Pain is protective and essential for survival when understood as a warning signal that something has gone wrong in the body. However, when pain persists indefinitely the central nervous system (CNS) begins to sense, transmit, modulate, and interpret the pain experience differently. 17 When the nociceptors, or sensory receptors, become sensitized, they discharge more frequently. In peripheral sensitization, this state of heightened neuronal excitability occurs at the site where the pain impulse originated in the body; in central sensitization, it occurs in the spinal neurons, Pain classifications Pain can be categorized in several ways, including by type, duration, etiology, and pathophysiology: ● Acute pain is a physiologic response to noxious stimuli with a sudden onset and expected short duration. 3 It commonly occurs as a result of burn, trauma, musculoskeletal and neural injury, and after surgery or other procedures in the perioperative period. 3,23 Acute pain flares may also occur periodically in the course of chronic pain and medical conditions. 3 Anxiety and distress may exacerbate the acute pain experience. 25 ● Chronic pain lasts longer than normal healing and is generally diagnosed after persisting or recurring for longer than three to six months. 17 ○ Chronic pain’s many possible causes include injuries, malignancies, chronic diseases, medical treatments or surgeries, or inflammation that appears as a result of injury or chronic disease. ○ Chronic pain may occur in the absence of a defined injury or cause. ○ Anxiety, depression, and stress are known to complicate the chronic pain experience. 3 ○ Chronic relapsing pain conditions have periods of remission and frequent relapses (e.g., various degenerative, inflammatory, immune-mediated, rheumatologic, and neurologic conditions such as multiple sclerosis [MS], trigeminal neuralgia, Parkinson’s disease, complex regional pain syndrome [CRPS], porphyria, systemic lupus erythematosus, lumbar radicular pain, migraines, and cluster headaches). 3 New diagnostic categories for chronic pain Accurately diagnosing a pain condition can be challenging, particularly when the etiology or pathophysiology of the pain is not clearly understood. To systematically gather together all relevant codes for the management of chronic pain, new diagnostic categories in the International Statistical Classification of Diseases and Related Health Problems (ICD-11) took effect in January 2022. 27 These diagnostic categories are intended to assist HCPs in reaching an accurate diagnosis to better create an optimal treatment plan. Per ICD-11, chronic pain is considered primary when pain has persisted for more than three months, is associated with significant emotional distress and/or functional disability and is not better accounted for by
which begin to fire spontaneously, resulting in pain that intensifies and lasts far longer than the stimulus applied. 17 Sensitization can result in hyperalgesia, where response to pain-causing stimuli is intensified, and allodynia, a pain response to stimuli that normally are not painful. 17 Therefore, the resulting pain comes not just from an injury site but from neural impulses. The pathologies created by central sensitization can persist and continue to generate pain impulses indefinitely, far outlasting pain’s usefulness as a warning signal. ● Nociceptive pain is the normal response to any type of stimulus that results in tissue damage and includes visceral and somatic pain. 17 Examples of nociceptive or inflammatory pain include postoperative pain, osteoarthritis, mechanical low back pain, sickle cell crises, and pain from traumatic injuries. ○ Visceral pain is nociceptive pain that arises from the body’s organs and may be cramping, throbbing, and/or vague. 17 Examples are pain related to myocardial infarction, pancreatitis, or cholecystitis. ○ Somatic pain , whether superficial or deep, is nociceptive pain that results from issues within the bone, joints, muscles, skin, or connective tissue; it may be localized and stabbing, aching, and/or throbbing. 17 Examples include mechanical low back pain, osteoarthritis, and muscle sprain or strain. ● Neuropathic pain results from damage to or abnormal processing of the CNS or peripheral nervous system and may be sharp, stabbing, burning, tingling, and/or numb. 17 Certain neuropathic pain conditions may be diagnosed as chronic pain before the three-month mark. 26 Examples include diabetic neuropathy, regional pain syndrome, or trigeminal neuralgia. 6 ● Referred pain spreads beyond the initial injury site and can have both nociceptive and neuropathic features. 17 ● Chronic pain may be primarily nociceptive or neuropathic or have mixed nociceptive- neuropathic characteristics. another condition. Thus, in chronic primary pain, the pain is the chief complaint and disease. A diagnosis of somatic symptom disorder is not made on the basis of unexplained pain alone but requires positive psychiatric criteria. The six subgroups of chronic primary pain are: 27 ● Chronic primary pain. ● Chronic widespread pain (e.g., fibromyalgia). ● Chronic primary visceral pain (e.g., irritable bowel syndrome). ● Chronic primary musculoskeletal pain (e.g., nonspecific low-back pain). ● Chronic primary headache or orofacial pain (e.g., migraine, tension-type headache, trigeminal autonomic cephalalgias). ● Chronic regional pain syndrome.
Book Code: MDCO1025
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