Pain

context: Pain is a distressing feeling often caused by intense or damaging stimuli, such as stubbing a toe, burning a finger, putting alcohol on a cut, and bumping the "funny bone". Because it is a complex, subjective phenomenon, defining pain has been a challenge. The International Association for the Study of Pain's widely used definition states: "Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." In medical diagnosis, pain is a symptom.
qas: answers: text: intense or damaging
question: What type of stimuli causes pain?

answers: text: distressing
question: What type of feeling is pain?

answers: text: complex, subjective phenomenon
question: Why has defining pain been a challenge?

answers: text: The International Association for the Study of Pain
question: What organization's definition is widely used?

answers: text: a symptom
question: In medical diagnosis, what is pain considered?

context: Pain is the most common reason for physician consultation in most developed countries. It is a major symptom in many medical conditions, and can interfere with a person's quality of life and general functioning. Psychological factors such as social support, hypnotic suggestion, excitement, or distraction can significantly affect pain's intensity or unpleasantness. In some arguments put forth in physician-assisted suicide or euthanasia debates, pain has been used as an argument to permit terminally ill patients to end their lives.
qas: answers: text: Pain
question: What is the most common reason people go to the doctor in first world countries?

answers: text: interfere
question: How can pain effect a person's quality of life and general functioning?

answers: text: Psychological
question: Excitement and distraction are what type of factors which affect pain's intensity?

answers: text: end their lives
question: What has pain sometimes been used as an argument to allow terminally ill patients the right to do?

context: In 1994, responding to the need for a more useful system for describing chronic pain, the International Association for the Study of Pain (IASP) classified pain according to specific characteristics: (1) region of the body involved (e.g. abdomen, lower limbs), (2) system whose dysfunction may be causing the pain (e.g., nervous, gastrointestinal), (3) duration and pattern of occurrence, (4) intensity and time since onset, and (5) etiology. However, this system has been criticized by Clifford J. Woolf and others as inadequate for guiding research and treatment. Woolf suggests three classes of pain : (1) nociceptive pain, (2) inflammatory pain which is associated with tissue damage and the infiltration of immune cells, and (3) pathological pain which is a disease state caused by damage to the nervous system or by its abnormal function (e.g. fibromyalgia, irritable bowel syndrome, tension type headache, etc.).
qas: answers: text: 1994
question: What year did the IASP respond to the need to create a more useful system for describing pain?

answers: text: 5
question: How many classes of pain does the IASP system note?

answers: text: Clifford J. Woolf and others
question: Who has criticized the IASP's system?

answers: text: guiding research and treatment
question: What do some people feel the IASP's system is inadequate for?

answers: text: three
question: How many classes of research does Woolf encourage?

context: Pain is usually transitory, lasting only until the noxious stimulus is removed or the underlying damage or pathology has healed, but some painful conditions, such as rheumatoid arthritis, peripheral neuropathy, cancer and idiopathic pain, may persist for years. Pain that lasts a long time is called chronic or persistent, and pain that resolves quickly is called acute. Traditionally, the distinction between acute and chronic pain has relied upon an arbitrary interval of time from onset; the two most commonly used markers being 3 months and 6 months since the onset of pain, though some theorists and researchers have placed the transition from acute to chronic pain at 12 months.:93 Others apply acute to pain that lasts less than 30 days, chronic to pain of more than six months' duration, and subacute to pain that lasts from one to six months. A popular alternative definition of chronic pain, involving no arbitrarily fixed durations, is "pain that extends beyond the expected period of healing". Chronic pain may be classified as cancer pain or else as benign.
qas: answers: text: Pain
question: What is usually temporary?

answers: text: only until the noxious stimulus is removed
question: How long does pain tend to last?

answers: text: acute
question: What is pain which resolves quickly called?

answers: text: interval of time from onset
question: What has the distinction between acute and chronic pain been arbitrarily measured by?

answers: text: cancer pain
question: What might chronic pain sometimes be referred to as?

context: Nociceptive pain is caused by stimulation of peripheral nerve fibers that respond to stimuli approaching or exceeding harmful intensity (nociceptors), and may be classified according to the mode of noxious stimulation. The most common categories are "thermal" (e.g. heat or cold), "mechanical" (e.g. crushing, tearing, shearing, etc.) and "chemical" (e.g. iodine in a cut or chemicals released during inflammation). Some nociceptors respond to more than one of these modalities and are consequently designated polymodal.
qas: answers: text: Nociceptive
question: Stimulating nociceptors will induce which type of pain?

