Chronic pain is not an extension of acute pain but rather an evolving process. An initial event results in certain conditioning that produces other changes in peripheral nerves, muscles, spinal cord, and, ultimately, the brain. As time goes by, these higher-level dysfunctions may become independent of the initial problem.
Pain is subjective. Its presence cannot be objectively measured. Even so-called functional MRI cannot distinguish between “psychological” and “physical” pain. Physicians are often challenged in assessing the severity and significance of chronic pain in their patients. Medical professionals and laypeople tend to view pain complaints with suspicion and disbelief. As Elaine Scarry said, “to have great pain is to have certainty, to hear that another person has pain is to have doubt.”
Even when medical tests can provide explanations, the reality is not apparent. For example, in up to 85% of individuals who reported back pain, no obvious cause was identified. That is why the medical community resorted to a dubious definition of “non-specific low back pain.” On the other hand, disc herniations were found in 30% of healthy people who never had any back or leg pain. In many pain conditions (e.g., headaches, fibromyalgia, pain due to whiplash) anatomical abnormality cannot be found. Thus, pain can exist without tissue damage, and tissue damage can exist without pain. There is no “pain thermometer,” and every patient should be evaluated individually. The International Association for the Study of Pain defined pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." This definition is vague and confusing.
Pain is the most common reason for seeking medical attention. Chronic low back pain alone accounts for more disability than any other condition, and headaches are the leading reason for work abstinence.
Chronic pain has the capacity to dominate a person’s existence, contributing to significant functional losses, disability, poor quality of life, depression and anxiety, inadequate sleep, and essentially, ruined personal and family life. This vicious cycle results in Chronic Pain Syndrome. This is essentially an abnormal illness behaviour that consists mainly of excessive adoption of the sick role.
Earlier focused pain management may effectively prevent deterioration in physical and psychological aspects and thwart the development of Chronic Pain Syndrome.