An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage (International Association for the Study of Pain). Chronic pain is different than acute pain. Chronic pain is defined as pain that lasts or recurs for longer than 3 months. Chronic pain is one of the most common reasons why adults visit health care professionals.
The prevalence of chronic pain in India is 19.3%. There is a higher prevalence in females (25.2%). Pain prevalence increases steeply beyond the age of 65 years old (2).It causes restrictions in mobility and daily activities, dependence on opioids, anxiety and depression, and poor perceived health or reduced quality of life. Chronic pain is a major healthcare problem. Although acute pain may reasonably be considered a symptom of a disease or trauma which may successfully be treated. However, CP may be considered a disease in its own.
Chronic primary pain is defined as pain in one or more anatomical regions that 1) persists or recurs for longer than 3 months 2) is associated with significant emotional distress (eg, anxiety, anger, frustration, or depressed mood) and/or significant functional disability (interference in activities of daily life and participation in social roles), 3) and the symptoms are not better accounted for by another diagnosis.
In other words, the experience of chronic pain should be sufficiently concerning for the person to seek help for it. As in all conditions, before a diagnosis is made as chronic pain, it is important to rule out any other condition.
Chronic pain has various dimensions to it. All dimensions should fit in the following framework to get a comprehensive overview of all problems faced by the individual (ICF format).
Classification of Chronic Pain:
Many chronic pain conditions have a very obscure etiology and pathophysiology, but they are characterized by a complex interplay of biological, psychological, and social factors.
Chronic Pain does not always respond to conventional curative treatments and can have a devastating impact on an individual’s ability to function and perform life roles in the way they would like. Psychological approaches to pain management have been advocated for over 40 years. Evidence supports that combining physiotherapy and psychological approaches improves physical function in chronic pain.
Physiotherapy varied from a general exercise protocol including a range of motion exercises, strengthening and cardiovascular exercise, manual therapy (spinal and peripheral joint mobilization) in combination with exercises for strengthening and postural control. Modalities like hot water fomentation may be used in adjuvant to exercise therapy.
Psychological interventions are based upon a cognitive-behavioural model, Functional Behavioral Analysis approach, operant behavioural approach, problem-solving, graded activity and modification of thoughts and pain behaviours.
Following is an example of treatment guidelines for the treatment of CRPS (Chronic RSD).
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