Assessing and Managing Chronic Pain in the Primary Care Setting

Abstract

Pain is experienced by almost everyone at some point in time. For most persons, the experience of pain is brief and uncomplicated, with pain remitting fully in the absence of medical intervention. For a small but significant proportion of the population, the experience of pain, due to its duration, intensity, and functional impacts, will precipitate contact with a health care provider. It has been observed that two of every five visits to a primary care provider (PCP) are made due to pain (Mantyselka, Turunen, Ahonen, & Kumpusalo, 2001). Pain conditions are common among patients attending primary care, with an estimated 20% of these patients diagnosed with persistent or chronic pain conditions (Gureje, Von Korff, Simon, & Gater, 1998). Despite the significant number of persons presenting to health care providers for evaluation and management of pain, pain is an experience that patients find difficult to communicate and that care providers find difficult to quantify. According to the International Association for the Study of Pain (IASP), pain is defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (Merskey & Bogduk, 1994, p. 210). The most widely accepted classification of pain reflects a pain-injury association. Acute pain is commonly defined as pain that does not last longer than six months and that remits when the underlying cause of pain has healed. Pain that persists for longer than six months is referred to as chronic pain (IASP, 1986). Although the IASP definitions of acute pain and chronic pain are widely recognized and accepted, the acute pain and chronic pain are frequently used to describe pain that persists up to three months and longer than three months, respectively. Another category of pain that is garnering increased research attention is widespread pain. Widespread pain is defined as pain present at two contralateral quadrants of the body and in the axial skeleton, and persisting for at least two months