PAIN-CHRONIC PAIN

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SUMMARY

1. Pain that persists past normal healing time[1] and hence lacks the acute warning function of physiological nociception[2].

2. Pain that lasts or recurs > 3 to 6 months[3].

CLASSIFICATION
1. Primary pain: pain in ≥ 1 anatomic regions that persists/recurs for > 3 months, is associated with significant emotional distress or functional disability and that cannot be explained by another chronic pain condition

2. Cancer pain: pain caused by the cancer itself or by treatment; subdivided based on location into visceral, musculoskeletal, and somatosensory (neuropathic); either continuous (background pain) or intermittent (episodic pain) if associated with physical movement or clinical procedures

3. Post-surgical & post-traumatic pain: pain that persists at least 3 months after surgery or tissue trauma[4]; 30% is often neuropathic[5], more severe than nociceptive and affects life more adversely[6].

4. Neuropathic pain: chronic neuropathic pain is caused by a lesion or disease of the somatosensory nervous system[7][8].

5. Headache & orofacial pain: defined as headaches or orofacial pains that occur on at least 50% of the days during at least 3 months.

6. Visceral pain: perceived in the somatic tissues of the body wall (skin, subcutis, muscle) in areas that receive the same sensory innervation as the internal organ at the origin of the symptom (referred visceral pain)[9].

7. Musculoskeletal pain: disease process directly affecting bone(s), joint(s),muscle(s), or related soft tissue(s).


Reference(s)

  1. Bonica JJ. The management of pain. Philadelphia: Lea & Febiger, 1953.
  2. Treede RD. Entstehung der Schmerzchronifizierung. In: Baron R, Koppert W, Strumpf M, Willweber-Strumpf A, editors. Praktische Schmerztherapie. Heidelberg: Springer, 2011. p. 3–13.
  3. Merskey H, Bogduk N. Classification of chronic pain. 2nd ed. Seattle: IASP Press, 1994. p. 1.
  4. Macrae WA. Chronic post-surgical pain: 10 years on. Br J Anaesth 2008; 101:77–86.
  5. Haroutiunian S, Nikolajsen L, Finnerup NB, Jensen TS. The neuropathic component in persistent postsurgical pain: a systematic literature review. PAIN 2013;154:95–102.
  6. Jensen MP, Chodroff MJ, Dworkin RH. The impact of neuropathic pain on health-related quality of life: review and implications. Neurology 2007;68: 1178–82.
  7. International Organization for the Study of Pain (IASP). Available at:(http://www.iasp-pain.org/Education/Content.aspx? ItemNumber51698&navItemNumber5576). Accessed November 11, 2014 and archived: http://www.webcitation.org/6U0KsS4QV.
  8. Jensen TS, Baron R, Haanpa¨ a¨ M, Kalso E, Loeser JD, Rice AS, Treede RD. A new definition of neuropathic pain. PAIN 2011;152:2204–5.
  9. Giamberardino MA, Affaitati G, Costantini R. Referred pain from internal organs. In:Cervero F, Jensen TS, editors. Handbook of clinical neurology. Amsterdam: Elsevier, 2006. p. 343–61.


Cifu, D.X. (2020). Braddom’s physical medicine and rehabilitation. Elsevier. Get it on Amazon.
Cuccurullo, S. (2019). Physical medicine and rehabilitation board review. New York: Demosmedical. Get it on Amazon.
O’Young, B., Young, M.A. and Stiens, S.A. (2008). Physical Medicine and Rehabilitation Secrets. Mosby. Get it on Amazon.