answers: text: according to the mode of noxious stimulation
question: How is nociceptive pain classified?

answers: text: heat or cold
question: The thermal category of pain deals with which two temperature ranges?

answers: text: mechanical
question: Crushing, tearing and shearing are examples of which type of pain?

answers: text: polymodal
question: What is the term for nociceptors which respond to more than one type of stimuli?

context: Nociceptive pain may also be divided into "visceral", "deep somatic" and "superficial somatic" pain. Visceral structures are highly sensitive to stretch, ischemia and inflammation, but relatively insensitive to other stimuli that normally evoke pain in other structures, such as burning and cutting. Visceral pain is diffuse, difficult to locate and often referred to a distant, usually superficial, structure. It may be accompanied by nausea and vomiting and may be described as sickening, deep, squeezing, and dull. Deep somatic pain is initiated by stimulation of nociceptors in ligaments, tendons, bones, blood vessels, fasciae and muscles, and is dull, aching, poorly-localized pain. Examples include sprains and broken bones. Superficial pain is initiated by activation of nociceptors in the skin or other superficial tissue, and is sharp, well-defined and clearly located. Examples of injuries that produce superficial somatic pain include minor wounds and minor (first degree) burns.
qas: answers: text: Nociceptive
question: What type of of pain is visceral a division of?

answers: text: Visceral
question: What type of structures are sensitive to being stretched but not very sensitive to burning?

answers: text: Deep somatic
question: Which type of pain is dull, aching and hard to pin-point?

answers: text: nausea and vomiting
question: What can visceral pain be accompanied by?

answers: text: Superficial
question: What type of pain are first degree burns classified as causing?

context: The prevalence of phantom pain in upper limb amputees is nearly 82%, and in lower limb amputees is 54%. One study found that eight days after amputation, 72 percent of patients had phantom limb pain, and six months later, 65 percent reported it. Some amputees experience continuous pain that varies in intensity or quality; others experience several bouts a day, or it may occur only once every week or two. It is often described as shooting, crushing, burning or cramping. If the pain is continuous for a long period, parts of the intact body may become sensitized, so that touching them evokes pain in the phantom limb, or phantom limb pain may accompany urination or defecation.
qas: answers: text: nearly 82%
question: What percentage of people who've had upper limbs amputated feel phantom pain?

answers: text: 54%
question: What is the percentage of of phantom pain felt by lower limb amputees?

answers: text: phantom limb pain
question: What may accompany urination for amputees? 

answers: text: become sensitized
question: What may happen with intact body parts if there is continuous pain for a long period?

answers: text: 65 percent
question: After six months, what percentage of people who had limbs amputated still felt pain in those limbs?

context: Local anesthetic injections into the nerves or sensitive areas of the stump may relieve pain for days, weeks, or sometimes permanently, despite the drug wearing off in a matter of hours; and small injections of hypertonic saline into the soft tissue between vertebrae produces local pain that radiates into the phantom limb for ten minutes or so and may be followed by hours, weeks or even longer of partial or total relief from phantom pain. Vigorous vibration or electrical stimulation of the stump, or current from electrodes surgically implanted onto the spinal cord, all produce relief in some patients.
qas: answers: text: may relieve pain
question: What happens when an anesthetic injection is directed into the nerves a limb stump?

answers: text: permanently
question: How long can an anesthetic, at max, relieve pain for, despite wearing off in only hours?

answers: text: hypertonic saline
question: What is injected in small amounts into the soft tissue between vertebrae to produce local pain?

answers: text: relief
question: Vibrating the stump of an amputee's limb can produce what in some patients?

context: Paraplegia, the loss of sensation and voluntary motor control after serious spinal cord damage, may be accompanied by girdle pain at the level of the spinal cord damage, visceral pain evoked by a filling bladder or bowel, or, in five to ten per cent of paraplegics, phantom body pain in areas of complete sensory loss. This phantom body pain is initially described as burning or tingling but may evolve into severe crushing or pinching pain, or the sensation of fire running down the legs or of a knife twisting in the flesh. Onset may be immediate or may not occur until years after the disabling injury. Surgical treatment rarely provides lasting relief.
qas: answers: text: loss of sensation and voluntary motor control
question: What is paraplegia?

answers: text: burning or tingling
question: What is the initial phantom body pain sensation experienced by people with spinal cord damage?

