Chronic pain

Eliminating pain remains one of the most challenging medical dilemmas of today. Unfortunately, there is no single cause of chronic pain, which makes its assessment, diagnosis, and treatment very difficult.

A huge portion of the population suffers from chronic pain. After cancer and heart disease, chronic pain is the third leading cause of disability in the United States. Approximately 1 in every 3 people has persistent or recurring pain. Of these, more than half are partially or totally disabled for days, weeks, months, or years.

Types of pain

A useful general description of pain is an "unpleasant physical or emotional sensation."

Acute pain refers to pain caused by tissue damage or disease that lasts for only a short time. However, chronic pain persists beyond the normally expected healing time of 1 to 3 months. Chronic pain can be categorized into several types:

• benign pain: pain that continues even after the original injury has healed
• pain due to nerve damage, e.g., post herpetic neuralgia (PHN), reflex sympathetic dystrophy (RSD) - now known as complex regional pain syndrome (CRPS), and diabetic neuropathy
• inflammatory conditions, e.g., arthritis
• malignant pain due to ongoing tissue damage, e.g., in cancer

Factors which perpetuate pain and disability include physical deconditioning, inappropriate use of medications, and faulty beliefs about body mechanics. Other equally important factors that compound the problem are inability to deal with stress and lack of job skills.

Once chronic pain sets in and neurological pain patterns become established, it becomes increasingly difficult to restore the patient to normal function. Consequences of untreated or inappropriately treated chronic pain can include sleep disturbance, deconditioning, increasing stress, and medication dependence. As the vicious cycle of pain and disability deepens, irritability, anxiety, frustration, and depression worsen, as do problems with memory and concentration.

Chronic pain syndrome

This syndrome consists of a group of signs and symptoms frequently found together, for example, persistent pain complicated by symptoms of anxiety, depression, muscle deconditioning, and ongoing disability.