FRCA Notes


Pain Physiology


  • Pain is an "an unpleasant sensory and/or emotional experience associated with, or resembling that associated with, actual or potential tissue damage " (IASP)

Acute Pain

  • Pain of recent onset, limited duration and with an identifiable cause
  • Pain is <3months duration
  • It is important to remember that pain is a protective evolutionary mechanism!

Transitional Pain

  • Transitional pain is a relatively novel concept
  • Covers the period during which there is peripheral and central sensitisation of nociceptors
  • Is a period of potential intervention to prevent chronic pain arising
Transitionalpain.jpeg

Chronic Pain

  • Pain that persists after both removal of the stimulus and the normal recovery period i.e. after the initial injury has healed
  • Pain that persists for >3 months
  • Chronic pain is always pathological; has no physiological value and almost always negatively impacts on function/psychological wellbeing

Nociceptive pain

  • Pain which arises from actual or threatened damage to non-neural tissue, due to noxious stimulation of nociceptors
  • Can be further subdivided into:
    • Superficial somatic pain (e.g. skin) - well localised, sharp pain
    • Deep somatic pain (e.g. ligaments, tendons) - poorly localised, dull pain
    • Visceral pain (e.g. organs, viscera) - varying localisation, cramping pain associated with referred pain and autonomic stimulation

Neuropathic pain

  • Pain which arises from a lesion or disease of the somatosensory nervous system

Nociplastic pain

  • Pain which arises from altered nociception despite no clear evidence of:
    • Actual or threatened tissue damage causing the activation of peripheral nociceptors
    • Disease or lesions of the somatosensory nervous system
  • I.e. there is a disturbance of central pain processing, with either increased sensitisation and/or decreased pain inhibition

  • Further pain topics include: