# PWR-084 — Nociceptive discrimination: learner worksheet Release: Revision 7T · Full Tutorial Edition Estimated time: Estimated 25 min reading and worksheet pass Difficulty: Intermediate Equipment: Basic stationery or digital tools — A symptom sheet with separate fields for event, observed facts, sensation, pain report, function, possible explanation and warning signs.; The learner’s current local official health-service contact details for any real symptom.; FICTIONAL PRACTICE ROUTING CARD — use only for the supplied fictional cases: choose EMERGENCY when the card states immediate danger such as trouble breathing, chest pain, new confusion, new major weakness, uncontrolled bleeding or severe injury; choose URGENT for a new or rapidly spreading sensory change accompanied by altered ordinary function; choose ROUTINE CLINICAL for persistent or recurrent unexplained symptoms without an emergency or urgent feature; choose MONITOR only for a mild, clearly improving event with normal function and none of the listed warning signs.; MONITOR means keep observing according to the card and escalate if the pattern stops improving or a warning sign appears.; Set 1 Card A: chest pain and trouble breathing began ten minutes ago.; Set 1 Card B: new burning and numbness along one foot began without a clear injury and walking has become less steady. Space: Desk / seated Automated structural checklist: 10 of 10 structural checks present Evidence quality/context: G6; Deep research depth Automated method-quality band: Comprehensive Method-rating basis: Structure coverage, instruction/check specificity, alternative distinctness, source troubleshooting, comparison depth and whether purpose/check fields are authored rather than derived. Editorial review: Pending manual editorial sign off ## Before you begin - [ ] I read the tutorial authority and stop conditions. - [ ] I have the required equipment/space or a declared accessible alternative. ## Canonical source context Nociception is neural processing of potentially tissue-damaging events; pain is a personal sensory and emotional experience. They are related but not interchangeable. This lesson does not create, intensify or compare painful stimuli. It teaches how to stop self-provocation, describe an already-occurring experience, separate observation from interpretation, check urgent warning signs and route the concern to appropriate care. Target outcome: Using the supplied practice-only routing card, the learner completes two sets of fictional cases by separating event, sensation, pain report, function and uncertainty, then consistently selects EMERGENCY, URGENT, ROUTINE CLINICAL or MONITOR without provoking pain. ### Authority and setup conditions - End any deliberate pain test and move away from an accidental hazard when that can be done safely. - For a real symptom, use the current local official service rather than the fictional practice card. - If a real event includes an emergency sign, get emergency help instead of completing the sheet. - Ask permission before helping another person and preserve their own words for their experience. ### Required or supplied materials - A symptom sheet with separate fields for event, observed facts, sensation, pain report, function, possible explanation and warning signs. - The learner’s current local official health-service contact details for any real symptom. - FICTIONAL PRACTICE ROUTING CARD — use only for the supplied fictional cases: choose EMERGENCY when the card states immediate danger such as trouble breathing, chest pain, new confusion, new major weakness, uncontrolled bleeding or severe injury; choose URGENT for a new or rapidly spreading sensory change accompanied by altered ordinary function; choose ROUTINE CLINICAL for persistent or recurrent unexplained symptoms without an emergency or urgent feature; choose MONITOR only for a mild, clearly improving event with normal function and none of the listed warning signs. - MONITOR means keep observing according to the card and escalate if the pattern stops improving or a warning sign appears. - Set 1 Card A: chest pain and trouble breathing began ten minutes ago. - Set 1 Card B: new burning and numbness along one foot began without a clear injury and walking has become less steady. - Set 1 Card C: unexplained hand burning has returned most evenings for three weeks, with no listed emergency or urgent feature. - Set 1 Card D: after an ordinary minor bump, a small local ache has steadily improved for 24 hours; ordinary movement is normal and no warning sign is present. - Set 2 Card E: new confusion and major one-sided weakness began suddenly. - Set 2 Card F: numbness is spreading through one hand and the person has begun dropping ordinary objects. - Set 2 Card G: unexplained pain has repeatedly interrupted sleep for two weeks, without a listed emergency or urgent feature. - Set 2 Card H: a mild local ache after a known low-risk activity is clearly improving, ordinary function is normal and no warning sign is present. - Covered practice answer strip: Set 1 A = EMERGENCY, B = URGENT, C = ROUTINE CLINICAL, D = MONITOR. Set 2 E = EMERGENCY, F = URGENT, G = ROUTINE CLINICAL, H = MONITOR. - No heat, ice, pressure, pin, electrical, chemical, exercise-tolerance or other stimulus equipment. ## 1. Stop provocation Do not press, heat, cool, stretch, exercise or repeat a movement merely to see whether pain returns. Make the immediate situation safe. Why: Provocation can worsen harm and does not create a valid home test of nociception. Success check: No challenge is underway and no additional stimulus has been introduced. Accessible alternative: A supported, seated, reduced-range or slower version of “Do not press, heat, cool, stretch, exercise or repeat a movement merely to see whether pain returns. Make the immediate situation safe.” is equivalent only when it keeps the same trained or measured target, declared configuration and success check: “No challenge is underway and no additional stimulus has been introduced.” If any of those change, record it as a related alternative rather than an equivalent repetition. