Chronic pain

Pain : an unpleasant sensory and emotional

experience associated with actual or
potential tissue damage, or described in
terms of such damage

Chronic pain : is defined as pain that

persists longer than the temporal course
of natural healing, associated with a
particular type of injury or disease process
 Functional anatomy
The anatomy of the nociceptive system can be grossly divided into the

perirpheal nervous system

central nervous system
 Nociception
convey information regarding Nociceptors •
damage or trauma from the body to the
central nervous system, a process called
nociception, where it is interpreted by the
brain as pain. Nociception occurs in any
tissue or organ in which pain signals arise
.secondary to a disease process or trauma
If the pain occurs due to dysfunction or •
damage to nerves themselves, it is called
.neuropathic pain
 Pathophysiology
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
 Classification
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.
 Diagnoses
Pain may be a response to injury or any number of •
disease states that provoke nociception. Advances in
imaging studies and electrophysiological studies allow us
to gain a deeper insight into the characteristics and
properties associated with the phenomenon of chronic
.pain
Some chronic pain may be psychosomatic. Indicators •
include diffuse, difficult to describe symptoms, especially
if they moved around the body and have no obvious
verifiable physical cause. Having unexplained pain in
.three or more body parts is especially indicative
 Related sequelae
Chronic pain may cause other symptoms or
conditions, including depression and
anxiety. It may also contribute to
decreased physical activity given the
apprehension of exacerbating pain. Very
little work has been done on the cognitive
effects of chronic pain, with most of the
publications focussing on the effects of
cognition on pain but only 5% examining
.the effects of pain on cognition