Sections
A Brief Overview of Pain | Neuroanatomy of Pain | Traumatic Brain Injury, Chronic Pain, and Cognitive
Dysfunction | Pain Assessment | Pain Management | Conclusion | Key Clinical Points | Recommended Readings | References
Excerpt
Pain is defined by the International Association for the Study
of Pain as "an unpleasant sensory and emotional experience
associated with actual or potential tissue damage, or described
in terms of such damage" (Merskey and Bogduk 1994,
pp. 209–214). Acute pain, usually occurring in response
to identifiable tissue damage or a noxious event, has a time-limited
course during which treatment is aimed at correcting the underlying
pathological process (if any such intervention is deemed necessary).
Chronic pain, generally considered as pain persisting for longer
than 6 months, may or may not be associated
with any obvious tissue damage or pathological process. In the case
of chronic pain, presentation may be characterized by maladaptive
protective responses or pain behaviors, protracted courses of medication
use and minimally effective medical services, and marked behavioral
or emotional changes, including restrictions in daily activities.
Pain-related avoidance behaviors and reduced activity are likely
to result in a cyclic disability-enhancing pattern. The longer pain
persists, the more recalcitrant it becomes and the more treatment
goals focus on improved coping with pain and its concomitants (Kulich and Baker 1999; Martelli et al. 1999a). Finally,
there is increasing evidence and growing acceptance that persistent
pain may be associated with peripheral sensitization or central
sensitization effects in which hyperresponsiveness or spontaneous
discharge of components of the pain system develops (Lidbeck 2002; Nicholson 2000b; Nicholson and Martelli 2004). In this regard, it has been noted that there is an
association between posttraumatic stress reactions and the development
of chronic pain (Bryant et al. 1999; Miller 2000; Sharp and Harvey 2001), with uncontrollable pain after physical
injury potentially representing the core trauma, resulting in posttraumatic symptomatology
(Schreiber and Galai-Gat 1993).