Nociceptive Peripheral Central Cognitive Affective / Social /

(Mechanical, Neuropathic Neurogenic Emotional Environmental

Chemical,
Thermal)
Adaptive, Pathological, Changes in the Thoughts, Diagnosable or Contextual
Orthodromic, peripheral nerve central N.S. that beliefs, values definable clinical factors that
Protective injury, lead to an or perceptions or subclinical interact with bio
May still orthodromic environment of that affect psychopathology and psych to
exhibit signs of and antidromic nociceptive interpretation influence
peripheral facilitation and suffering interpretation,
sensitization reporting, and
other behaviors
• ‘Mechanical’ • History • Longer-term • Catastrophic • Major / Minor • Spousal
pattern of (obvious or duration of beliefs (PCS Depressive responses
reproduction likely) of symptoms >20) Disorder • Job
– predictable nerve trauma • Non- • Fear of (PHQ-9 or satisfaction
and • Non- mechanical movement / HADS) • Job laterality
consistent mechanical patterns of injury • Generalized • Unpaid /
• Makes patterns, symptom (FABQ, Anxiety gendered roles
anatomical spontaneous reproduction TSK) Disorder • Compensation
sense pain localized • Diagnostic • Sense of (HADS, • Litigation
• Local to innervation findings clear victimization DASS) • Access to care
hyperalgesia territory of or equivocal (IEQ) • Post-traumatic • Cultural
• Responsive lesioned • Widespread • Low self- Stress norms
to nerve sensory efficacy Disorder • Ethnic norms
appropriate • Sensory loss: hyperalgesia beliefs (PCL, PDS, • Previous life
OTC hypoesthesia, • Dysfunctional (PSEQ) IES)
experiences
medication hypoalgesia conditioned • Poor • Somatoform
(e.g. • Sensory gain: pain expectations Disorder
NSAIDs) Allodynia, modulation of recovery • Borderline
• Predictable Hyperalgesia • Central (BIPQ) Personality
diurnal • Dysesthesias: Sensitivity • Generalized Disorder,
patterns electric, Index trauma- Narcissism
shocking, (≥40/100) related • Social Phobias
burning, cold, • Usually distress • Obsessive –
heavy, associated (TIDS) Compulsive
itching, with other • Any number Disorder
crawling symptoms of other
• Screening incl. cognitive
tools: digestive, tools
SLANSS (≥ sleep,
12/24), DN4 cognitive,
(≥4/10) or sensory or
PainDETECT motor
(≥19/38) interference
• Localized • Poor laterality
wind-up pain recognition
Pain Mechanism Summary Table by Dr. Dave Walton