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LEARNING OBJECTIVES
Assess the impact of chronic pain on individuals and society.
Clarify terminology associated with nociception, pain, and chronic pain.
Compare and contrast nociceptive, neuropathic pain, and nociplastic pain.
Apply the International Classification of Functioning, Disability, and Health (ICF) model to chronic pain.
Explain the pathophysiological processes underlying chronic pain, including peripheral and central sensitization, as well as immune, endocrine, and autonomic system involvement.
Propose risk factors associated with chronic pain.
Describe methods for obtaining a thorough, biopsychosocial history from patients.
Contrast various outcome measures for examining chronic pain and its impact on activity and participation.
Describe tests and measures appropriate for examining individuals with chronic pain.
Relate examination findings to evaluation and prognosis for individuals with chronic pain.
Describe appropriate physical therapy interventions for individuals with chronic pain.
Summarize medical management of chronic pain.
Discuss complementary and alternative medicine approaches to managing chronic pain.
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Pain is the most common reason people visit healthcare providers and physical therapists. According to the 2019 National Health Interview Survey, chronic pain affects more than 50 million adult Americans—more than 20% of the U.S. adult population.1 Chronic pain is the leading cause of long-term disability in the United States, affecting more people than diabetes, heart disease, and cancer combined.2 Chronic pain is more prevalent among women, minorities, military veterans, and rural and marginalized populations.3
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Chronic pain exacts a huge toll in medical care, lost workdays, and compromised quality of life. In the United States, the national economic cost of chronic pain in 2010 was estimated at $560 billion to $635 billion per year, with $261 billion to $386 billion per year of that due to direct medical costs. Lost productivity due to pain costs $297 billion to $336 billion per year. Quality of life is severely compromised for people with chronic pain.4
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This chapter focuses on individuals with chronic pain who are most likely to present for PT intervention. It is not the goal of this chapter to address cancer or visceral pain, even though they are growing specialty areas within PT. Recent advances in pain physiology are presented as a foundation for understanding common chronic pain conditions and the appropriate management for those conditions.
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PAIN TERMINOLOGY AND BASIC CONCEPTS
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Pain is defined as “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”; the International Association for the Study of Pain (IASP) has added “six key notes” to further qualify the definition (Box 25.1).5 Pain is not just the firing of nociceptive neurons, it is an interaction among internal and external stimuli, context, and emotional and social factors. An analogy would be that some people perceive spicy food as unpleasant or even painful, while others perceive it as delicious; interpretation depends in part ...