Classification Of Chronic Persistent Pain

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Classification of Chronic Persistent Pain

Nociceptive pain is pain resulting when special nerve endings (nociceptors) are stimulated. A classic example is the initial pain from a burn. It is often the pain of the acute phase but may become chronic. Patients complain of sharp and aching pain. It is part of many chronic pain conditions and therefore was not given its own category in table 1.

CPP is pain that was expected to resolve, but lasting longer than 3 months, or beyond the usual course or disease causing the pain. The pain, and its causes are frequently multifactorial, and maybe exacerbated by pathophysiology, psychosocial, environmental (loss of work) factors, and physical disability.12,13 Pain can aggravate other medical, and
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Most of the time, the pain is distributed in a neurological distribution. There maybe impairment in mood, quality of life, and activities of daily living.20 Sensory deficit may present in a glove and stocking (peripheral neuropathy), dermatomal (mononeuropathy), or hemispheric (stroke) distribution. Palpation of the skin may show coolness and mottling in a neurological distribution (autonomic neuropathy).17 Depending on the history and clinical findings, work up may include chemistry profile, CBC, CRP, ESR, TSH, free T4, vitamin B1, B6, B12, RPR, HIV, Lyme titer, and ANA. One may also consider MRI, CT, EMG, nerve conduction velocity, nerve biopsy, and skin biopsy.

Fibromyalgia (FM): The diagnosis of FM has been controversial over the years; it was felt to be a “garbage” diagnosis. Patients were diagnosed as “hysterics,” and told their pain was “imagined.” Even though we do not understand its pathogenesis completely, an increasing body of abnormal findings compared to controls supports the diagnosis, and alterations in the CNS may contribute to the chronic pain of FM.21 FM is the result of centrally-mediated augmentation of pain and sensory process.21 This is supported by increased levels of various pain neurotransmitters, glutmate and substance P,22,23 and fMRI data demonstrated low intensity stimuli in patients with fibromyalgia comparable to high intensity stimuli in controls.24

Patients present with diffuse pain, fatigue, and insomnia. Fibromyalgia tender
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