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

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

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

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

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]

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

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]

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]

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]

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

• Bony pain secondary to metastasis
• Postradiation mucositis or neuritis
• Visceral pain secondary to mass effects

• Cervical radiculopathy
• Cluster headache
• Migraine headache
• Temporomandibular Joint Syndrome
• Tension headache

• Facet Syndrome
• Lumbar radiculopathy
• Myofascial pain
• Spinal Stenosis

• Ankylosing Spondylitis
• Bilateral soft tissue Rheumatism
• Dermatomyositis
• Eosinophilia myalgia syndrome
• Fibromyalgia
• Myofascial pain syndrome
• Polymyalgia
• Polymyositis
• Psychogenic rheumatism
• Reiter’s Syndrome
• Repetitive strain syndromes
• Rheumatoid Arthritis
• Silicone implants
• Sjogren’s Syndrome
• Soft tissue injury
• Vasculitis

• Cervical radiculopathy
• Diabetic neuropathy
• Phantom limb
• Post-herpetic neuralgia
• Postoperative thoracotomy
• Reflex sympathetic dystrophy

• Endometriosis
• Fibroids
• Interstitial cystitis
• Irritable Bowel Syndrome

• Anxiety
• Depression
• Emotional, physical, and/or sexual abuse
• Malingering
• Somatization

• Chronic Fatigue Syndrome
• Entrapment neuropathy
• Hypermobility
• Hyperthyroidism
• Hypophosphatemia
• Hypothyroidism
• Metabolic bone disease
• Multiple Sclerosis
• Osteomalacia
• Overuse syndromes
• Paraneoplastic syndrome
• Postviral arthralgia, myalgia

(In alphabetical order)

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

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

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Robert G. Badgett, M.D.[1], Parth Vikram Singh, MBBS[2]

A randomized controlled trial found a reduction in pain and disability although no reduction in opioid use^[1]. The intervention includes 12 modules of learning coping skills. The modules include:

1. Understanding pain/pain education and role of pain coping skills
2. Applying progressive muscle relaxation (PMR) and adaptation model.
3. Activity-rest cycle
4. Pleasant activity scheduling
5. Relaxation mini-practices
6. Pleasant imagery
7. Emotional regulation: leaning in
8. Emotional regulation: leaning out
9. Cognitive restructuring
10. Use of calming self-statements
11. Problem-solving/reinforcing the application of learned skills
12. Relapse prevention and maintenance enhancement training

As alluded to earlier there are other modalities used in the treatment of chronic pain. These include: physical modalities such as thermal agents and electrotherapy. Complementary and alternative medicine, therapeutic exercise and behavioral therapy are also utilized autonomously or in tandem with interventional techniques and conventional pharmacotherapy. This is most often structured in a multidisciplinary or interdisciplinary program.^[2]

Electroanalgesia is a nonpharmacologic pain-management approach that delivers electrical stimulation through cutaneous electrodes to modulate pain signaling. Contemporary forms of electroanalgesia are used primarily in patients with chronic pain and neuropathic pain, particularly when pharmacologic therapies are ineffective or poorly tolerated.^[3]

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