romikgosai/squad_modified huggingface dataset:
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.

Questions and answers:
['
Q: What triad are the inventory scales of hysteria, depression and hypochondriasis classified as?
A: neurotic', '
Q: When people have long-term pain, what do they frequently display?
A: psychological disturbance', '
Q: Clinical evidence indicates that neuroticism is caused by what?
A: chronic pain', "
Q: If long-term pain can be relieved by therapy, what does a person's neurotic triad score do?
A: fall", '
Q: What shows improvement in many patients once their pain has been resolved?
A: Self-esteem']
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.

Questions and answers:
['
Q: What is the term for pain which is acute and note alleviated by normal pain management?
A: Breakthrough', '
Q: How do cancer patients usually control their background pain?
A: medications', '
Q: Who is breakthrough pain common among?
A: cancer patients', '
Q: What class of medication is fentanyl an example of?
A: opioids', '
Q: What activity in relation to breakthrough pain requires heavy use of opiods?
A: Management']
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.

Questions and answers:
["
Q: Which type of injection has caused patients to report they have pain but aren't bothered by it?
A: morphine", '
Q: How much do some patients going through psychosurgery suffer from the sensation of pain?
A: little, or not at all', "
Q: IASP's definition of pain includes what aspect as an essential part?
A: unpleasantness", '
Q: What is it possible to induce which is, contrary to expectations, devoid of unpleasantness?
A: a state described as intense pain', '
Q: What perspective towards pain are some people with perfectly normal nerves born with?
A: Indifference']
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.

Questions and answers:
['
Q: An abnormality of the nervous system can render a small number of people insensitive to what?
A: pain', '
Q: What is it known as when someone is born without being able to feel pain because of their nervous system?
A: congenital insensitivity to pain', '
Q: What happens to children with congenital insensitivity to pain?
A: repeated damage to their tongues, eyes, joints, skin, and muscles', "
Q: What is the life expectancy for people who can't feel pain?
A: reduced", '
Q: What gene is responsible for coding for a sodium channel necessary for conducting pain nerve stimuli?
A: SCN9A']
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.

Questions and answers:
['
Q: When was Descartes pontificating about his theories regarding pain?
A: 1644', '
Q: What did Descartes think pain was?
A: a disturbance', '
Q: What state does the intensive theory conceive pain as being?
A: emotional', '
Q: What theory perceives pain as being a specific sensation?
A: Specificity', '
Q: Who migrated to the theory of specificity en mass?
A: psychologists']
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].

Questions and answers:
['
Q: What year was peripheral pattern theory developed? 
A: 1955', '
Q: Whose suggestion prompted the development of peripheral pattern theory?
A: John Paul Nafe', '
Q: What does the gate control theory specify the diameter of which is responsible for the amount of pain sensation?
A: nerve fibers', '
Q: What did DC Sinclair and G Weddell propose a property of all skin fiber endings is?
A: identical', '
Q: Why were peripheral pattern theory and gate control theory left behind?
A: superseded by more modern theories of pain']
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)

Questions and answers:
['
Q: How many dimensions did Melzack and Casey describe pain in terms of?
A: three', '
Q: The affective-motivational dimension of pain is characterized by what urge?
A: urge to escape the unpleasantness', '
Q: What did Melzack and Casey theorize could influence the perception of the magnitude of pain?
A: cognitive activities', '
Q: War game excitement appears to block what aspect of pain?
A: dimensions', "
Q: What did Melack's and Casey's paper end with a call towards?
A: action"]
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.

Questions and answers:
['
Q: What type of signal can be generated by intense enough stimulation of any sensory receptor?
A: pain', "
Q: What types of stimuli can't some sensory fibers differentiate between?
A: noxious and non-noxious", '
Q: What type of stimuli do nociceptors response to?
A: noxious, high intensity', '
Q: How many different types of ion channels have so far been identified?
A: Dozens', '
Q: What does stimuli generate to send signals along a nerve fiber?
A: currents']
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.

Questions and answers:
['
Q: How does the pain signal travel from the periphery to the spinal cord?
A: along an A-delta or C fiber', '
Q: Which fiber is thicker?
A: A-delta', '
Q: What is the electrically insulting material that sheaths a-delta fiber?
A: myelin', "
Q: How do first order neurons enter the spinal cord?
A: via Lissauer's tract", '
Q: What is pain evoked by a-delta fibers described as?
A: sharp and is felt first']
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.

