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8733 West Beverly Blvd.
Suite 400
West Hollywood, CA 90048
Telephone: 310-652-5800
Adjacent to Cedars-Sinai Medical Center Campus

What is Chronic Pain?

Chronic pain (also known as Intractable Pain or IP) has several different meanings in medicine. Traditionally, the distinction between acute and chronic or intractable pain has relied upon an arbitrary interval of time from onset; the two most commonly used markers being 3 months and 6 months since the initiation of pain, though some theorists and researchers have placed the transition from acute to chronic pain at 12 months. Others apply acute to pain that lasts less than 30 days, chronic to pain of more than six months duration, and subacute to pain that lasts from one to six months. A popular alternative definition of chronic pain, involving no arbitrarily fixed durations is "pain that extends beyond the expected period of healing.

Chronic pain may be divided into "nociceptive" (caused by activation of nociceptors) and "neuropathic" (caused by damage to or malfunction of the nervous system).

Nociceptive pain may be divided into "superficial somatic" and "deep", and deep pain into "deep somatic" and .visceral.. Superficial somatic pain is initiated by activation of nociceptors in the skin or superficial tissues. Deep somatic pain is initiated by stimulation of nociceptors in ligaments, tendons, bones, blood vessels, fasciae and muscles, and is dull, aching, poorly-localized pain. Visceral pain originates in the viscera (organs). Visceral pain may be well-localized, but often it is extremely difficult to locate, and several visceral regions produce "referred" pain when injured, where the sensation is located in an area distant from the site of pathology or injury.

Neuropathic pain is divided into "peripheral" (originating in the peripheral nervous system) and "central" (organized in the brain or spinal cord). Peripheral neuropathic pain is often described as burning, tingling, electrical, stabbing, or pins and needles. Bumping the "funny bone" elicits peripheral neuropathic pain.

Under persistent activation nociceptive transmission to the dorsal horn may induce a wind up phenomenon. This induces pathological changes that lower the threshold for pain signals to be transmitted. In addition it may generate nonnociceptive nerve fibers to respond to pain signals. Nonnociceptive nerve fibers may also be able to generate and transmit pain signals. In chronic pain this process is difficult to reverse or eradicate once established. Chronic pain of different etiologies has been characterized as a disease affecting brain structure and function. Magnetic Resonance Imaging (MRI) studies have shown abnormal anatomical and functional connectivity involving areas related to the processing of pain. Also, persistent pain has been shown to cause grey matter loss, reversible once the pain has resolved.

Complete and sustained remission of many neuropathies and most idiopathic chronic pain (pain that extends beyond the expected period of healing, or chronic pain that has no known underlying pathology) is rarely achieved, but much can be done to reduce suffering and improve quality of life.

Pain management (also called pain medicine) is that branch of medicine employing an interdisciplinary approach to the relief of pain and improvement in the quality of life of those living with pain. The typical pain management team includes medical practitioners, clinical psychologists, physical therapists and others.

People with high-intensity chronic pain have significantly reduced ability to perform attention-demanding tasks. Pain appears to strongly capture the attention of people with chronic pain; tests assessing the ability to attend show poorer performance than pain-free people on all tests demanding attention. In experimental testing, two-thirds of individuals with chronic pain demonstrate clinically significant impairment of attention, independent of age, education, medication and sleep disruption.