat patients' pain is to change their perceptions of pain.3


Pain does have a purpose. It warns us that something is wrong and can provoke a withdrawal response to avoid further injury. It also results in muscle spasm and guards or protects the injured part. Pain, however, can persist after it is no longer useful. It can become a means of enhancing disability and inhibiting efforts to rehabilitate the patient.4 Prolonged spasm, which leads to circulatory deficiency, muscle atrophy, disuse habits, and conscious or unconscious guarding, may lead to a severe loss of function.5 Chronic pain may become a disease state in itself. Often lacking an identifiable cause, chronic pain can totally disable a patient.


Research in recent years has led to a better understanding of pain and pain relief, as well as the psychology of pain, offering new approaches to the treatment of musculoskeletal injury and pain.6 The evolution of the treatment of pain is, however, incomplete.


The control of pain is an essential aspect of caring for an injured patient. This chapter does not provide a complete explanation of neurophysiology, pain, and pain relief. Several physiology textbooks provide extensive discussions of human neurophysiology and neurobiology to supplement this chapter. Instead, this chapter presents an overview of some theories of pain control, which are intended to provide a stimulus for the clinician to develop his or her own rationale for managing pain.8


Types of Pain

Acute Versus Chronic Pain

Traditionally, pain has been categorized as either acute or chronic. Acute pain is experienced when tissue damage is impending and after injury has occurred. Pain lasting for more than 6 months is generally classified as chronic.9 More recently, the term persistent pain has been used to differentiate chronic ...

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