Which sensation is NOT typically expected as normal during PAMS?

• A. Hot or cold
• B. Mild warmth
• C. Different textures
• D. Unbearable pain

Answer: (D)

In PAMS, the goal is to provide graded, non-noxious sensory input that the nervous system can reliably interpret. You’d expect sensations that reflect normal sensory processing: exposure to hot or cold changes, a comfortable mild warmth, and the ability to distinguish different textures. These responses show the sensory pathways are being engaged at a tolerable level and support accurate re-education without distress.

Unbearable pain is not considered a normal or expected outcome. It indicates the stimulus is too intense or that the patient has heightened sensitivity, and it risks tissue damage or negative neuroplastic changes. If pain becomes unbearable, the stimulus should be stopped, the level adjusted to a tolerable range, and reassessed before proceeding.