answers: text: serious spinal cord damage,
question: What can cause paraplegia?

answers: text: Surgical
question: What is an inefficient treatment for chronic pain which rarely provides any sort of true relief?

answers: text: phantom body
question: The sensation of a knife twisting in the flesh is an example of what type of pain?

context: People with long-term pain frequently display psychological disturbance, with elevated scores on the Minnesota Multiphasic Personality Inventory scales of hysteria, depression and hypochondriasis (the "neurotic triad"). Some investigators have argued that it is this neuroticism that causes acute pain to turn chronic, but clinical evidence points the other way, to chronic pain causing neuroticism. When long-term pain is relieved by therapeutic intervention, scores on the neurotic triad and anxiety fall, often to normal levels. Self-esteem, often low in chronic pain patients, also shows improvement once pain has resolved.
qas: answers: text: neurotic
question: What triad are the inventory scales of hysteria, depression and hypochondriasis classified as?

answers: text: psychological disturbance
question: When people have long-term pain, what do they frequently display?

answers: text: chronic pain
question: Clinical evidence indicates that neuroticism is caused by what?

answers: text: fall
question: If long-term pain can be relieved by therapy, what does a person's neurotic triad score do?

answers: text: Self-esteem
question: What shows improvement in many patients once their pain has been resolved?

context: Breakthrough pain is transitory acute pain that comes on suddenly and is not alleviated by the patient's normal pain management. It is common in cancer patients who often have background pain that is generally well-controlled by medications, but who also sometimes experience bouts of severe pain that from time to time "breaks through" the medication. The characteristics of breakthrough cancer pain vary from person to person and according to the cause. Management of breakthrough pain can entail intensive use of opioids, including fentanyl.
qas: answers: text: Breakthrough
question: What is the term for pain which is acute and note alleviated by normal pain management?

answers: text: medications
question: How do cancer patients usually control their background pain?

answers: text: cancer patients
question: Who is breakthrough pain common among?

answers: text: opioids
question: What class of medication is fentanyl an example of?

answers: text: Management
question: What activity in relation to breakthrough pain requires heavy use of opiods?

context: Although unpleasantness is an essential part of the IASP definition of pain, it is possible to induce a state described as intense pain devoid of unpleasantness in some patients, with morphine injection or psychosurgery. Such patients report that they have pain but are not bothered by it; they recognize the sensation of pain but suffer little, or not at all. Indifference to pain can also rarely be present from birth; these people have normal nerves on medical investigations, and find pain unpleasant, but do not avoid repetition of the pain stimulus.
qas: answers: text: morphine
question: Which type of injection has caused patients to report they have pain but aren't bothered by it?

answers: text: little, or not at all
question: How much do some patients going through psychosurgery suffer from the sensation of pain?

answers: text: unpleasantness
question: IASP's definition of pain includes what aspect as an essential part?

answers: text: a state described as intense pain
question: What is it possible to induce which is, contrary to expectations, devoid of unpleasantness?

answers: text: Indifference
question: What perspective towards pain are some people with perfectly normal nerves born with?

context: A much smaller number of people are insensitive to pain due to an inborn abnormality of the nervous system, known as "congenital insensitivity to pain". Children with this condition incur carelessly-repeated damage to their tongues, eyes, joints, skin, and muscles. Some die before adulthood, and others have a reduced life expectancy.[citation needed] Most people with congenital insensitivity to pain have one of five hereditary sensory and autonomic neuropathies (which includes familial dysautonomia and congenital insensitivity to pain with anhidrosis). These conditions feature decreased sensitivity to pain together with other neurological abnormalities, particularly of the autonomic nervous system. A very rare syndrome with isolated congenital insensitivity to pain has been linked with mutations in the SCN9A gene, which codes for a sodium channel (Nav1.7) necessary in conducting pain nerve stimuli.
qas: answers: text: pain
question: An abnormality of the nervous system can render a small number of people insensitive to what?

answers: text: congenital insensitivity to pain
question: What is it known as when someone is born without being able to feel pain because of their nervous system?

answers: text: repeated damage to their tongues, eyes, joints, skin, and muscles
question: What happens to children with congenital insensitivity to pain?

answers: text: reduced
question: What is the life expectancy for people who can't feel pain?

answers: text: SCN9A
question: What gene is responsible for coding for a sodium channel necessary for conducting pain nerve stimuli?

