AANN Core Curriculum, 7th Edition, Ch. 24 Pain and Headaches: Digital Version-Chapter 24

Chapter 24
Pdf Summary
Pain is a subjective sensory and emotional experience shaped by biological, psychological, and social factors. It affects function and quality of life, and may be present even when a person cannot communicate verbally. Pain mechanisms involve transduction, transmission, and modulation; ongoing sensitization in peripheral nerves or the central nervous system can amplify pain and contribute to chronicity.<br /><br />Pain is classified by mechanism as nociceptive, neuropathic, or nociplastic, and by duration as acute or chronic. Chronic pain may be a condition in its own right or secondary to another disease. Important syndromes include neuropathic pain, trigeminal neuralgia, complex regional pain syndrome, migraine and other headaches, fibromyalgia, and myofascial pain.<br /><br />Assessment should prioritize the patient’s report and evaluate pain quality, location, timing, severity, triggers, and effects on daily function, mood, sleep, and social life. Tools should suit the patient’s age and communication or cognitive abilities. Examination and diagnostic testing help identify causes, but imaging findings do not necessarily correspond to pain severity.<br /><br />Management is individualized and multimodal. Options include education, self-care, exercise and rehabilitation, psychological therapies, and medications. Nonopioid treatments are generally preferred; opioids may be appropriate for selected severe acute pain but require careful risk assessment and monitoring, and are generally discouraged for neuropathic and chronic pain. Procedures and implanted stimulation may be considered when other treatments are insufficient. Complementary approaches—such as acupuncture, massage, mindfulness, yoga, and spinal manipulation—may help some conditions. Patients should be asked about supplements and cannabis use, informed about uncertain benefits and potential adverse effects or drug interactions, and encouraged to use complementary therapies alongside appropriate conventional care.<br /><br />Headache care depends on headache type and warning signs. Migraine treatment may include acute and preventive medicines, trigger management, and headache diaries; tension-type and cluster headaches require distinct approaches. Across conditions, treatment goals should include improved function and well-being, not pain intensity alone.
Keywords
pain
chronic pain
neuropathic pain
nociceptive pain
nociplastic pain
pain assessment
pain management
migraine
fibromyalgia
headache treatment