Chronic pain is a confusing term. Most people have difficulty grasping the meaning and significance of daily pain experiences. It has been perplexing even for doctors, specifically when patient complaints seem detached from an appearance. There is no simple way to verify that a person is indeed in pain. A measuring instrument when a person is asked to grade the severity of pain on a so-called numeric scale between 0 and 10 is utterly meaningless in a non-acute setting. Chronic pain is an individual contextual experience, mostly obscured from an observer's eyes. The phenomenon has also become medicalized in modern society. A half-century ago, a 70-year-old would certainly expect to have some "inconveniences" such as morning back stiffness and joint pain. He would never consider visiting a doctor. Currently, people expect to find medical solutions for any age or physiology-related discomfort, let alone pain. We thrive to live pain-free. Nonetheless, allegedly 20-30% of the population affected by chronic pain. It would be wise to examine a cause of this seemingly unsolvable problem. Aside from the obvious reasons, such as the brain, spinal cord or peripheral nerve injuries, cancer and other debilitating conditions, chronic pain may be explained as a maladaptive (dysfunctional) behaviour. In 1987 American Medical Association (AMA) argued that chronic pain syndrome, as opposed to chronic pain, "has the added component of certain recognizable psychological and socioeconomic influences." The AMA stated that chronic pain syndrome has its origin in both iatrogenic (caused by medical treatment) factors, such as prolonged use of passive physiotherapy and inactivity, and nomogenic factors (nomogenesis refers to abnormal illness behaviour functionally related to social legislation that rewards complaints of pain, suffering, and disability).
It was initially assumed that psychological factors would require some time to have an impact following an acute injury, possibly due to avoidance learning leading to disuse, a concept now challenged. For example, a longitudinal evaluation of the recovery of 117 individuals from an acute back pain episode discovered that "there was no evidence of chronic pain evolving and growing, but rather of the persistence of the acute presentation." Although the AMA clearly stated that chronic pain syndrome does not constitute a mental health problem, the diagnosis is often equated with the psychiatric diagnosis of pain disorder associated with psychological factors.
A common delineator of chronic pain syndrome is individual suffering endorsed by medical, societal, and environmental factors. Pain is an essential and evolutionary useful sensation alerting individuals to avoid further injury (e.g., quickly remove finger from a stove) and provide an educational experience (e.g., to mix hot and cold water before taking a shower). Chronic pain has no adaptogenic role. It is a nuisance, an obstacle, and an enemy. Yet, it has a physiological, or more accurate, pathophysiological role in modifying human behaviour. Consciously or subconsciously, it can be useful to avoid responsibilities, receive attention, obtain disability benefits, and escape into artificial existence supported by chemical coping (e.g., opioids). Pain is a function of the brain. Thus, chronic pain syndrome is a disease of the central nervous system with its somatic (e.g., diffuse pain, decreased range of motion, sensory and motor abnormalities), psychological (e.g., depression, catastrophizing, poor sleep, personality changes, memory loss) and social (e.g., loss of income, social withdrawal) aspects. There is no doubt that social contracts play a significant role in the development and maintaining of chronic pain syndrome. However, the affected person has a lower quality of life on the individual level than a patient with a heart attack.
Although multidisciplinary pain management has demonstrated efficacy for pain reduction and functional recovery, only motivated patients are deemed to benefit from these costly and lengthy programs. Therefore, there is a need for socially responsible and effective actions focused on the support and transformation of people suffering from chronic pain. Humans should learn from social animals. A flock of geese will not carry a weak bird on their wings but rather surround it and encourage it to keep flying to the destination. Motivation for goal setting and cheering up personal achievements are probably the most critical steps to recovery. There is no doubt any beginning is complicated and thorny. Daily ratification and encouragement would often be necessary to change harmful habits and to break self-damaging routines. However, as new patterns are developed, people may observe positive changes that will establish positive-loop feedback, encouraging further progress. People who could reconnect with themselves and society may not stop having pain because of the underlying conditions. Still, they may become merely detached from the construct of suffering. Once the issue regressed to an unpleasant but mundane experience, no medical attention is necessary. The doctor's role is not just to treat the ill when medically possible but also to facilitate personal and community transformation as an educator and public advocate.