How to define chronic pain?


The International Association for the Study of Pain (IASP) offers one of the most widely accepted descriptions of pain:

"Pain is an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage."1

From this definition it is apparent that pain is not only a purely sensory experience, it also impacts emotionally.

Pain serves as a warning signal of imminent or actual damage. In this respect, pain has an important function in preventing damage to the body and if damage does occur, in restoring the body to its normal functions. However, pain may also be experienced occasionally in the absence of any tissue damage, or its intensity may not be in proportion to the original injury.

 

Chronic pain: a disease in its own right

Pain is recognized by the World Health Organisation (WHO) as an important global, public health concern. In 2007, the WHO identified a need for improved, standardized management of chronic pain (both malignant and non-malignant) and acute pain.2

Importantly, pain is more than just a symptom. It is a serious comorbidity which affects and influences patients’ responses to medical and surgical treatment, with an impact on both clinical outcomes and quality of life.

Chronic and recurrent pain should be viewed as diseases in their own right and pose a specific healthcare burden.1 Around a quarter of Europeans are thought to have chronic pain conditions.3

The physician managing the patient with chronic pain needs to appreciate that chronic pain is multifaceted – chronic pain involves the interaction of physical, psychological, and social factors. Consequently, management plans should be developed on the basis of good physician-patient communication and jointly agreed goals that take account of the patients’ pain characteristics as well as their physical and psychosocial needs.

 

Bio-psycho-social pain model Biopsychosocial pain model


References

1 IASP, 1994. Part III: Pain Terms, A Current List with Definitions and Notes on Usage (pp 209-214). Classification of Chronic Pain, Second Edition, IASP Task Force on Taxonomy, edited by H. Merskey and N. Bogduk, ISAP Press, Seattle, 1994. http://www.iasp-pain.org.
2 WHO Normative Guidelines on Pain Management. June 2007. http://www.who.int/medicines/areas/quality_safety/delphi_study_pain_guidelines.pdf.
3 European Commission Health in the European Union: Special EUROBAROMETER 272, 2007. http://ec.europa.eu/health/ph_publication/eb_health_en.pdf