Overview Of Pain


Chronic pain is often defined as any pain lasting more than 12 weeks. Whereas acute pain is a normal sensation that alerts us to possible injury, chronic pain is very different. Chronic pain persists—often for months or even longer.

Chronic pain may arise from an initial injury, such as a back sprain, or there may be an ongoing cause, such as illness. However, there may also be no clear cause. Other health problems, such as fatigue, sleep disturbance, decreased appetite, and mood changes, often accompany chronic pain. Chronic pain may limit a person’s movements, which can reduce flexibility, strength, and stamina. This difficulty in carrying out important and enjoyable activities can lead to disability and despair.


Pain is a very personal and subjective experience. There is no test that can measure and locate pain with precision. So, health professionals rely on the patient’s own description of the type, timing, and location of pain. Defining pain as sharp or dull, constant or on-and-off, or burning or aching may give the best clues to the cause of the pain. These descriptions are part of what is called the pain history, taken during the start of the evaluation of a patient with pain.

Since chronic pain may occur in a variety of locations in the body and for many different reasons, patients and their health professionals need to work together to identify the causes and symptoms of that pain and how it can be relieved.

Although technology can help health professionals form a diagnosis, the best treatment plans are tailored to the person, with input from healthcare team members, who each have different training backgrounds and understand chronic pain. The person with pain and his or her loved ones also must be actively involved in the treatment.

In deciding how to treat chronic pain, it is important to distinguish between CHRONIC PAIN and a CHRONIC PAIN SYNDROME. A chronic pain syndrome differs from chronic pain in that people with a chronic pain syndrome, over time, develop a number of related life problems beyond the sensation of pain itself. It is important to distinguish between the two because they respond to different types of treatment.
Most individuals with chronic pain (estimates are about 75% nationally) do not develop the more complicated and distressful chronic pain syndrome. Although they may experience the pain for the remainder of their lives, little change in their daily regimen of activities, family relationships, work, or other life components occurs. Many of these individuals may never seek treatment for pain. Those that do often require less intensive, single-modality interventions.
The 25% who do develop chronic pain syndromes tend to experience increasing physical, emotional, and social deterioration over time. They may abuse pain medications (usually narcotics and/or muscle relaxants), and typically require more intensive, multimodal treatment to stop the cycle of increasing dysfunction.

Symptoms Of Chronic Pain Syndromes

  • Reduced activity
  • Impaired sleep
  • Depression
  • Suicidal ideation
  • Social withdrawal
  • Irritability
  • Fatigue
  • Memory and cognitive impairment
  • Poor self-esteem
  • Less interest in sex
  • Relationship problems
  • Pain behaviors
  • Kinesiophobia, or the avoidance of certain movements or activities due to fear of reinjury or re-experiencing the pain.
  • Helplessness
  • Hopelessness
  • Alcohol abuse
  • Medication abuse
  • Guilt
  • Anxiety
  • Misbehavior by children in the home
  • Loss of employment

Fake versus Real Pain

Perhaps no other issue has done as much damage to individuals with chronic pain as this one. Many health care professionals fail to recognize the complexity of pain and believe that it can be dichotomized based on the presence or absence of physical findings, secondary gain, or prior emotional problems. As a result, countless individuals have been informed that "The pain is all in your head". And if these same individuals react with anger and hurt, we (health care staff) are ready to compound the problem by labeling the individual as hostile, demanding, or aggressive.

In actuality, the correspondence between physical findings (e.g., MRI, CT, or X-ray results) and pain complaints is fairly low (generally, 40% to 60%). Individuals may have abnormal tests (e.g., MRI shows a "bulging disk" or a herniation) with no pain, or substantial pain with negative results. This is because chronic pain can develop in the absence of the gross skeletal changes we are able to detect with current technology. Muscle strain and inflammation are common causes of chronic pain, yet may be extremely difficult to detect. Other conditions may be due to systemic problems (e.g., HIV-related pain or sickle cell pain), trauma to nerves (e.g., post-thoracotomy pain), circulatory difficulties (e.g., diabetic neuropathy), CNS dysfunction (e.g., central pain syndromes), or many others. Yet, in each of these cases we may be unable to "see" the cause of the problem. Instead, we have to rely on the person’s report of their pain, coupled with behavioral observations and indirect medical data. This does not mean that the pain is psychogenic. Rather, it means that we are less able to detect or understand its cause.


With chronic pain, the goal of treatment is to reduce pain and improve function, so the person can resume day-to-day activities. Patients and their healthcare providers have a number of options for the treatment of pain. Some are more effective than others. Whatever the treatment plan, it is important to remember that chronic pain usually cannot be cured, but it can be managed. The following treatments are among the most common ways to manage pain.

Medications, acupuncture, electrical stimulation, nerve blocks, or surgery are some treatments used for chronic pain. Less invasive psychotherapy, relaxation therapies, biofeedback, and behavior modification may also be used to treat chronic pain. These methods can be powerful and effective in some people. When it comes to chronic pain treatment, many people find adding complementary or alternative medicine (CAM) approaches can provide additional relief. These may include tai chi, acupuncture, meditation, massage therapies, and similar treatments.

Self-management of chronic pain holds great promise as a treatment approach. In self-management programs, the individual patient becomes an active participant in his or her pain treatment—engaging in problem-solving, pacing, decision-making, and taking actions to manage their pain. Although self-management programs can differ, they have some common features. Their approach is that the person living with pain needs help learning to think, feel, and do better, despite the persistence of pain. Improving communication with the healthcare provider is part of that empowerment.

Self-management programs have had success, regardless of the underlying conditions, Individuals who participate in these programs have significantly increased their ability to cope with pain. They improve their ability to be active, healthy, and involved members of their communities. In fact, new research suggests that the best self-management programs teach people different ways of thinking about and responding to pain, making their actions to relieve it more effective.

What Your Healthcare Provider Will Want to Know About Your Pain History

  1. When did your pain start? What brings on your pain?
  2. How long does your pain last? Does your pain come and go, or is it there all the time?
  3. Where is your pain located? Does it move to other parts of your body?
  4. What makes it better? What makes it worse?
  5. How has your pain affected your mood and daily activities?
  6. What words would you use to describe your pain; for example: burning, prickling, tingling, sharp, dull, stabbing, aching?
  7. What have you tried to relieve your pain? Include prescription and over-the-counter drugs, as well as non-medicine treatments (meditation, acupuncture, etc.).
  8. Are there any other symptoms with your pain?
  9. What are your goals for pain relief and daily activity?

If you are taking any medicines, tell your healthcare provider the following:

• The names of your medicines. Be sure to include any prescription and over-the-counter medicines, as well as herbal remedies.
• How long you have been taking them.
• How well they work.
• How much you take and how often.
• Any bad reactions or side effects, such as increased drowsiness, dry mouth, rash, or other reactions.

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