🔥 Pain Classification [Neurosurgery Wiki]

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====== 🔥 Pain Classification ======

===== 📌 Definition =====
Pain is classified by **intensity** to guide assessment and treatment decisions. The classification into **mild**, **moderate**, and **severe** pain is commonly based on patient-reported scores using scales such as:

  * **[[Numeric Rating Scale]] (NRS)**: 0 = no pain, 10 = worst imaginable pain
  * **[[Visual Analog Scale]] (VAS)**: 0–10 cm line
  * **[[Verbal Rating Scale]] (VRS)**: "No pain", "Mild", "Moderate", "Severe"

===== 🔢 Numeric Scale Cutoffs =====
^ Category ^ NRS/VAS Score ^ Description ^
| **[[Mild pain]]** | 1–3 | Noticeable, but does not interfere with daily activities or concentration |
| **[[Moderate pain]]** | 4–6 | Interferes with some activities, may require analgesia, affects mood or function |
| **[[Severe pain]]** | 7–10 | Disabling, constant, interferes with sleep, mobility, and vital signs; requires strong analgesia |

===== 🧠 Clinical Examples =====

^ Pain Intensity ^ Neurosurgical Context ^
| **Mild pain** | Discomfort at surgical site, tension headache, early postop day 2–3 |
| **Moderate pain** | Typical post-craniotomy headache, lumbar drain discomfort, wound stretching |
| **Severe pain** | Intracranial pressure headache, post-DREZotomy pain, hemorrhage or infection |

===== 💊 Analgesia Guidelines by Pain Severity =====

^ Pain Level ^ First-Line Treatment ^ Optional Add-ons ^
| **Mild** | Paracetamol (acetaminophen), NSAID | Local measures, positioning |
| **Moderate** | Paracetamol + NSAID | Weak opioids (e.g., tramadol), gabapentinoids |
| **Severe** | Strong opioids (morphine, oxycodone) | IV rescue, sedation, PCA pump |

===== ⚠️ Notes =====
  * Pain is **subjective**: assessment should include **behavioral cues**, especially in non-verbal or sedated patients
  * Use [[pain scales]] **regularly** to guide titration of analgesics
  * Always consider **neuropathic** or **visceral** components in persistent or disproportionate pain

===== 📌 Summary =====
Understanding pain intensity helps tailor analgesic strategies.  
- **Mild pain**: tolerable, non-limiting  
- **Moderate pain**: interferes with activity  
- **Severe pain**: disabling, urgent treatment required

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Major types of pain:

[[Nociceptive pain]]

a) somatic: well localized. Described as sharp, stabbing, aching or cramping. Results from tissue
injury or inflammation, or from nerve or plexus compression. Responds to treating the underlying pathology or by interrupting the nociceptive pathway.

b) visceral: poorly localized. Poor response to primary pain medications.

[[Deafferentation]]

Poorly localized. Described as crushing, tearing, tingling or numbness. Also causes burning dysesthesia numbness often with lancinating pain, and hyperpathia. Unaffected by ablative procedures.

“Sympathetically maintained” pain and the likes, e.g. [[causalgia]]
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Often classified as acute or chronic. 

[[Acute pain]] is frequently associated with anxiety and hyperactivity of the sympathetic nervous system (eg, tachycardia, increased respiratory rate and BP, diaphoresis, dilated pupils). 

[[Chronic pain]] 

[[Musculoskeletal pain]]

see [[Neuropathic pain]]

see [[Back pain]]

see [[Leg pain]]

[[Abdominal pain]]

[[Lancinating pain]]

[[Intractable pain]]