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INTRODUCTION

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LEARNING OBJECTIVES

  1. Assess the importance of chronic pain in terms of its effect on individual activity and participation, as well as the cost to society.

  2. Compare and contrast the presentation of acute, persistent, and chronic pain.

  3. Apply the International Classification of Function (ICF) model to chronic pain.

  4. Explain the physiology of chronic pain, contrasting chronic with acute pain.

  5. Classify different types of chronic pain and provide examples of each type.

  6. Propose causes and risk factors for chronic pain.

  7. Relate psychosocial factors to the presentation, physiology, and risk factors for chronic pain.

  8. Contrast various outcome measures for examining chronic pain and its impact on activity and participation.

  9. Summarize medical management options for chronic pain.

  10. Describe tests and measures appropriate for examining individuals with chronic pain.

  11. Identify issues relevant in the evaluation and prognosis of individuals with chronic pain.

  12. Describe intervention approaches appropriate for individuals with chronic pain.

  13. Discuss complementary and alternative medicine approaches to managing chronic pain.

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Pain is the most common reason why people visit health care providers and physical therapists. Chronic pain affects about 116 million Americans,1,2,3 accounting for up to 20% of all primary care visits in the United States;4,5 low back pain (LBP) is the second most common reason for physician visits.6 Chronic pain affects more people than diabetes, heart disease, and cancer combined.2 Up to 26% of American adults have had pain for more than 3 months, and one-third of those report that this pain is disabling.7 Internationally, chronic pain affects up to 35% of adults and 25% of children; chronic pain is almost twice as prevalent in women compared to men.8,9 Spinal pain, headache, and arthritis are the most common sources of chronic pain: LBP affects 28%, headache and migraine affect 16%, neck pain affects 15%, and combined peripheral joint pain affects 30% of Americans.5,10 Other conditions such as stroke, spinal cord injury (SCI), diabetes, multiple sclerosis (MS), HIV/AIDS, amputation, Guillain-Barré syndrome, cancer, and a variety of other conditions can also lead to chronic pain.11

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Chronic pain exacts a huge toll in terms of medical care, lost workdays, and compromised quality of life. In the United States, the national economic cost of chronic pain is estimated at $560 billion to $635 billion per year with $261 billion to $300 billion per year of that due to direct medical costs.1 Lost productivity due to pain costs $297 billion to $336 billion per year.1 Quality of life is severely compromised for people with chronic pain, often rated even lower than among people dying of cancer.12

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This chapter will focus on chronic neuromuscular and musculoskeletal pain most likely to present for physical therapy intervention. It is not the goal of this chapter to address cancer or visceral pain, even though those are growing specialty areas within physical therapy. Recent advances ...

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