Questions and answers:
['
Q: What are some spinal cord fibers exclusive to?
A: A-delta', '
Q: Pain signals travel first to what region of the brain?
A: thalamus', '
Q: What are dynamic range neurons?
A: spinal cord fibers', '
Q: Where does pain-related activity in the thalamus spread to? 
A: the insular cortex', '
Q: Pain which is distinctly located also activates what cortices? 
A: somatosensory']
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).

Questions and answers:
['
Q: Who wrote "The Greatest Show on Earth: The Evidence for Evolution"?
A: Richard Dawkins', '
Q: What does Dawkins explain must compete with each other in living begins?
A: drives', '
Q: What would be the most fit creature?
A: one whose pains are well balanced', '
Q: What type of designer is natural selection?
A: poor', '
Q: What might the relative intensities of pain resemble?
A: risk']
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.

Questions and answers:
['
Q: Along with with ethnicity and genetics, what is the other factor associated with differences in pain perception?
A: sex', "
Q: What might some people of Mediterranean origin report as painful that people of this origin wouldn't?
A: Europeans", '
Q: What nationality can tolerate the least amount of electric shock?
A: Italian', '
Q: What do some individuals in all cultures have significantly higher than normal?
A: pain perception', '
Q: Patients who have painless heart attacks have higher what?
A: pain thresholds']
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.

Questions and answers:
["
Q: What is the most reliable measure of pain?
A: person's self-report", '
Q: What do health-care professionals tend to underestimate? 
A: severity', '
Q: What did Margo McCaffery introduce in 1968?
A: definition of pain', '
Q: What scale might a patient be asked to locate their pain on?
A: 0 to 10', '
Q: What are patients asked to use the McGill Pain Questionnaire to indicate?
A: which words best describe their pain']
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.

Questions and answers:
['
Q: What is MPI an abbreviation for?
A: Multidimensional Pain Inventory', '
Q: How many classes of chronic pain patients are there?
A: three', "
Q: What do interpersonally distressed people feel their significant others aren't supportive of?
A: their pain problems", '
Q: What do dysfunctional people perceive the severity of their pain to be?
A: high', '
Q: What should MPI characterization of a person be combined with for deriving the most useful case descriptions?
A: their IASP five-category pain profile']
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.

Questions and answers:
['
Q: What become critical when a person is non-verbal? 
A: observation', '
Q: What can be monitored as pain indicators?
A: specific behaviors', '
Q: What type of social behavior might patients experiencing pain exhibit?
A: withdrawn', '
Q: How can patients with dementia indicate discomfort exists?
A: signal', '
Q: Facial grimacing and guarding indicate what?
A: pain']
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.

Questions and answers:
['
Q: Why may older adults quit doing activities the love?
A: because it hurts too much', '
Q: What does the experience of pain have throughout cultures?
A: dimensions', '
Q: What might an aging adult not respond to the same way as a younger person would?
A: pain', "
Q: An older adult may also not report pain because they're scared they may be put on what?
A: a drug", "
Q: Aging adult's ability to recognize pain may be blunted by what?
A: illness"]
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.

Questions and answers:
["
Q: What kind of barriers can prevent a person from telling someone they're in pain?
A: Cultural", '
Q: How can religious beliefs contribute to a person remaining in pain?
A: prevent the individual from seeking help', "
Q: Some people may not report pain because they think it's a sign what is near?
A: death", '
Q: What do many people fear pain treatment will lead to?
A: potentially addicting drugs', '
Q: What is an issue of reporting pain specific to Asians?
A: do not want to lose respect in society by admitting they are in pain']
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.

Questions and answers:
['
Q: What does the IASP advocate that the relief of pain should be recognized as?
A: a human right', '
Q: What should chronic pain be considered in its own right?
A: a disease', '
Q: What two countries is treating pain a specialty in?
A: China and Australia', '
Q: What is pain medicine often under disciplines like physiatry, neurology, etc?
A: subspecialty', '
Q: As of 2011, how many people worldwide are still denied access to inexpensive medications for severe pain?
A: tens of millions']