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 longer than 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.
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%). Women were more likely than men to report both acute (1.2:1) and chronic pain (1.8:1). The most common type of pain was musculoskeletal (63%). Similarly, a survey of over 10,000 women attending general practices identified a chronic pain complaint in 38% of women, with over 80% consulting their physician for their chronic pain complaint. The most common site for chronic pain was the back (54%).
Costs related to chronic pain are high. A survey of an employer claims' database showed annual direct plus indirect costs for employees with painful conditions were 1.5-3.5 times greater than those for the average employee ($7088-16,874 vs $4849; P <0.01). Of the costs, about 60% were attributed to direct health care expenses. Among patients with low back pain, there is an estimated direct cost for medical expenses of $357 per month.
Koleva D et al: Pain in primary care: an Italian survey. Eur J Public Health 2005;15:475.
Ritzwoller DP et al: The association of comorbidities, utilization and costs for patients identified with low back pain. BMC Musculoskelet Disord 2006;7:72.
Smith BH et al: Royal College of General Practitioners' Oral Contraception Study: is chronic pain a distinct diagnosis in primary care? Evidence arising from the Royal College of General Practitioners' Oral Contraception Study. Fam Pract 2004;21:66.
White AG et al: Economic burden of illness for employees with painful conditions. J Occup Environ Med 2005;47:884-892.
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 ...