Managing Pain Together: The Pathophysiology of Pain

Publication ID Published Volume
8335 November 23, 2010 6


Pain has traditionally been taught using static two-dimensional images in textbooks or on overhead projectors. However, understanding the perception and treatment of pain can be complex. It requires more than a simple understanding of the basic pain pathways. To better understand the perception and treatment of pain, it is helpful to consider pain through four dimensions. Often, we can understand complex concepts by first understanding them in one dimension and then progressing on to see them through other dimensions. It is only by viewing pain from all dimensions that we can fully understand and treat it.

Managing Pain Together: The Pathophysiology of Pain is a bilingual, interactive eLearning module to teach medical students, physicians, and nurses about pain pathophysiology. The module illustrates the basic ascending pain pathways, as well as the descending pain-modulating pathways through clear interactive images. The four dimensions of pain are explained by pain experts through video. For each dimension, individual differences are addressed and the role of drugs and other pain management approaches are discussed using a combination of text, images, and animations. Pain phenomena that are not explained through the basic pathways of pain transmission are considered: How do we explain severe pain when only minor trauma exists? Or no pain but severe trauma? How do we explain chronic pain that persists long after the initial tissue trauma has appeared to have healed?

A comprehensive understanding of pain pathophysiology is fundamental to pain assessment and management. However, this is a complex topic and one often difficult to grasp from two-dimensional images in books or presentations. This eLearning module provides a dynamic, interactive approach to understanding the pathophysiology of pain for medical students, physicians, and nurses. It is accessible to users at no cost at any time from anywhere they have access to an Internet connection. A preliminary evaluation by second year medical students indicated that students loved the use of video, audio, and graphic technology.


Stodel E, Penning J, Hall P, Bush S, Ng P, Gravelle D. Managing pain together: the pathophysiology of pain. MedEdPORTAL Publications. 2010;6:8335.

Educational Objectives

  1. To be able to outline the neuroanatomical structures and nociceptive pathways that are involved with a stimulus in the great toe being perceived as pain in the brain.
  2. To be able to define the physiological processes of transduction, transmission, modulation, and perception.
  3. To be able to explain how three similar appearing patients having the identical physical trauma or injury may report significantly differing levels of pain.
  4. To be able to describe the physiological mechanism by which large doses of opioids may actually make pain worse.
  5. To be able to explain the mechanisms of action for different approaches for managing pain.


  • Managing Pain, Pathophysiology, eLearning, Opioid Receptors

Prior Scholarly Dissemination


  1. Stodel, E., Bush, S.H., Penning, J., Ng, P., Gravelle, D., & Hall, P. (2010, October). The four dimensions of pain: An innovative and accessible eLearning module on pain pathophysiology for healthcare professionals. Poster presented at the 18th International Congress on Palliative Care, Montréal, Québec, Canada.
  2. Stodel, E., Penning, J., Hall, P., Bush, S.H., Ng, P., & Gravelle, D. (2010, April). Pathophysiology of pain: Learning through new dimensions. Poster session presented at the Academy for Innovation in Medical Education 3rd annual Medical Education Day, Ottawa, Ontario, Canada.

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ISSN 2374-8265