Pain in its many forms is one of the
major reasons we seek medical attention. Over 65 million
Americans suffer from painful illnesses every year,
and over 90% of all illnesses are first noticed because
of pain. Chronic pain can lead to depression, interpersonal
problems, decreased productivity, and unemployment.
Pain may arise from a discrete cause, such as postoperative
pain or pain associated with a malignancy, or it may
be a syndrome in which pain is the primary problem,
such as neuropathic pains or headaches. The diagnosis
of painful syndromes relies on the interpretation of
patient history; review of laboratory, imaging and electrodiagnostic
studies; occupational and avocational assessments; and
physical examination.
Acute pain is an alert that something is wrong within
the body. It protects the body from further damage and
thus can be beneficial. When pain does not resolve after
medical treatment and is prolonged, it no longer serves
a protective function. Chronic pain is a complex medical
condition that refers to pain that has lasted beyond
the expected time for a particular disease, syndrome,
or injury. Such pain can be caused by a variety of conditions
including crush injury, nerve or spinal cord injury,
spinal cord lesions, or lesion and/or injury to the
brain. It is frequently severe enough to limit a person's
activity and make it difficult to function at work or
at home. To further complicate matters, a variety of
psychological and behavioral changes occur in patients
with long-standing pain.
Chronic pain can occur long after nerve and tissue damage
has apparently healed. In this situation pain seems
to come from an injury that is not really there. It
is a problem caused by pain nerves incorrectly telling
the brain that a severe injury is present. The result
is severe pain without an injury to cause it. Nonetheless,
the pain signals sent to the brain make the pain very
real to the person experiencing it. Chronic pain can
result in severe mental stress and sometimes major behavioral
changes or depression. These problems sometimes result
in patients becoming so depressed that they are not
able to work or carry on activities of daily living.
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