Principles & Practice of Pain Medicine > Part II. Pain: General Principles and Evaluation > Chapter 6. Evaluating the Patient with Chronic Pain Jeremy Goodwin and Zahid H. Bajwa

Defining the Type of Pain

"Pain should be broadly defined as nociceptive (somatic or visceral), neuropathic, or idiopathic. Toward this end, pain location is of utmost importance to accurate diagnosis. It may be well localized, as in entrapment neuropathy (e.g., carpal tunnel syndrome), widespread and diffuse (e.g., fibromyalgia), or regional (e.g., musculoskeletal pain). Patterns of radiation may help determine the site of pathology, such as in cervical or lumbar radiculopathy. Radicular pain (along a dermatome) implies involvement of a nerve root. Pain may also be referred, as in visceral pain, when it is felt over a particular area of skin that is embryologically associated with but anatomically distant from the source of irritation. Accurate characterization of the pain's location and pathophysiology provides the rationale for treatment. Tables 6-1, 6-2, and 6-3 provide examples of referred pain contrasted with clinical findings associated with nerve root versus peripheral nerve pathology...."