Chronic pain

In order to better understand the nature of chronic pain, we will first start with the definition of pain. 

Pain comes from the Latin word poena, which means punishment. (Mosby's Medical Dictionary, 2009). It is an unpleasant sensation, and it can occur in different degrees of severity. It may be a consequence of injury, disease, and/or emotional disorder. (The American Heritage Medical Dictionary, 2007)

Pain can be classified into two basic types: acute, and chronic. (Cole, 2003, page 24)

Acute pain serves a protective purpose. It warns us of potential danger, and serves to limit the use of a injured or diseased body part (Cole, 2003, page 24). Acute pain lasts less than 12 weeks (The British Pain Society, 2008), and is directly related to tissue damage (International Association for the Study of Pain, 2011). Dental work, surgery, labor and childbirth, burns, cuts, and broken bones are all typical injuries that can provoke acute pain. (Brenman, 2007)

Chronic pain does not have any protective purpose, and it may interfere with productive activity (Cole, 2003, page 24). It is defined as a continuous, long-term pain that lasts more than 12 weeks, or after the time that healing would have been thought to have occurred in pain after trauma or surgery. (The British Pain Society, 2008)

This basic definition of chronic pain may be complemented by adding important details such as ''pain that continues or recurs over a prolonged period'', or that may be ''caused by various diseases or abnormal conditions''. (Mosby's Medical Dictionary, 2009)

Chronic pain may or not be less intense than acute pain. A person suffering chronic pain will not usually display increased pulse and rapid respiration, since these reactions to (acute) pain cannot be sustained for a long period of time. (Mosby's Medical Dictionary, 2009). Chronic pain can also refer to pain from cancer, degenerative/chronic diseases, or from an unidentified cause''. (Gale Encyclopedia of Medicine, 2008)

Chronic pain has been established as a nursing diagnosis by the North American Nursing Diagnosis Association. NANDA defines it as an unpleasant sensory and/or emotional experience of mild to severe intensity, which may arise from actual or potential tissue damage, with a sudden or slow onset, and no predictable end. (Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, 2003)

The term chronic pain may also be used as a synonym for chronic pain syndrome. Chronic pain syndrome (CPS) is a ''a constellation of syndromes that usually do not respond to the medical model of care." (Singh, Patel and Gallagher, 2011, page 1). 

Chronic pain has caused such a degree of suffering in our society, that it has prompted the U.S. government to designate the next 10 years as the "Decade of Pain Control and Research". According to the American Academy of Pain Medicine (2011), more than 1.5 billion people around the world suffer from chronic pain. In the US, the number of people suffering from chronic pain is 116 million; that is more than diabetes, cancer and heart disease sufferers combined (page 2). 

Chronic pain seems to affect more women than men worldwide. According to the International Association for the Study of Pain (2011), 80% to 90 % of fibromyalgia (chronic widespread pain) sufferers are women. Other types of chronic pain that affect women are rheumatoid arthritis, osteoarthritis, chronic pelvic pain and migraine headache. 

Chronic pain can be the result of an initial physical or emotional/psychological trauma. Trauma is the Greek word for ''wound'' and can have either a physical or emotional cause (Mosby's Medical Dictionary, 2009)

When one thinks of trauma, one may not necessarily think of typical common accidents. Falls, sports injuries, surgery (especially in the first 3 years of life) and/or auto accidents are all types of physical accidents that may prove to be highly traumatic and/or psychologically scarring to an individual. (Smith and Segal, 2011)

Emotional and/or psychological events that can be traumatic are the sudden death of a close friend or family, the breakup of a significant relationship, a humiliating or deeply disappointing experience, or the discovery of a life-threatening illness or disabling condition. (Smith and Segal, 2011)

Other sources of physical and/or psychological traumatic experiences can come from war, torture (Amris and Williams, 2007, page 1), natural disasters, and violent attacks. They may also be a result of the continuous stress of living in a war-torn area, crime-ridden city, or dealing with a serious illness. (Smith and Segal, 2011)

Childhood trauma can also negatively affect an individual's responses to trauma later in life. While in normal circumstances a person may have a relatively quick recovery from an accident, surgery or illness, a victim of childhood trauma may suffer from that same type of accident or illness for a much longer period of time. Typical examples of childhood trauma include: unstable or unsafe environment, separation from a parent, serious illness, intrusive medical procedures, sexual, physical, or verbal abuse, domestic violence, neglect, and/or bullying. (Smith and Segal, 2011)

People respond to traumatic experiences in different ways. Anger, guilt, sadness, anxiety are all common responses to trauma. Others may develop a physical response, even if the trauma was purely emotional and/or psychological in nature, and no physical harm was ever experienced. Typical symptoms may include muscle tension, fatigue and pain. (Smith and Segal, 2011)

According to the American Academy of Pain Medicine (2011), the most common types of chronic pain in the United States are: low back pain (25%) severe headache or migraine pain (15%), neck pain (15%) and facial ache or pain (4%). More than 26 million Americans suffer from chronic back pain, which makes them ''more than four times as likely to experience serious psychological distress as people without low back pain." (page 2)

People may also develop chronic pain as a response to an inability to cope with daily psychological stresses such as work, family, or their physical surroundings. People suffering from psychological problems such as major depression, or hypochondriasis, are also more prone to suffer from chronic pain syndrome. (Nazario, 2010)

There is still considerable controversy when it comes to the origin, diagnosis and treatment of chronic pain. What makes its diagnose and treatment difficult is the fact that pain is highly subjective. People feel and experience pain in different ways; they also respond to treatment in a varying, and sometimes conflicting, manner. (Freudenrich, 2011)

Chronic pain, and preoccupation with the pain, can cause depression and irritability, which can also lead to insomnia. According to the Ohio State University Medical Center (2011), this vicious cycle is known as the ''terrible triad'': a state of suffering, sleeplessness, and sadness. Chronic pain sufferers may also become drug-dependent, opt to receive repeated surgeries, or look for questionable treatments. 

There have been numerous studies done on chronic pain diagnosis and treatment. The Clinical Journal of Pain (2011), for example, lists studies which involve cost and effectiveness of both treatment and outcome, and look at possibilities such as conservative (standard) care, pharmacological treatments, surgery, and pain rehabilitation programs.

The American Psychological Association (2011) has also published several studies on the research and development of psychological therapies that treat chronic pain. (Molitor, Keck and Nordal, 2011)

Medications, acupuncture, electrical stimulation, brain stimulation, exercise, hypnosis, surgery, low-power lasers, magnets, narcotics, nerve blocks, opioids, physical therapy and placebos are an example of the many methods that may be employed in the treatment of chronic pain (National Institute of Neurological Disorders and Stroke, 2011). 

A new, important method in treating sufferers of chronic pain is helping them understand the causes of their pain (National Institute of Neurological Disorders and Stroke, 2011). Psychological techniques and therapies have also become greatly effective tools in the management of chronic chronic pain (Molitor, Keck and Nordal, 2011).

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