context: In 1644, René Descartes theorized that pain was a disturbance that passed down along nerve fibers until the disturbance reached the brain, a development that transformed the perception of pain from a spiritual, mystical experience to a physical, mechanical sensation[citation needed]. Descartes's work, along with Avicenna's, prefigured the 19th-century development of specificity theory. Specificity theory saw pain as "a specific sensation, with its own sensory apparatus independent of touch and other senses". Another theory that came to prominence in the 18th and 19th centuries was intensive theory, which conceived of pain not as a unique sensory modality, but an emotional state produced by stronger than normal stimuli such as intense light, pressure or temperature. By the mid-1890s, specificity was backed mostly by physiologists and physicians, and the intensive theory was mostly backed by psychologists. However, after a series of clinical observations by Henry Head and experiments by Max von Frey, the psychologists migrated to specificity almost en masse, and by century's end, most textbooks on physiology and psychology were presenting pain specificity as fact.
qas: answers: text: 1644
question: When was Descartes pontificating about his theories regarding pain?

answers: text: a disturbance
question: What did Descartes think pain was?

answers: text: emotional
question: What state does the intensive theory conceive pain as being?

answers: text: Specificity
question: What theory perceives pain as being a specific sensation?

answers: text: psychologists
question: Who migrated to the theory of specificity en mass?

context:  In 1955, DC Sinclair and G Weddell developed peripheral pattern theory, based on a 1934 suggestion by John Paul Nafe. They proposed that all skin fiber endings (with the exception of those innervating hair cells) are identical, and that pain is produced by intense stimulation of these fibers. Another 20th-century theory was gate control theory, introduced by Ronald Melzack and Patrick Wall in the 1965 Science article "Pain Mechanisms: A New Theory". The authors proposed that both thin (pain) and large diameter (touch, pressure, vibration) nerve fibers carry information from the site of injury to two destinations in the dorsal horn of the spinal cord, and that the more large fiber activity relative to thin fiber activity at the inhibitory cell, the less pain is felt. Both peripheral pattern theory and gate control theory have been superseded by more modern theories of pain[citation needed].
qas: answers: text: 1955
question: What year was peripheral pattern theory developed? 

answers: text: John Paul Nafe
question: Whose suggestion prompted the development of peripheral pattern theory?

answers: text: nerve fibers
question: What does the gate control theory specify the diameter of which is responsible for the amount of pain sensation?

answers: text: identical
question: What did DC Sinclair and G Weddell propose a property of all skin fiber endings is?

answers: text: superseded by more modern theories of pain
question: Why were peripheral pattern theory and gate control theory left behind?

context: In 1968 Ronald Melzack and Kenneth Casey described pain in terms of its three dimensions: "sensory-discriminative" (sense of the intensity, location, quality and duration of the pain), "affective-motivational" (unpleasantness and urge to escape the unpleasantness), and "cognitive-evaluative" (cognitions such as appraisal, cultural values, distraction and hypnotic suggestion). They theorized that pain intensity (the sensory discriminative dimension) and unpleasantness (the affective-motivational dimension) are not simply determined by the magnitude of the painful stimulus, but "higher" cognitive activities can influence perceived intensity and unpleasantness. Cognitive activities "may affect both sensory and affective experience or they may modify primarily the affective-motivational dimension. Thus, excitement in games or war appears to block both dimensions of pain, while suggestion and placebos may modulate the affective-motivational dimension and leave the sensory-discriminative dimension relatively undisturbed." (p. 432) The paper ends with a call to action: "Pain can be treated not only by trying to cut down the sensory input by anesthetic block, surgical intervention and the like, but also by influencing the motivational-affective and cognitive factors as well." (p. 435)
qas: answers: text: three
question: How many dimensions did Melzack and Casey describe pain in terms of?

answers: text: urge to escape the unpleasantness
question: The affective-motivational dimension of pain is characterized by what urge?

answers: text: cognitive activities
question: What did Melzack and Casey theorize could influence the perception of the magnitude of pain?

answers: text: dimensions
question: War game excitement appears to block what aspect of pain?

answers: text: action
question: What did Melack's and Casey's paper end with a call towards?

