II-17 Clinical Issues in Pain Management

Question 1

Distinguish among three types of chronic pain.

Answer 1

1. Chronic benign pain: Typically persists for 6 months or longer is relatively intractable to treatment. The pain varies in severity and may involve any of a number of muscle groups. Chronic low back pain and myofascial pain syndrome are examples.
2. Recurrent acute pain: Involves a series of intermittent episodes of pain that are acute in character but chronic inasmuch as the condition persists for more than 6 months. Migraine headaches, temporomandibular disorder (involving the jaw), and trigeminal neuralgia (involving spasms of the facial muscles) are examples.
3. Chronic progressive pain: Persists longer than 6 months and increases in severity over time. Typically it is associated with malignancies or degenerative disorders, such as cancer or rheumatoid arthritis. More than 130 million Americans suffer from chronic pain at any given time, with back pain being the most common. Chronic pain is not necessarily present every moment, but the fact that it is chronic virtually forces sufferers to organize their lives around it.

Question 2

List three ways that acute and chronic pain differ.

Answer 2

1. Chronic pain is more often linked to psychological distress, such as depression, anxiety and anger.
2. Chronic pain is much harder to treat.
3. Chronic pain involves the complex interaction of physical, psychological and social components.

Question 3

Describe the impact of chronic pain on the sufferer’s life.

Answer 3

Chronic pain can have a disruptive influence on virtually every aspect of a person’s life, including their work, leisure, family life, friendships, sleep patterns, income, self-esteem and sex lives.

Question 4

Discuss the relationship between chronic pain and Minnesota Multiphasic Personality Inventory (MMPI) scores.

Answer 4

Chronic pain patients typically show elevated scores on three MMPI subscales: hypochondriasis, hysteria, and depression. This constellation of three factors is commonly referred to as the “neurotic triad” because it frequently shows up in the personality profiles of patients with neurotic disorders.

Question 5

acute pain

Answer 5

Short-term pain that usually results from a specific injury.

Question 6

chronic pain

Answer 6

Pain that may begin after an injury but which does not respond to treatment and persist over time.

Question 7

pain-prone personality

Answer 7

A constellation of personality traits that predisposes a person to experience chronic pain.