![]() Nonetheless, pharmacologic measures are commonly prescribed as a component of chronic pain management. Unfortunately, the heterogeneous nature of chronic pain syndromes and the lack of a functional understanding of chronic pain contribute to the absence of a clearly identifiable, appropriate management strategy for many patients. Ĭurrently, several treatment modalities exist for the management of chronic pain, including physical therapy, pharmacologic therapy, behavioral medicine, neuromodulation, minimally-invasive interventions, and surgery. Similarly, spinal cord neurons in the central nervous system exposed to repetitive pain stimuli may undergo changes that result in transmission of action potentials with a reduced threshold of synaptic input. Neurons surrounding damaged tissue have even shown the ability to develop spontaneous discharges that communicate pain information in the absence of external input. In the setting of injury, for example, inflammatory changes in the biochemical milieu surrounding peripheral nerves can result in hypersensitization of nociceptors, such that pain signals are communicated in the absence of appropriate stimuli. There are multiple mechanisms that underlie the dysregulation of this system in chronic pain. Ultimately, signals reach the forebrain for interpretation of the sensory experience. The stimulation leads to activation of primary sensory nerve fibers that transmit this information to the central nervous system, via a complex network of interneurons housed predominantly in the dorsal root ganglia, posterior horn of the spinal cord, brain stem, and thalamus. Nociceptors recognize stimuli in the form of thermal, mechanical, or chemical inputs. The perception of noxious stimuli originates from nociceptors of the peripheral nervous system. The specific duration of symptoms required to qualify for a diagnosis of chronic pain is debatable, but generally is considered to be in the range of 3 to 6 months. It is generally agreed that pain becomes “chronic” when it persists beyond the expected period of tissue injury and healing. When pain fails to communicate biologically useful or accurate information, it is maladaptive and thereby becomes a disease state in its own right. In the acute setting, this sensation can serve as a protective role by alerting an individual to avoid potentially harmful stimuli and to protect the body during healing. In simplest terms, pain can be defined as a bodily sensation experienced during genuine, or perceived, tissue injury. It predisposes to psychiatric comorbidity, and its massive impact is highlighted by the fact that it is the most common cause of long-term disability in the USA. ![]() Chronic pain is estimated to affect 100 million people in the USA alone, resulting in up to $635 billion in medical expenses and lost productivity each year.
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