context: Wilhelm Erb's (1874) "intensive" theory, that a pain signal can be generated by intense enough stimulation of any sensory receptor, has been soundly disproved. Some sensory fibers do not differentiate between noxious and non-noxious stimuli, while others, nociceptors, respond only to noxious, high intensity stimuli. At the peripheral end of the nociceptor, noxious stimuli generate currents that, above a given threshold, begin to send signals along the nerve fiber to the spinal cord. The "specificity" (whether it responds to thermal, chemical or mechanical features of its environment) of a nociceptor is determined by which ion channels it expresses at its peripheral end. Dozens of different types of nociceptor ion channels have so far been identified, and their exact functions are still being determined.
qas: answers: text: pain
question: What type of signal can be generated by intense enough stimulation of any sensory receptor?

answers: text: noxious and non-noxious
question: What types of stimuli can't some sensory fibers differentiate between?

answers: text: noxious, high intensity
question: What type of stimuli do nociceptors response to?

answers: text: Dozens
question: How many different types of ion channels have so far been identified?

answers: text: currents
question: What does stimuli generate to send signals along a nerve fiber?

context: The pain signal travels from the periphery to the spinal cord along an A-delta or C fiber. Because the A-delta fiber is thicker than the C fiber, and is thinly sheathed in an electrically insulating material (myelin), it carries its signal faster (5–30 m/s) than the unmyelinated C fiber (0.5–2 m/s). Pain evoked by the (faster) A-delta fibers is described as sharp and is felt first. This is followed by a duller pain, often described as burning, carried by the C fibers. These first order neurons enter the spinal cord via Lissauer's tract.
qas: answers: text: along an A-delta or C fiber
question: How does the pain signal travel from the periphery to the spinal cord?

answers: text: A-delta
question: Which fiber is thicker?

answers: text: myelin
question: What is the electrically insulting material that sheaths a-delta fiber?

answers: text: via Lissauer's tract
question: How do first order neurons enter the spinal cord?

answers: text: sharp and is felt first
question: What is pain evoked by a-delta fibers described as?

context: Spinal cord fibers dedicated to carrying A-delta fiber pain signals, and others that carry both A-delta and C fiber pain signals up the spinal cord to the thalamus in the brain have been identified. Other spinal cord fibers, known as wide dynamic range neurons, respond to A-delta and C fibers, but also to the large A-beta fibers that carry touch, pressure and vibration signals. Pain-related activity in the thalamus spreads to the insular cortex (thought to embody, among other things, the feeling that distinguishes pain from other homeostatic emotions such as itch and nausea) and anterior cingulate cortex (thought to embody, among other things, the motivational element of pain); and pain that is distinctly located also activates the primary and secondary somatosensory cortices. Melzack and Casey's 1968 picture of the dimensions of pain is as influential today as ever, firmly framing theory and guiding research in the functional neuroanatomy and psychology of pain.
qas: answers: text: A-delta
question: What are some spinal cord fibers exclusive to?

answers: text: thalamus
question: Pain signals travel first to what region of the brain?

answers: text: spinal cord fibers
question: What are dynamic range neurons?

answers: text: the insular cortex
question: Where does pain-related activity in the thalamus spread to? 

answers: text: somatosensory
question: Pain which is distinctly located also activates what cortices? 

context: In his book, The Greatest Show on Earth: The Evidence for Evolution, biologist Richard Dawkins grapples with the question of why pain has to be so very painful. He describes the alternative as a simple, mental raising of a "red flag". To argue why that red flag might be insufficient, Dawkins explains that drives must compete with each other within living beings. The most fit creature would be the one whose pains are well balanced. Those pains which mean certain death when ignored will become the most powerfully felt. The relative intensities of pain, then, may resemble the relative importance of that risk to our ancestors (lack of food, too much cold, or serious injuries are felt as agony, whereas minor damage is felt as mere discomfort). This resemblance will not be perfect, however, because natural selection can be a poor designer. The result is often glitches in animals, including supernormal stimuli. Such glitches help explain pains which are not, or at least no longer directly adaptive (e.g. perhaps some forms of toothache, or injury to fingernails).
qas: answers: text: Richard Dawkins
question: Who wrote "The Greatest Show on Earth: The Evidence for Evolution"?

answers: text: drives
question: What does Dawkins explain must compete with each other in living begins?

answers: text: one whose pains are well balanced
question: What would be the most fit creature?

answers: text: poor
question: What type of designer is natural selection?

answers: text: risk
question: What might the relative intensities of pain resemble?

