What is Chronic Pain?

The following is the American Medical Association Diagnostic Characteristics of Chronic Pain Syndrome. The presence of two or more of the following characteristics should be considered to establish a presumptive diagnosis of chronic pain syndrome.

1. Duration

In the past, the term "chronic pain" has been applied to pain of greater than 6 months duration; however, current opinion is that the chronic pain syndrome can be diagnosed as early as 2 to 4 weeks after its onset. Prompt evaluation and treatment are essential.

2. Dramatization

Patients with chronic pain display unusual verbal and nonverbal pain behavior. Words used to describe the pain are emotionally charged, affective, and exaggerated. Patients may exhibit maladaptive, theatrical behavior, such as moaning, groaning, gasping, grimacing, posturing, or pantomiming.

3. Diagnostic Dilemma

Patients tend to have extensive histories of evaluations by multiple physicians. The patient has undergone repeated diagnostic studies, despite which the clinical impressions tend to be vague, inconsistent, and inaccurate.

4. Drugs

Substance dependence and abuse involving drugs and alcohol is a frequent concomitant. Patients are willing recipients of multiple drugs, which may interact adversely. Often they consume excessive amounts of prescribed drugs. These patients become dependent on their physicians and demand excessive medical care. They expect passive types of physical therapy over long periods of time, but these provide no lasting benefit. They become dependent on their spouses and families and relinquish all domestic and social responsibilities.

5. Depression

The condition is characterized by emotional upheaval. Patients tend to have psychological test results that suggest depression, hypochondriasis, and hysteria. Cognitive aberrations give way to unhappiness, depression, despair, apprehension, irritability, and hostility. Coping mechanisms are severely impaired. Low self-esteem results in impaired self reliance and increased dependence on others.

6. Disuse

Prolonged, excessive immobilization results in secondary pain of musculoskeletal origin. Self imposing splinting may be validated by misguided medical directives to be "cautious", and this can result in progressive muscular dysfunction and generalized deconditioning. The secondary pain further perpetuates the reverberating pain cycle.

7. Dysfunction

Having lost adequate coping skills, patients with chronic pain begin to withdraw from the social milieu. They disengage from work, drop recreational endeavors, tend to alienate friends and family, and become increasingly isolated, eventually restricting their activities to the bare essentials of life. Bereft of social contacts, rebuffed by the medical system, and deprived of adequate financial means, the patient becomes an invalid in the broadest sense: physical, emotional, social, and economic.

8. Dependence

These patients become dependent on their physicians and demand excessive medical care. They expect passive types of physical therapy over long periods, but these provide no lasting benefit. They become dependent on their spouse and families and relinquish all domestic and social responsibilities.