Learning Objectives

By the end of this session, the learner will be able to:

  1. list three ways that nociceptive inputs undergo aberrant processing by the PNS and CNS. Clinically, this may produce long-term enhancement and spatial expansion of perceived pain.
  2. appreciate that enhanced pain signaling due to PNS and CNS dysfunction can make diagnosis difficult, initiating treatment can aid the diagnostic process by helping refine the perception of pain.
  3. know that pain medications and pain profoundly impact cognition meaning that t is possible at times to treat pain pharmacologically, without substantively improving function, e.g. the ‘cognitive trap’. Multimodal therapy may be especially beneficial in this context.
  4. describe the potential role of the primary care physician in the management of acute and chronic pain, recognizing how physicians can positively influence pain behavior
  5. appreciate the importance of comprehensive, multi-profession care in pain.
  6. know the importance of physician counseling and techniques for communicating, how this is modified in the context of ongoing pain.
  7. identify and assess the multidimensional aspects of neuropathic pain, and distinguish this from musculoskeletal pain.
  8. describe components of a comprehensive management plan that addresses the goals of patient and utilizes members of the multidisciplinary team.
  9. recognize the need to assess and manage functional outcomes in addition to symptoms, including the role of increased self-efficacy and self-management.

The student will know that:

  1. specific anticonvulsants may be effective in certain pain conditions. These play a major role in adjunctive therapy of many chronic pain states but may have serious side effects.
  2. specific antidepressants, including tricyclic antidepressants (TCAs) which have been demonstrated to be effective, may be used in the treatment of neuropathic pain and other chronic pain; cardiac side effects predominate in TCAs. Among newer antidepressants, only selected agents relieve pain, use of these is increasingly important in treating neuropathic and persistent pain.
  3. local anesthetics and other sodium channel agents can be effective against both acute and chronic pain. Topical and focal application of these and other agents may be useful.


Dr. Beth Murinson

Dr. Suzanne Nesbit

Dr. Marlis Gonzalez Fernandez

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Johns Hopkins School of Medicine