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Chronic Pain
Chronic Pain
Chronic pain is often defined as recurrent or persistent pain lasting ≥3 months. The child may have a definable medical condition but often does not have a specific disease diagnosis or identifiable etiology for the pain other than the pain symptoms (often called chronic primary pain or central pain syndrome), and the central pain syndrome is often associated with other overlapping pain conditions. Chronic primary pain is associated with functional and emotional disabilities but is independent of identifiable biologic or psychologic contributors. The central nature of the pain may occur when the central nervous system’s response to pain is hypersensitive. Simple touch that should not be painful is perceived as pain ( allodynia ), or minor noxious stimuli produce an exaggerated pain perception (hyperalgesia). This pain amplification and hypersensitivity to pain create a cascade of events resulting in localized (migraine, low back, jaw) or generalized pain perception. In most patients, the pain is constant but may be intermittent and manifest in a broad spectrum of severity and characterizations (burning, stabbing, dull, paresthesias, sharp). Comorbidities are common and include fatigue, sleep impairment, poor concentration, and disturbances in affect.
Chronic Overlapping Pain Condition
Many pain conditions tend to co-aggregate, coexist, or overlap. Approximately 20% of adults in the United States who report chronic generalized pain will also report having pain in the face or jaw, back, or neck, as well as headache. The National Institutes of Health designated 10 conditions that often co-occur with chronic pain as part of the chronic overlapping pain conditions (COPCs) . These conditions include temporomandibular joint (TMJ) disorder, myalgic encephalomyelitis/chronic fatigue syndrome (CFS), fibromyalgia (FM), irritable bowel syndrome (IBS), vulvodynia, painful bladder syndrome/interstitial cystitis (PBS/IC), headaches and migraines, chronic lower back syndrome, and endometriosis. The prevalence of COPCs in adults is ∼4–44 million persons. Fifteen percent of the adult population will report neck pain and migraine or severe headache and almost 29% report back pain. Interestingly, when assessing the other comorbid pain conditions, it is important to understand that they will depend on which is the index symptom that is being evaluated. Furthermore, although the cardinal symptom of COPC is pain, other nonpainful symptoms coexist with the COPC such as fatigue, anxiety, depression, sleep disorders, difficulty concentrating, and reduced ability to perform physical activities.
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