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Chronic pain

Editor-in-Chief: Steven D. Feinberg, M.D. Adjunct Clinical Professor, Stanford University School of Medicine, Board Certified, Physical Medicine and Rehabilitation, Board Certified, Electrodiagnostic Medicine, Board Certified, Pain Medicine, Qualified Medical Evaluator (QME); Associate Editor-in-Chief: M.Umer Tariq [1], Parth Vikram Singh, MBBS[2]

Overview

Overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Chronic pain was originally defined as pain that has lasted 6 months or longer. More recently it has been defined as pain that persists longer than the temporal course of natural healing, associated with a particular type of injury or disease process.[1]

The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”[2] It is important to note that pain is subjective in nature and is defined by the person experiencing it, and the medical community’s understanding of chronic pain now includes the impact that the mind has in processing and interpreting pain signals.

As a summary;

  • Chronic pain is defined as pain that continues beyond the recognized time for the body to heal (usually 4-6 weeks)
  • Historically, chronic pain is underdiagnosed, and therefore undertreated
  • Chronic pain becomes a disease state itself without a physiologic role
  • Depending upon the distribution of symptoms, the pain can be categorized as regional or diffuse
  • High rates of psychiatric co-morbidities exist with these conditions

References

  1. ↑ Shipton EA, Tait B (2005). “Flagging the pain: preventing the burden of chronic pain by identifying and treating risk factors in acute pain”. European journal of anaesthesiology. 22 (6): 405–12. PMID 15991501.
  2. ↑ Merskey H (1994). “Logic, truth and language in concepts of pain”. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 3 Suppl 1: S69–76. PMID 7866375.


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Historical Perspective

Historical Perspective

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

References


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Classification

Classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Nociception (pain) may arise from injury or disease to visceral, somatic and neural structures in the body. More broadly pain is described as malignant or non-malignant in origin.[1]

References

  1. ↑ Vanderah TW (2007). “Pathophysiology of pain”. Med. Clin. North Am. 91 (1): 1–12. PMID 17164100.


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Pathophysiology

Pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Functional Anatomy

The anatomy of the nociceptive system can be grossly divided into the peripheral and central nervous system. The peripheral nervous system consists of small myelinated and unmyelinated nerve fibers. These nerve fibers converge into a region of the spinal cord referred to as the dorsal horn. The dorsal horn is the first relay station in pain signal transmission. The next element of pain transmission includes nerve fibers that then travel to the thalamus. From the thalamus the next order of neurons ascend to the limbic system and sensory cortex. This accounts for the affective elements and discriminative of pain respectively.[1][2]

Nociception

The experience of pain biologically is referred to as nociception. Nociception occurs in any tissue or organ in which pain signals arise secondary to a disease process or trauma. The nociception can also occur if there is dysfunction or damage to nerves themselves.[3]

The Pathophysiology of Chronic Pain

Under persistent activation nociceptive transmission to the dorsal horn may induce a wind up phenomenon. This induces pathological changes that lower the threshold for pain signals to be transmitted. In addition, it may generate nonnociceptive nerve fibers to respond to pain signals. Nonnociceptive nerve fibers may also be able to generate and transmit pain signals. In chronic pain this process is difficult to reverse or eradicate once established.[4]

References

  1. ↑ Romanelli P, Esposito V (2004). “The functional anatomy of neuropathic pain”. Neurosurg. Clin. N. Am. 15 (3): 257–68. PMID 15246335.
  2. ↑ Vanderah TW (2007). “Pathophysiology of pain”. Med. Clin. North Am. 91 (1): 1–12. PMID 17164100.
  3. ↑ Merskey H (1994). “Logic, truth and language in concepts of pain”. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 3 Suppl 1: S69–76. PMID 7866375.
  4. ↑ Vadivelu N, Sinatra R (2005). “Recent advances in elucidating pain mechanisms”. Current opinion in anaesthesiology. 18 (5): 540–7. PMID 16534290.


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Causes

Causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Causes

Cancer Pain

Headache

Low Back Pain

Musculoskeletal

Neuropathic

Pelvic/Abdominal

Psychiatric

Miscellaneous

Causes by Organ System

Cardiovascular

Behcet’s disease, Budd-Chiari syndrome, Buerger’s disease, Cholesterol Emboli Syndrome, Cholesterol pericarditis, Chronic Stable Angina, Deep vein thrombosis, Dilated cardiomyopathy, Peripheral artery occlusive disease, Raynaud’s phenomenon, Varicose veins, Vasculitis,

