Abstract
We present a framework for the study of states of chronic pain and transitions between those states. We capture in the framework the dynamic nature of pain: people live with pain that changes over time. First, we offer definitions of both acute and chronic pain and explore the contextual considerations related to the common use of this temporal dichotomy. Second, we promote the importance of incorporating the impact pain has on a person's life. Finally, we discuss the challenges and opportunities inherent in implementing this common approach. Our goal is to produce a framework for the study of the development, maintenance, and resolution of chronic pain.
Whether a single brief event or a constant feature of life, pain interrupts to prioritise protection, interferes with activity, reduces quality of life, and can alter identity.44 Protection is achieved by escape from harm, avoidance of perceived danger, withdrawal for respite and repair, and communication of incapacity and environmental risk; longer-term protection is achieved by learning the cues for pain and injury.53 From this perspective, pain is most usefully considered a need state, fundamentally a motivational drive to protect.49 This approach centres our attention on the consequences of pain for the person in their context, on its duration and its impact.
2. A person's pain status
Pain is defined as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”34 There is a logical case of a state of “no pain,” but to have no pain is a rare occurrence, only recently made possible by the advent of anaesthesia/analgesia. A state of the continuous absence of any pain at all is profoundly abnormal, appearing only as congenital nociceptor deficiency or dysfunction. It is far from adaptive, notably leading to major clinical problems associated with the absence of defensive responding and learning with a consequent severe shortening of life
Whether a single brief event or a constant feature of life, pain interrupts to prioritise protection, interferes with activity, reduces quality of life, and can alter identity.44 Protection is achieved by escape from harm, avoidance of perceived danger, withdrawal for respite and repair, and communication of incapacity and environmental risk; longer-term protection is achieved by learning the cues for pain and injury.53 From this perspective, pain is most usefully considered a need state, fundamentally a motivational drive to protect.49 This approach centres our attention on the consequences of pain for the person in their context, on its duration and its impact.
2. A person's pain status
Pain is defined as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”34 There is a logical case of a state of “no pain,” but to have no pain is a rare occurrence, only recently made possible by the advent of anaesthesia/analgesia. A state of the continuous absence of any pain at all is profoundly abnormal, appearing only as congenital nociceptor deficiency or dysfunction. It is far from adaptive, notably leading to major clinical problems associated with the absence of defensive responding and learning with a consequent severe shortening of life
| Original language | English |
|---|---|
| Pages (from-to) | 2143-2147 |
| Number of pages | 5 |
| Journal | PAIN |
| Volume | 164 |
| Issue number | 10 |
| DOIs | |
| Publication status | Published - 1 Oct 2023 |
Bibliographical note
Funding Information:This duration-impact framework has been developed in the context of a major UK research programme investigating the psychosocial determinants of high-impact chronic pain funded by the Advanced Pain Discovery Platform. The APDP has a focus on determining the causal influences on the onset and maintenance of high- and low-impact chronic pain. The consortium is exploring determinants of pain-state transitions using existing databases such as ALSPAC, ELSA, UK BIOBANK, HWW, and HEAF the synthesis of findings across published studies, and through new investigations.