Pain is a complex and subjective experience that is the body’s response to harmful stimuli. It is a warning system that alerts the body to potential injury or damage, and it can vary greatly in intensity, duration, and quality.
The international Association for the Study of Pain (IASP) defines pain as “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”
Pain is classified in several ways, most commonly into two main types: acute and chronic. Acute pain is usually a temporary response to injury or tissue damage, and it typically goes away once the injury or damage has healed. Chronic pain, on the other hand, persists for longer than six months, and can be caused by a variety of factors, including injury, illness, and certain medical conditions.
Pain can be felt in different parts of the body, such as the skin, muscles, bones, internal organs and it can be described in various ways, such as sharp, dull, aching, throbbing, or shooting. Pain can also be described as somatic, which means it’s felt in the body’s tissues, or visceral, which means it’s felt in the body’s organs.
Pain can be treated using a combination of medication, physical therapy, procedures and surgeries, psychological therapies and lifestyle modification. The goal of pain management is to reduce the intensity of pain, improve the individual’s ability to function, and improve their quality of life.
The most commonly quoted definition for chronic pain is “pain that persists for three months or more, or for longer than the expected tissue healing time”. This is only one type of ‘chronic pain’ and not all chronic pain fits this definition.
This definition is “Chronic Primary Pain” and is pain that is most influenced by psychosocial factors, and has less to do with biomedical factors. This is also refered to as ‘non-specific’ pain, or nociplastic pain, and with this type of chronic pain no pathological or structural cause for the pain can be found. Chronic Primary Pain is mild to moderate, never severe. Although people who have this time of pain may rate it as ‘severe’ because their fear and distress amplifies their pain. This type of pain should be treated with education and psychological therapies. When these people’s fear and distress are reduced, the pain itself is mild. The disability caused by this kind of pain is psycholgoical, a product of the person’s poor self-efficacy, poor coping skills and poor choices. Opioids should never be used to manage this kind of pain.
Chronic SECONDARY Pain is a very different kind of pain, however. This kind of pain is nociceptive pain, that is pain that is caused by pathology, damage, inflammation. This is pain with a structural cause or pain as a result of a disease process. Chronic Secondary pain is NOT treated primarily with education and psycholgoical treatments, as psychosocial factors generally only play a small part in the develoment and ongoing of this kind of pain. Chronic secondary pain can be mild, moderate or severe. When it is severe, opioids are a safe and effective choice for managing this kind of pain. Peple with chorinc secondary pain are often entrenched in the biomedial system, which is appropriate for this kind of pain. they often have an underlying disease that requires treatment with medication, procedures and surgeries.
Examples of chronic secondary pain include pain caused by cancer, arthritis (either inflammatory or osteo), spinal cord injury, multiple sclerosis, adhesive arachnoidisis, and a long list of other diseases.
It’s very important to understand that there are two different types of chronic pain – chronic primary pain and chronic secondary pain and the distinction is extremely important as these two types of pain are treated very differently. Read more at Introduction to chronic pain