context: Differences in pain perception and tolerance thresholds are associated with, among other factors, ethnicity, genetics, and sex. People of Mediterranean origin report as painful some radiant heat intensities that northern Europeans describe as nonpainful. And Italian women tolerate less intense electric shock than Jewish or Native American women. Some individuals in all cultures have significantly higher than normal pain perception and tolerance thresholds. For instance, patients who experience painless heart attacks have higher pain thresholds for electric shock, muscle cramp and heat.
qas: answers: text: sex
question: Along with with ethnicity and genetics, what is the other factor associated with differences in pain perception?

answers: text: Europeans
question: What might some people of Mediterranean origin report as painful that people of this origin wouldn't?

answers: text: Italian
question: What nationality can tolerate the least amount of electric shock?

answers: text: pain perception
question: What do some individuals in all cultures have significantly higher than normal?

answers: text: pain thresholds
question: Patients who have painless heart attacks have higher what?

context: A person's self-report is the most reliable measure of pain, with health care professionals tending to underestimate severity. A definition of pain widely employed in nursing, emphasizing its subjective nature and the importance of believing patient reports, was introduced by Margo McCaffery in 1968: "Pain is whatever the experiencing person says it is, existing whenever he says it does". To assess intensity, the patient may be asked to locate their pain on a scale of 0 to 10, with 0 being no pain at all, and 10 the worst pain they have ever felt. Quality can be established by having the patient complete the McGill Pain Questionnaire indicating which words best describe their pain.
qas: answers: text: person's self-report
question: What is the most reliable measure of pain?

answers: text: severity
question: What do health-care professionals tend to underestimate? 

answers: text: definition of pain
question: What did Margo McCaffery introduce in 1968?

answers: text: 0 to 10
question: What scale might a patient be asked to locate their pain on?

answers: text: which words best describe their pain
question: What are patients asked to use the McGill Pain Questionnaire to indicate?

context: The Multidimensional Pain Inventory (MPI) is a questionnaire designed to assess the psychosocial state of a person with chronic pain. Analysis of MPI results by Turk and Rudy (1988) found three classes of chronic pain patient: "(a) dysfunctional, people who perceived the severity of their pain to be high, reported that pain interfered with much of their lives, reported a higher degree of psychological distress caused by pain, and reported low levels of activity; (b) interpersonally distressed, people with a common perception that significant others were not very supportive of their pain problems; and (c) adaptive copers, patients who reported high levels of social support, relatively low levels of pain and perceived interference, and relatively high levels of activity." Combining the MPI characterization of the person with their IASP five-category pain profile is recommended for deriving the most useful case description.
qas: answers: text: Multidimensional Pain Inventory
question: What is MPI an abbreviation for?

answers: text: three
question: How many classes of chronic pain patients are there?

answers: text: their pain problems
question: What do interpersonally distressed people feel their significant others aren't supportive of?

answers: text: high
question: What do dysfunctional people perceive the severity of their pain to be?

answers: text: their IASP five-category pain profile
question: What should MPI characterization of a person be combined with for deriving the most useful case descriptions?

context: When a person is non-verbal and cannot self-report pain, observation becomes critical, and specific behaviors can be monitored as pain indicators. Behaviors such as facial grimacing and guarding indicate pain, as well as an increase or decrease in vocalizations, changes in routine behavior patterns and mental status changes. Patients experiencing pain may exhibit withdrawn social behavior and possibly experience a decreased appetite and decreased nutritional intake. A change in condition that deviates from baseline such as moaning with movement or when manipulating a body part, and limited range of motion are also potential pain indicators. In patients who possess language but are incapable of expressing themselves effectively, such as those with dementia, an increase in confusion or display of aggressive behaviors or agitation may signal that discomfort exists, and further assessment is necessary.
qas: answers: text: observation
question: What become critical when a person is non-verbal? 

answers: text: specific behaviors
question: What can be monitored as pain indicators?

answers: text: withdrawn
question: What type of social behavior might patients experiencing pain exhibit?

answers: text: signal
question: How can patients with dementia indicate discomfort exists?

answers: text: pain
question: Facial grimacing and guarding indicate what?

context: The experience of pain has many cultural dimensions. For instance, the way in which one experiences and responds to pain is related to sociocultural characteristics, such as gender, ethnicity, and age. An aging adult may not respond to pain in the way that a younger person would. Their ability to recognize pain may be blunted by illness or the use of multiple prescription drugs. Depression may also keep the older adult from reporting they are in pain. The older adult may also quit doing activities they love because it hurts too much. Decline in self-care activities (dressing, grooming, walking, etc.) may also be indicators that the older adult is experiencing pain. The older adult may refrain from reporting pain because they are afraid they will have to have surgery or will be put on a drug they might become addicted to. They may not want others to see them as weak, or may feel there is something impolite or shameful in complaining about pain, or they may feel the pain is deserved punishment for past transgressions.
qas: answers: text: because it hurts too much
question: Why may older adults quit doing activities the love?

