Page 377 Guide to Pain Management in Low-Resource Settings

Appendix: Glossary 365

erent modes, ffect of certain the stimulus and the response are in di ffwith sedation, which usually is a side e
uenced whereas with hyperalgesia they are in the same mode. flmedical interventions and therefore maybe in
by changing the therapeutic regimen. Fatigue is the Current evidence suggests that hyperalgesia is a conse-
symptom palliative patients complain about most, and quence of perturbation of the nociceptive system with
uence. peripheral or central sensitization, or both, but it is im- flcult to in ffiunfortunately it is di
portant to distinguish between the clinical phenomena,
Fibromyalgia
nition emphasizes, and the interpreta- fiwhich this de
ecting middle-aged fe- ffA pain disorder—mostly a
tion, which may well change as knowledge advances.
males—in which a person feels widespread pain and
Hyperalgesia and hyperpathia are an exaggerated re-
ness in the muscles, fatigue, and other symptoms. ffsti
sponse to something that causes pain, with continued
bromyalgia” suggests a muscular fiAlthough the name “
pain after the cause of the pain is no longer present.
- fidisorder, recent research makes it more likely that
bromyalgia is caused by central nervous system changes Hyperesthesia
with central hypersensitivity. Th erefore, current treat- Increased sensitivity to stimulation, excluding the spe-
ment concepts aim at the descending inhibitory system cial senses. Th e stimulus and location should be speci-
ed. Hyperesthesia may refer to various modes of cuta- fibromyalgia should fiand central sensitization. Probably
be seen in the same context as other hypersensitiv- neous sensibility, including touch and thermal sensation
ity syndromes, such as chronic back pain, seronegative without pain, as well as to pain. Th e word is used to in-
polyarthritis, or tension headache. dicate both diminished threshold to any stimulus and
an increased response to stimuli that are normally rec-
Hospice
ognized. Allodynia is suggested for pain after stimula-
A special way of caring for people with terminal ill-
tion that is not normally painful. Hyperesthesia includes
nesses and their families by meeting the patient’s physi-
c fiboth allodynia and hyperalgesia, but the more speci
cal, emotional, social, and spiritual needs, as well as the
terms should be used wherever they are applicable.
needs of the family. Th e goals of hospice are to keep the
patient as comfortable as possible by relieving pain and Hyperpathia
other symptoms; to prepare for a death that follows the A painful syndrome characterized by an abnormally
wishes and needs of the patient; and to reassure both painful reaction to a stimulus, especially a repetitive
the patient and family members by helping them to un- stimulus, as well as an increased threshold. It may occur
derstand and manage what is happening. Hospice care with allodynia, hyperesthesia, hyperalgesia, or dysesthe-
cation and localization of the stimulus, fiespecially aims to help patients who are unwilling or un- sia. Faulty identi
able to be taken care of in their homes and have stable delay, radiating sensation, and aftersensation may be
or manageable symptoms. Hospice care usually ends present, and the pain is often explosive in character. Th e
cation of allodynia fiwith the death of the recipient, while palliative ward changes in this note are the speci
care allows reambulation of the patient in many patients and the inclusion of hyperalgesia explicitly. Previously
after stabilization. Pallium India and Hospice Africa hyperalgesia was implied, since hyperesthesia was men-
Uganda are remarkable examples of hospice care in low- tioned in the previous note and hyperalgesia is a special
resource settings. Currently, in many countries, “home case of hyperesthesia.
care” is promoted to avoid as long as possible and as of-
Hypoalgesia
ten as possible hospice or palliative ward treatment.
Diminished pain in response to a normally pain-
ned as di- fiHyperalgesia ful stimulus. Hypoalgesia was formerly de
An increased response to a stimulus that is normally minished sensitivity to noxious stimulation, making
ects increased pain on supra- it a particular case of hypoesthesia. However, it now flpainful. Hyperalgesia re
threshold stimulation. For pain evoked by stimuli that refers only to the occurrence of relatively less pain in
usually are not painful, the term allodynia is preferred, response to stimulation that produces pain. Hypoes-
while hyperalgesia is more appropriately used for cases thesia covers the case of diminished sensitivity to stim-
with an increased response at a normal threshold, or ulation that is normally painful. Hypoalgesia, as well as
at an increased threshold, such as in patients with neu- allodynia, hyperalgesia, and hyperpathia, do not have
ropathy. It should also be recognized that with allodynia to be symmetrical and are not symmetrical at present.