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 2. Write the event Record what happened immediately before the experience, if known, using observable language. If no trigger is known, write “no clear event.” Why: An event is useful information but is not itself pain or a diagnosis. Success check: The record clearly distinguishes a known event from an unknown trigger. Accessible alternative: Complete the same research action — “Record what happened immediately before the experience, if known, using observable language. If no trigger is known, write “no clear event.”” — using speech-to-text, text-to-speech, enlarged text, keyboard-only navigation, shorter work blocks or a support person. Preserve this declared check: “The record clearly distinguishes a known event from an unknown trigger.” Do not convert the research task into capability practice. Alternative relationship: Target preserving when declared check is preserved Learner notes: ________________________________________________________________________________ Completed: [ ] ## 3. Record the person’s experience Use the person’s own words for location, quality, start time, pattern and current intensity. Why: Pain is personal; replacing the report with a disease label destroys information. Success check: Location, quality, timing, pattern and the person’s chosen rating or communication method are present. Accessible alternative: A supported, seated, reduced-range or slower version of “Use the person’s own words for location, quality, start time, pattern and current intensity.” is equivalent only when it keeps the same trained or measured target, declared configuration and success check: “Location, quality, timing, pattern and the person’s chosen rating or communication method are present.” If any of those change, record it as a related alternative rather than an equivalent repetition. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 4. Separate the layers Put observed facts, felt sensation, pain report and changed function in separate boxes. Put possible explanations in a fifth box labelled UNCERTAIN. Why: This prevents an event, visible sign or neural term from being treated as the whole experience. Success check: Every sentence belongs to one declared box and no uncertain explanation is written as fact. Accessible alternative: Complete “Put observed facts, felt sensation, pain report and changed function in separate boxes. Put possible explanations in a fifth box labelled UNCERTAIN.” in shorter passes, or use keyboard input, dictation or a support person, while preserving this success check: “Every sentence belongs to one declared box and no uncertain explanation is written as fact.” Allow a trusted supporter to write while the person controls the wording and consent. Alternative relationship: Target preserving when declared check is preserved Learner notes: ________________________________________________________________________________ Completed: [ ] ## 5. Choose one routing category For fictional practice, apply the supplied FICTIONAL PRACTICE ROUTING CARD exactly once. For a real symptom, apply the current local official rule. Select EMERGENCY, URGENT, ROUTINE CLINICAL or MONITOR and copy the exact sign that controls the choice. Why: A fixed rule prevents repeated body testing and arbitrary escalation or dismissal. Success check: The chosen category and its controlling sign are both written down. Accessible alternative: Complete “For fictional practice, apply the supplied FICTIONAL PRACTICE ROUTING CARD exactly once. For a real symptom, apply the current local official rule. Select EMERGENCY, URGENT, ROUTINE CLINICAL or MONITOR and copy the exact sign that controls the choice.” in shorter passes, or use keyboard input, dictation or a support person, while preserving this success check: “The chosen category and its controlling sign are both written down.” For children or people who do not use numerical ratings, use their established communication method and do not treat silence as absence of pain. Alternative relationship: Target preserving when declared check is preserved Learner notes: ________________________________________________________________________________ Completed: [ ] ## 6. Route or monitor Contact the selected real service when the real rule requires it. If the applicable rule permits MONITOR, write what will be observed, when it will be reviewed and which change would trigger escalation. Why: MONITOR remains an active plan rather than an assumption that nothing matters. Success check: The record contains either the contacted service and next action or a timed monitoring and escalation plan. Accessible alternative: Complete the same research action — “Contact the selected real service when the real rule requires it. If the applicable rule permits MONITOR, write what will be observed, when it will be reviewed and which change would trigger escalation.” — using speech-to-text, text-to-speech, enlarged text, keyboard-only navigation, shorter work blocks or a support person. Preserve this declared check: “The record contains either the contacted service and next action or a timed monitoring and escalation plan.” Do not convert the research task into capability practice. Alternative relationship: Target preserving when declared check is preserved Learner notes: ________________________________________________________________________________ Completed: [ ] ## Reflection What changed? ________________________________________________________________________________ What remains difficult? ________________________________________________________________________________ What will I repeat, adapt, ask for help with, or stop? ________________________________________________________________________________ --- Completion of this worksheet demonstrates tutorial participation only. It does not establish capability, qualification, safety clearance, diagnosis, treatment or independent validation.