answers: text: dimensions
question: What does the experience of pain have throughout cultures?

answers: text: pain
question: What might an aging adult not respond to the same way as a younger person would?

answers: text: a drug
question: An older adult may also not report pain because they're scared they may be put on what?

answers: text: illness
question: Aging adult's ability to recognize pain may be blunted by what?

context: Cultural barriers can also keep a person from telling someone they are in pain. Religious beliefs may prevent the individual from seeking help. They may feel certain pain treatment is against their religion. They may not report pain because they feel it is a sign that death is near. Many people fear the stigma of addiction and avoid pain treatment so as not to be prescribed potentially addicting drugs. Many Asians do not want to lose respect in society by admitting they are in pain and need help, believing the pain should be borne in silence, while other cultures feel they should report pain right away and get immediate relief. Gender can also be a factor in reporting pain. Sexual differences can be the result of social and cultural expectations, with women expected to be emotional and show pain and men stoic, keeping pain to themselves.
qas: answers: text: Cultural
question: What kind of barriers can prevent a person from telling someone they're in pain?

answers: text: prevent the individual from seeking help
question: How can religious beliefs contribute to a person remaining in pain?

answers: text: death
question: Some people may not report pain because they think it's a sign what is near?

answers: text: potentially addicting drugs
question: What do many people fear pain treatment will lead to?

answers: text: do not want to lose respect in society by admitting they are in pain
question: What is an issue of reporting pain specific to Asians?

context: The International Association for the Study of Pain advocates that the relief of pain should be recognized as a human right, that chronic pain should be considered a disease in its own right, and that pain medicine should have the full status of a specialty. It is a specialty only in China and Australia at this time. Elsewhere, pain medicine is a subspecialty under disciplines such as anesthesiology, physiatry, neurology, palliative medicine and psychiatry. In 2011, Human Rights Watch alerted that tens of millions of people worldwide are still denied access to inexpensive medications for severe pain.
qas: answers: text: a human right
question: What does the IASP advocate that the relief of pain should be recognized as?

answers: text: a disease
question: What should chronic pain be considered in its own right?

answers: text: China and Australia
question: What two countries is treating pain a specialty in?

answers: text: subspecialty
question: What is pain medicine often under disciplines like physiatry, neurology, etc?

answers: text: tens of millions
question: As of 2011, how many people worldwide are still denied access to inexpensive medications for severe pain?

context:  Sugar taken orally reduces the total crying time but not the duration of the first cry in newborns undergoing a painful procedure (a single lancing of the heel). It does not moderate the effect of pain on heart rate and a recent single study found that sugar did not significantly affect pain-related electrical activity in the brains of newborns one second after the heel lance procedure. Sweet oral liquid moderately reduces the incidence and duration of crying caused by immunization injection in children between one and twelve months of age.
qas: answers: text: Sugar
question: What, when taken orally, can reduce total crying time of newsborns undergoing a painful procedure?

answers: text: heart rate
question: What doesn't sugar change the effect of pain on?

answers: text: pain-related
question: Sugar also doesn't measurably change what type of electrical activity in the brains of newborns a second after the heel lance procedure?

answers: text: crying
question: A sweet oral liquid does moderately reduce the incidence and duration of what?

context: A number of meta-analyses have found clinical hypnosis to be effective in controlling pain associated with diagnostic and surgical procedures in both adults and children, as well as pain associated with cancer and childbirth. A 2007 review of 13 studies found evidence for the efficacy of hypnosis in the reduction of chronic pain in some conditions, though the number of patients enrolled in the studies was low, bringing up issues of power to detect group differences, and most lacked credible controls for placebo and/or expectation. The authors concluded that "although the findings provide support for the general applicability of hypnosis in the treatment of chronic pain, considerably more research will be needed to fully determine the effects of hypnosis for different chronic-pain conditions."
qas: answers: text: controlling
question: Clinical hypnosis may be effective in doing what with pain associated with surgical procedures in adults and children?

answers: text: 13
question: How many studies in 2007 found evidence for the efficacy of hypnosis in the reduction of chronic pain?

