Acute pain is a vital, protective mechanism that permits us to live in an environment fraught with potential dangers. In contrast, chronic pain serves no such physiologic role and is itself not a symptom, but a disease state. It is usually defined as pain which lasts beyond the ordinary duration of time that an insult or injury to the body needs to heal. This is commonly thought of as four to six weeks, although others have chosen three months as the dividing line between acute and chronic pain. The difference is more than semantic; pain that outlasts this period may be a harbinger of a serious condition, in which treatment delay may lead to an irreversible and intractable condition.
Classification of Chronic Pain
A taxonomy of pain has been very difficult to derive for many reasons, not the least of which is the presence of pain as a feature in so many disease states. This coupled with the subjective nature of pain as a symptom, and the wide variety of practitioners and opinions within the field of pain management, has made standardization of pain taxonomy imprecise and complicated.
Nociceptive pain
Nociceptive pain is the perception of nociceptive input described in terms of tissue damage (eg, postoperative pain). Nociceptive pain is further subdivided into somatic and visceral pain.
Somatic pain:
arises from damage to body tissues. It is well localized but variable in description and experience.
Visceral pain:
is pain arising from the viscera mediated by stretch receptors. It is poorly localized, deep, dull, and cramping (eg, appendicitis).
Neuropathic pain
Neuropathic pain is pain arising from abnormal neural activity secondary to disease or injury of the nervous system. It remains persistent without ongoing disease (eg, diabetic neuropathy). Neuropathic pain is further subdivided into the following:
Sympathetically mediated pain:
is pain arising from a peripheral nerve lesion and associated with autonomic changes.
Central pain:
arises from abnormal central nervous system (CNS) activity (eg, post-stroke pain).
Scope of the Problem
The impact of acute and chronic pain on our society is staggering. As one author states, "Throughout the world, chronic pain is the most frequent cause of suffering and disability that seriously impair the quality of life". A National Institutes of Health publication states that chronic pain is the third largest health problem in the world, affecting 65 million Americans in 1982.
Pain-related problems account for up to 80 percent of visits to physicians; the price tag for back pain alone is estimated to be $30 to 50 billion annually in the United States.
Treatment of Chronic Pain
Chronic pain is a summation of physical and psychological derangements. Thus, successful management requires addressing all of its aspects. This begins with making patients aware of what is available therapeutically and explaining what each therapy component offers. There is evidence that combination therapies are more effective than any single approach for maintaining long-term gains.
Nonpharmacologic Therapies
Nonpharmacologic therapies encompass a wide array of treatments, which may be grouped into the physical interventions including physical therapy, acupuncture, chiropractic manipulation, massage, electrical stimulation, and others, and the psychoeducational interventions such as cognitive-behavioral therapy, family therapy, patient education, and psychotherapy.
Other Therapies
There are a variety of treatment options for people with chronic pain. The goal of pain management is to provide symptom relief and improve an individual's level of functioning in daily activities. A number of types of medications have been used in the management of chronic pain, including acetaminophen, ibuprofen, COX-2 inhibitors, aspirin, anti-migraine medications, sedatives, opioids, and antidepressants.
Non pharmacologic agents we use at our clinic and are found to be very beneficial are trigger injections in any region of the body and facets injections in the cervical and lumbar spine.
Please contact us to evaluate your chronic pain and become one of many of our patients with much better control of thier pain and quality of life.