Chemical / poisoning

Lead poisoning,

Dermatologic

Cellulitis, Pilonidal cyst, Plantar fasciitis, Pyoderma gangrenosum,

Drug Side Effect

Opioid-induced hyperalgesia,

Ear Nose Throat

Aphthous ulcer, Otitis media, Plummer-Vinson syndrome, Sinusitis,

Endocrine

Diabetic neuropathy, Hyperthyroidism, Hypothyroidism,

Environmental No underlying causes
Gastroenterologic

Alcoholic Hepatitis, Anal fistula, Ascending cholangitis, Autoimmune Hepatitis, Autoimmune pancreatitis, Barrett’s esophagus, Celiac disease, Cholangiocarcinoma, Cholangitis, Cirrhosis, Colorectal cancer, Crohn’s disease, Esophageal cancer, Fructose malabsorption, Functional bowel disorder, Fundic gland polyposis, Gallbladder cancer, Gallstone Disease, Gastroesophageal reflux disease, Hemorrhoids, Intestinal pseudoobstruction, Irritable bowel syndrome, Ischemic colitis, Peptic ulcer, Ulcerative colitis, Viral Hepatitis ,

Genetic

Cystic fibrosis, Familial dysautonomia, Hurler’s Syndrome,

Hematologic

Acute intermittent porphyria, Acute myeloid leukemia, Atheroembolic disease, Erythromelagia, Leukemia, Post-thrombotic syndrome, Sickle-cell disease,

Iatrogenic

Graft-versus-host disease,

Infectious Disease

Ascaris infection, Chlamydia infection, Dientamoebiasis, Poliomyelitis,

Musculoskeletal / Ortho

Achilles tendinitis, Ankylosing Spondylitis, Baker’s cyst, Carpal tunnel syndrome, Chondromalacia patellae, Degenerative disc disease, DeQuervain’s syndrome, Dermatomyositis, Exostosis, Frozen Shoulder, Gout, Juvenile idiopathic arthritis, Myofascial pain syndrome, Myotonic dystrophy, Osteoarthritis, Osteochondroma, Osteomalacia, Paget’s Disease, Pelvic myoneuropathy, Polymyalgia Rheumatica, Polymyositis, Reactive arthritis, Sciatica, Spinal disc herniation, Spinal Stenosis, Spondylolisthesis, Synovial osteochondromatosis, Temporomandibular Joint Syndrome, Tendinitis, Tennis elbow,

Neurologic

Alexithymia, Amyotrophic lateral sclerosis, Arachnoiditis, Cerebellar Infarction, Cervical radiculopathy, Chronic inflammatory demyelinating polyneuropathy, Guillain-Barre syndrome, Migraine, Multiple Sclerosis, Neurofibromatosis type I, Schwannomatosis, Syringomyelia,

Nutritional / Metabolic

Beriberi, Farber disease, Gaucher’s disease, Metabolic bone disease,

Obstetric/Gynecologic

Chronic pelvic pain, Endometrial cancer, Endometriosis, Pelvic inflammatory disease, Polycystic ovary syndrome,


Oncologic

Cancer Pain, Desmoplastic small round cell tumor, Multiple myeloma, Nasopharyngeal carcinoma, Lymphangiomatosis, Pancreatic cancer, Paraneoplastic syndrome, Sacrococcygeal teratoma,

Opthalmologic

Keratoconjunctivitis sicca, Tolosa-Hunt syndrome,

Overdose / Toxicity No underlying causes
Psychiatric

Conversion disorder, Psychogenic rheumatism,

Pulmonary

Acute Chest Syndrome, Caplan’s Syndrome, Chronic bronchitis, Lung abscess, Lung cancer, Malignant Mesothelioma,

Renal / Electrolyte

Gout, Hypophosphatemia, Interstitial nephritis, Pyelonephritis, Renal osteodystrophy,

Rheum / Immune / Allergy

Angioedema, Ankylosing Spondylitis, Churg-Strauss syndrome, Henoch-Schonlein purpura, Periodic fever syndrome, Reactive arthritis, Rheumatoid arthritis, Sarcoidosis, Sjogren’s Syndrome, Systemic lupus erythematosus,

Sexual Epididymitis,
Trauma

Chronic wound,

Urologic

Interstitial cystitis, Obstructive uropathy,

Miscellaneous Anxiety,

Benign fasciculation syndrome, Chronic Fatigue Syndrome, Chronic functional abdominal pain, Cluster headache,

Causes by Alphabetical Order

(In alphabetical order)


References


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Epidemiology and Demographics

Epidemiology and Demographics

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

References


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Natural History, Complications and Prognosis

Natural History, Complications and Prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

References


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Diagnosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Other Diagnostic Studies

Treatment

Treatment

Medical Therapy | Non-medical Therapy


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