Chronic Pain and Diagnosis
Chronic pain usually serves little or no physiologic role and, in contrast to acute pain, it is perhaps best viewed as a disease state, not a symptom. Pain-related problems, particularly chronic pain management, are among the most challenging clinical problems confronted by clinicians ( Meldrum, 2003, JAMA;290(18):2470-2475).
The burden of moderate to severe chronic pain is highest among the poor, the uninsured, and those belonging to ethnic minorities Sturm & Gresenz, 2002, BMJ, 2002;324-20-23. Poor individuals may be more subject than others to hazardous work or living conditions that may lead to physical injury. When added to the daily difficulties of living in poverty, pain may make the simple act of living one’s life extremely difficult.
General Diagnosis Approach: The first step for health providers are to obtain a complete history of events that triggered the pain, ascertain how the pain interferes with the patient’s daily functioning and quality of life, determine the level of pain, and review prior diagnostic evaluations and treatments.
Chronic Pain Interventions
The history should elicit the patient’s broader life experiences with pain. Careful attention may provide insight into what is needed for effective treatment. Pain associated with a psychological traumatic event may require treatment for the emotional impact of that trauma or loss. Pain that interferes with work may respond to vocational retraining. Pain caused by an underlying chronic disease may improve through education or support groups that bolster coping skills.
A mutually agreed upon treatment plan should address four important factors: the underlying cause of the pain, level of pain, functional limitations, and realistic treatment goals. The health provider should try to form a partnership with the patient (and his/her support people) that is marked by mutual trust and an understanding of the challenges that may lie ahead. Effective pain management-often requiring extensive evaluations and treatments that never fully eliminate pain or completely restore physical function is one such challenge.
Social Issues & Barriers to Care
Health providers must rely primarily on patient report of the presence of pain and its severity. Although at once universal and subjective, pain varies in its expression both among and within individuals ( Green, Anderson, & Baker, 2003, Pain Medicine; 4:277-294.) The response to pain may be histrionic or stoic, panicked or accepting, help-seeking or highly skeptical for help (Bertakis, Azari, & Callahan, 2004, Annals of Family Medicine; 2:224-230). Often there are multiple potential causes of physical and emotional pain. Patients may have trouble communicating their subjective symptoms. Hence a holistic understanding of the patient is often as important as defining pain according to traditional classifications.
Pain can be modulated by a variety of external factors, including the effect of the pain on current life activities; learned behaviors and beliefs from family, cultural, or socioeconomic background; the meaning of the event that caused the pain; and underlying mental health disorders. Pain may lead to anxiety or depression, and primary anxiety and depression often amplify or even cause complaints of physical pain (Dersh, Polatin, & Gatchel, 2002, Psychosomatic Medicine; 64:773-786).
Chronic Pain Resources
American Pain Society
Pain and Policy Studies Group
Crisis Center Alachua County (Suicide Prevention, referrals for substance abuse, domestic violence) (352) 264-6785
Vocational Rehabilitation 352-955-3200
Chronic Pain Facts
Nine out of ten U.S.citizens aged 18 or older suffer pain at least once a month, 42% report experiencing pain every day, and nearly one in ten adults lives in moderate to severe chronic pain (American Medical Association).
CNP, pain that lasts six months or more and does not respond well to conventional medical treatment, affects more people than any other type of pain. Thirty-four million Americans suffer from chronic pain, and most are significantly disabled by it, sometimes permanently. Brownlee, Shannon, and Joannie M. Schrof. “The Quality of Mercy.” U.S. News and World Report, March 17, 1997: 55-57, 60-62, 65, 67.
The economic impact of CNP is staggering. Back pain, migraines, and arthritis alone account for medical costs of $40 billion annually, and pain is the cause of 25% of all sick days taken yearly. The annual total cost of pain from all causes is estimated to be more than $100 billion. Brownlee, Shannon, and Joannie M. Schrof. “The Quality of Mercy.” U.S. News and World Report, March 17, 1997: 55-57, 60-62, 65, 67.