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GENERAL CONSIDERATIONS

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Pain is defined by the International Association for the Study of Pain as “an unpleasant sensory or emotional experience associated with actual or potential tissue damage or described in terms of such damage.” This definition emphasizes that the pain experience is multidimensional and may include sensory, cognitive, and emotional components. Additionally, the latter part of the definition allows for the possibility, as in chronic pain states, that the overt tissue damage may no longer be present. Pain persisting for >3–6 months is defined as chronic pain. Pain persisting for 3 months, however, is unlikely to resolve spontaneously and may continue to be reported by patients after 12 months. In addition, many of the secondary problems associated with chronic pain, such as deconditioning, depression, sleep disturbance, and disability, begin within the first few months of the onset of symptoms of pain. Studies indicate that early patient identification and treatment are essential to reduce pain chronicity and prevent further disability.

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Chronic pain is one of the most common complaints seen in primary care. A survey of 89 general practices in Italy showed pain as a complaint for 3 of every 10 patients seen. Among these patients, pain was chronic for over half (53%). According to a recent Center for Disease Control and Prevention (CDC) survey, women are twice as likely as men to have chronic pain conditions such as migraines. A monograph from the Institute of Medicine, Relieving Pain in America, notes that 100 million Americans experience chronic pain with estimated annual medical and indirect costs of approximately $600 billion. Low back pain is most common, followed closely by migraines, neck pain, and other arthritic joint pain complaints.

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Committee on Advancing Pain Research Care, and Education–Board on Health Sciences Policy. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research. Institute of Medicine; June 29 , 2011.
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Koleva  D  et al.. Pain in primary care: an Italian survey. Eur J Public Health. 2005; 15:475.
[PubMed: 16150816]
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Schiller  JS, Lucas  JW, Peregoy  JA. Summary health statistics for U.S. adults: National Health Interview Survey, 2011. National Center for Health Statistics. Vital Health Stat. 2012; 10(256). 2012.

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PATHOGENESIS

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Acute pain occurs following some form of tissue injury (eg, ankle sprain) and is treated with RICE (rest, immobilization, compression, and elevation) and pain-soothing treatments, such as heat, ice, and massage. During the acute period of tissue injury and healing, patients appropriately limit activity to reduce risks of further injury (eg, development of a Charcot joint in a patient with neuropathy who risks aggravation of the injury because of impaired sensation). Studies show that patients improve best after acute injury when they reduce activities to what can be tolerated and allow healing to occur, in contrast to patients treated with either bed rest or acute physical therapy.

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Chronic pain occurs after ...

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