Original Publication
Open Access

Managing Pain Together: The Pathophysiology of Pain

Published: November 23, 2010 | 10.15766/mep_2374-8265.8335

Included in this publication:

  • MedEdPORTAL Instructor's Guide.docx
  • Managing Pain Together Module

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.

Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.


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. Managing Pain Together: The Pathophysiology of Pain, a bilingual, interactive web-based module, provides a dynamic, interactive approach to understanding the pathophysiology of pain for medical students, physicians, and nurses. 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? The module can be integrated into a medical education curriculum or used independently as a learning and revision aid. It is self-explanatory to use as it is learner-centered and self-paced. It is estimated that it will take learners 30-45 minutes to complete. There is no need for a facilitator to preparare ahead of time for implementation. This resource is part of the University of Ottawa undergraduate medical education curriculum and the online Managing Pain Together program. It is accessible to users at no cost at anytime 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.

Educational Objectives

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

  1. 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. Define the physiological processes of transduction, transmission, modulation, and perception.
  3. Explain how three similar appearing patients having the identical physical trauma or injury may report significantly differing levels of pain.
  4. Describe the physiological mechanism by which large doses of opioids may actually make pain worse.
  5. Explain the mechanisms of action for different approaches for managing pain.

Author Information

  • Emma Stodel, PhD: Learning 4 Excellence
  • John Penning, MD: University of Ottawa
  • Pippa Hall, MD: University of Ottawa
  • Shirley H. Bush, MBBS: University of Ottawa
  • Perry Ng: University of Ottawa
  • Debbie Gravelle, RN, BScN, MHS: Bruyere Continuing Care

None to report.

None to report. 

Prior Presentations
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. 

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.


Stodel E, Penning J, Hall P, Bush S, Ng P, Gravelle D. Managing pain together: the pathophysiology of pain. MedEdPORTAL. 2010;6:8335. https://doi.org/10.15766/mep_2374-8265.8335