Chronic pain

Chronic pain

Chronic pain is defined as pain that persists or recurs for more than 3 months. In chronic pain syndromes, pain can be the sole or a leading complaint and requires special treatment and care. This could be ‘chronic primary pain’, which may be conceived of as a disease in its own right, for example in condi tions such as fibromyalgia or non-specific low-back pain. In six other subgroups, pain is secondary to an underlying disease: chronic cancer-related pain, chronic neuropa thic pain, chronic secondary visceral pain, chronic post-traumatic and postsurgi cal pain, chronic secondary headache and orofacial pain and chronic secondary musculoskeletal pain. These conditions are summarised as ‘chronic secondary pain’, in which pain may at least initially be conceived as a symptom. In sur gical practice, patients with chronic pain may present for treatment of the cause (e.g. pancreatitis, malignancy) or concomitant benign pathology . Almost 50 years ago, using gate theor y , Melzeck and Wall proposed pain to be not only subjec tive but also a multidimensional experience that incorporates sensory/discriminative, motivational/a ff ect and cognitive aspects. Recent guidance from the International Association for the Study of Pain highlights tha t the multidimensional aspect is one of the key components, hence the treatment of chronic pain involves a multidisciplinary multimodal approach. Mechanistically , chronic pain may be classified into: /uni25CF Nociceptive pain , which may result from musculoskel etal disorders or cancer activating cutaneous nociceptors (pain receptors). Prolonged ischaemic or inflammatory processes result in sensitisation of peripheral nociceptor and altered activity in the central nervous system, leading to exaggerated responses in the dorsal horn of the spinal cord. The widened area of hyperalgesia and increased sen sitivity (allodynia) have been attributed to increased trans mission in the central nervous system. the peripheral or central nerves (excluding the ‘physiolog - ical’ pain due to noxious stimulation of the nerve termi - nals). It is classically of a ‘burning’, ‘shooting’ or ‘stabbing’ type and may be associated with allodynia, numbness and diminished thermal sensation. It is poorly responsive to - opioids. Examples include trigeminal neuralgia, posther - petic neuropathy and diabetic neuropathy . - Chronic pain

Chronic pain is defined as pain that persists or recurs for more than 3 months. In chronic pain syndromes, pain can be the sole or a leading complaint and requires special treatment and care. This could be ‘chronic primary pain’, which may be conceived of as a disease in its own right, for example in condi tions such as fibromyalgia or non-specific low-back pain. In six other subgroups, pain is secondary to an underlying disease: chronic cancer-related pain, chronic neuropa thic pain, chronic secondary visceral pain, chronic post-traumatic and postsurgi cal pain, chronic secondary headache and orofacial pain and chronic secondary musculoskeletal pain. These conditions are summarised as ‘chronic secondary pain’, in which pain may at least initially be conceived as a symptom. In sur gical practice, patients with chronic pain may present for treatment of the cause (e.g. pancreatitis, malignancy) or concomitant benign pathology . Almost 50 years ago, using gate theor y , Melzeck and Wall proposed pain to be not only subjec tive but also a multidimensional experience that incorporates sensory/discriminative, motivational/a ff ect and cognitive aspects. Recent guidance from the International Association for the Study of Pain highlights tha t the multidimensional aspect is one of the key components, hence the treatment of chronic pain involves a multidisciplinary multimodal approach. Mechanistically , chronic pain may be classified into: /uni25CF Nociceptive pain , which may result from musculoskel etal disorders or cancer activating cutaneous nociceptors (pain receptors). Prolonged ischaemic or inflammatory processes result in sensitisation of peripheral nociceptor and altered activity in the central nervous system, leading to exaggerated responses in the dorsal horn of the spinal cord. The widened area of hyperalgesia and increased sen sitivity (allodynia) have been attributed to increased trans mission in the central nervous system. the peripheral or central nerves (excluding the ‘physiolog - ical’ pain due to noxious stimulation of the nerve termi - nals). It is classically of a ‘burning’, ‘shooting’ or ‘stabbing’ type and may be associated with allodynia, numbness and diminished thermal sensation. It is poorly responsive to - opioids. Examples include trigeminal neuralgia, posther - petic neuropathy and diabetic neuropathy . - Chronic pain

Chronic pain is defined as pain that persists or recurs for more than 3 months. In chronic pain syndromes, pain can be the sole or a leading complaint and requires special treatment and care. This could be ‘chronic primary pain’, which may be conceived of as a disease in its own right, for example in condi tions such as fibromyalgia or non-specific low-back pain. In six other subgroups, pain is secondary to an underlying disease: chronic cancer-related pain, chronic neuropa thic pain, chronic secondary visceral pain, chronic post-traumatic and postsurgi cal pain, chronic secondary headache and orofacial pain and chronic secondary musculoskeletal pain. These conditions are summarised as ‘chronic secondary pain’, in which pain may at least initially be conceived as a symptom. In sur gical practice, patients with chronic pain may present for treatment of the cause (e.g. pancreatitis, malignancy) or concomitant benign pathology . Almost 50 years ago, using gate theor y , Melzeck and Wall proposed pain to be not only subjec tive but also a multidimensional experience that incorporates sensory/discriminative, motivational/a ff ect and cognitive aspects. Recent guidance from the International Association for the Study of Pain highlights tha t the multidimensional aspect is one of the key components, hence the treatment of chronic pain involves a multidisciplinary multimodal approach. Mechanistically , chronic pain may be classified into: /uni25CF Nociceptive pain , which may result from musculoskel etal disorders or cancer activating cutaneous nociceptors (pain receptors). Prolonged ischaemic or inflammatory processes result in sensitisation of peripheral nociceptor and altered activity in the central nervous system, leading to exaggerated responses in the dorsal horn of the spinal cord. The widened area of hyperalgesia and increased sen sitivity (allodynia) have been attributed to increased trans mission in the central nervous system. the peripheral or central nerves (excluding the ‘physiolog - ical’ pain due to noxious stimulation of the nerve termi - nals). It is classically of a ‘burning’, ‘shooting’ or ‘stabbing’ type and may be associated with allodynia, numbness and diminished thermal sensation. It is poorly responsive to - opioids. Examples include trigeminal neuralgia, posther - petic neuropathy and diabetic neuropathy . -