answers: text: credible controls for placebo and/or expectation
question: What did the studies regarding the effectiveness of hypnosis lack?

answers: text: effects of hypnosis
question: What is considerable more research needed to determine for different chronic pain conditions?

context: Pain is the most common reason for people to use complementary and alternative medicine. An analysis of the 13 highest quality studies of pain treatment with acupuncture, published in January 2009, concluded there is little difference in the effect of real, sham and no acupuncture. However other reviews have found benefit. Additionally, there is tentative evidence for a few herbal medicine. There is interest in the relationship between vitamin D and pain, but the evidence so far from controlled trials for such a relationship, other than in osteomalacia, is unconvincing.
qas: answers: text: Pain
question: What is the most common reason people seek out alternative medicine?

answers: text: little difference in the effect
question: What did an analysis of the 13 studies of pain treatment conclude about the effect of real treament versus sham treatments?

answers: text: herbal
question: What medicine is there tentative evidence for the efficacy of?

answers: text: benefit
question: Some contradictory reviews of 13 high quality studies found actual what?

answers: text: vitamin D
question: Other than in osteomalacia, what is there no evidence of a relationship between pain and?

context: Physical pain is an important political topic in relation to various issues, including pain management policy, drug control, animal rights or animal welfare, torture, and pain compliance. In various contexts, the deliberate infliction of pain in the form of corporal punishment is used as retribution for an offence, or for the purpose of disciplining or reforming a wrongdoer, or to deter attitudes or behaviour deemed unacceptable. In some cultures, extreme practices such as mortification of the flesh or painful rites of passage are highly regarded.
qas: answers: text: political
question: What type of topic is physical pain important in relation to many issues?

answers: text: deliberate infliction
question: Corporal punishment is a form of what type of pain?

answers: text: deter
question: How does pain inform attitudes deemed unacceptable?

answers: text: extreme
question: What kind of practices do some cultures highly regard?

answers: text: an offence
question: What is corporal punishment used as retribution for?

context: The most reliable method for assessing pain in most humans is by asking a question: a person may report pain that cannot be detected by any known physiological measure. However, like infants (Latin infans meaning "unable to speak"), animals cannot answer questions about whether they feel pain; thus the defining criterion for pain in humans cannot be applied to them. Philosophers and scientists have responded to this difficulty in a variety of ways. René Descartes for example argued that animals lack consciousness and therefore do not experience pain and suffering in the way that humans do. Bernard Rollin of Colorado State University, the principal author of two U.S. federal laws regulating pain relief for animals, writes that researchers remained unsure into the 1980s as to whether animals experience pain, and that veterinarians trained in the U.S. before 1989 were simply taught to ignore animal pain. In his interactions with scientists and other veterinarians, he was regularly asked to "prove" that animals are conscious, and to provide "scientifically acceptable" grounds for claiming that they feel pain. Carbone writes that the view that animals feel pain differently is now a minority view. Academic reviews of the topic are more equivocal, noting that although the argument that animals have at least simple conscious thoughts and feelings has strong support, some critics continue to question how reliably animal mental states can be determined. The ability of invertebrate species of animals, such as insects, to feel pain and suffering is also unclear.
qas: answers: text: asking a question
question: What is the most reliable method of learning about pain in a human?

answers: text: whether they feel pain
question: What can't animals answer?

answers: text: consciousness
question: What did Descartes argue animals lack?

answers: text: Colorado State University
question: What university is Bernard Rollin associated with?

answers: text: unclear
question: Can invertebrate species of animals like insects feel pain and suffering?

context: The presence of pain in an animal cannot be known for certain, but it can be inferred through physical and behavioral reactions. Specialists currently believe that all vertebrates can feel pain, and that certain invertebrates, like the octopus, might too. As for other animals, plants, or other entities, their ability to feel physical pain is at present a question beyond scientific reach, since no mechanism is known by which they could have such a feeling. In particular, there are no known nociceptors in groups such as plants, fungi, and most insects, except for instance in fruit flies.
qas: answers: text: presence
question: What about pain in an animal isn't able to be known with certainty?

answers: text: pain
question: An animals physical and behavioral reactions may be inferred to indicate the presence of what?

answers: text: vertebrates
question: Who do specialists believe can feel pain?

answers: text: plants
question: No mechanism is known by which what organisms would be able to have a feeling such as pain?

answers: text: nociceptors
question: What do fungi and fruit flies seem to lack?