Pain
Pain is a multi-dimensional perception involving not only the sensory dimension but also many other factors, including emotions, cognition, muscular movement and physiology [11].
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8.2 Pain Lars Arendt-Nielsen
8.2.1 Introduction Pain is a multi-dimensional perception involving not only the sensory dimension but also many other factors, including emotions, cognition, muscular movement and physiology [11]. The multidimensionality of pain has become widely accepted [25]. The perceptual aspect – the sensory-discriminative dimension – is hereby thought of as the function of pain, which gives information as to the site, duration and intensity of the pain. This dimension often plays a pivotal role in the experimental measurement of pain, but its significance should not be overestimated, given the complexity of pain [21]. Pain can only be adequately characterized by the relationship between its sensory and affective dimensions. Not only the complexity but also the subjectiveness of pain perception contributes to the difficulty of pain measurement [25, 26]. This has spawned efforts to establish an “objective” algesimetry, which does not require the report of subjective states, but primarily assesses responses to noxious stimuli in the motor, autonomic, endocrine and central nervous systems [15]. Despite the weak correlations between the subjective and objective parameters of pain perception, it seems advisable to view pain as multi-dimensional and not to unnecessarily exclude the subjective dimension [17, 18]. It is therefore necessary to combine different stimulation and assessment approaches to gain advanced differentiated information about the nociceptive system under both normal and pathophysiological conditions. Progress has been made in the development of “tonic pain” perception models in order to more precisely simulate clinical pain in the laboratory. The ultimate goal of advanced human experimental pain measurement (quantitative sensory testing) is to obtain a better understanding of mechanisms involved in pain transduction, transmission and perception under normal and pathophysiological conditions. Hopefully, this can provide a better characterization, prevention and management of pain. Experimental approaches can be applied in the laboratory for basic studies (e.g. central hyperexcitability or pre-clinical screening of drug efficacy) but also in the clinic to characterize patients with sensory dysfunctions and/or pain (e.g. neurogenic pain). In recent years, the use of experimental
pain measures to evaluate the efficacy of new potential analgesic compounds has developed significantly [5]. The primary advantages of quantitative pain assessment under normal and pathological conditions are: • Stimulus intensity, duration and modality that are controlled and not varying over time • Differentiated responses to different stimulus modalities • Physiological and psychophysical responses that can be assessed quantitatively and compared over time • Pain sensitivity that can be compared quantitatively between various normal/affected regions • Experimental models of pathological conditions (e.g. hyperalgesia) that can be studied Accordingly, the experimental assessment of pain perception for clinical q
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