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ICD-10 code G89.4 for Chronic pain syndrome is a medical classification medical classification A medical classification is used to transform descriptions of medical diagnoses or procedures into standardized statistical code in a process known as clinical coding. https://en.wikipedia.org › wiki › Medical_classification

Medical classification – Wikipedia

as listed by WHO under the range – Diseases of the nervous system.

What is Chronic pain syndrome?

Pain is your body’s normal reaction to an injury or illness, a warning that something is wrong. When your body heals, you usually stop hurting. But for many people, pain continues long after its cause is gone. When it lasts for 3 to 6 months or more, it’s called chronic pain.

When you hurt day after day, it can take a toll on your emotional and physical health. About 25% of people with chronic pain will go on to have a condition called chronic pain syndrome (CPS). That’s when people have symptoms beyond pain alone, like depression and anxiety, which interfere with their daily lives.

CPS can be hard to treat, but it’s not impossible. A mix of treatments like counseling, physical therapy, and relaxation techniques can help relieve your pain and the other symptoms that come with it. Doctors don’t know exactly what causes CPS. It often starts with an injury or painful condition such as:

Arthritis and other joint problems Back pain Headaches Muscle strains and sprainsRepetitive stress injuries, when the same movement over and over puts strain on a body part Fibromyalgia, a condition that causes muscle pain throughout the body Nerve damage Lyme disease Broken bones Cancer Acid reflux or ulcers Inflammatory bowel disease ( IBD ) Irritable bowel syndrome ( IBS ) Endometriosis, when tissue in the uterus grows outside of itSurgery

The roots of CPS are both physical and mental. Some experts think that people with the condition have a problem with the system of nerves and glands that the body uses to handle stress, That makes them feel pain differently. Other experts say CPS is a learned response.

When you’re in pain, you may start to repeat certain bad behaviors even after the pain is gone or has lessened. CPS can affect people of all ages and both sexes, but it’s most common in women. People with major depression and other mental health conditions are more likely to get CPS. CPS affects your physical health, your emotions, and even your social life over time.

The pain can lead to other symptoms, such as:

Anxiety Depression Poor sleep Feeling very tired or wiped outIrritabilityGuiltLoss of interest in sexDrug or alcohol abuse Marriage or family problemsJob loss Suicidal thoughts

Some people with CPS need to take more and more medicine to manage their pain, which can make them dependent on these drugs, Your doctor will ask you about any illnesses or injuries that might have started the pain. They will also ask other questions to learn more about the type of pain you feel and how long you’ve had it:

When did the pain start?Where on your body does it hurt?What does the pain feel like? Is it throbbing, pounding, shooting, sharp, pinching, stinging, burning, etc.?How severe is your pain on a scale of 1 to 10?What seems to set off the pain or make it worse?Have any treatments relieved it?

Imaging tests can show whether you have joint damage or other problems that cause pain :

CT, or computed tomography. It’s a powerful X-ray that makes detailed pictures inside your body. MRI, or magnetic resonance imaging. It uses magnets and radio waves to make pictures of organs and structures inside you. X-ray. It uses radiation in low doses to make images of structures in your body.

To treat your pain, you can visit:

Your primary care doctorA specialist for the medical condition that’s causing your pain – for example, a rheumatologist to treat arthritisA pain clinic or center

Your doctor will tailor your therapy to the source of your pain. You might get one or more of these treatments:

Physical therapy, including heat or cold on the part that hurts, massage, stretching exercises, and transcutaneous electrical nerve stimulation ( TENS )Occupational therapyCounseling, one-on-one or group therapy BracesRelaxation techniques such as deep breathing or meditation Biofeedback Spinal cord stimulationNerve blocksPain medicines such as NSAIDs, antidepressants, anti- seizure drugs, and muscle relaxantsSurgery to treat the condition that caused the pain

Some pain can be normal, especially if you’ve recently had an injury, illness, or surgery. Call your doctor if the pain is intense, it doesn’t stop, or it keeps you from doing your regular activities every day.

What is the ICD-10 code for pain disorder?

ICD-10 code F45.42 for Pain disorder with related psychological factors is a medical classification as listed by WHO under the range – Mental, Behavioral and Neurodevelopmental disorders.

What is the difference between chronic pain syndrome and chronic pain?

What is a chronic pain syndrome? – Your doctor has told you that you have a chronic pain syndrome. What does it mean? In most cases, chronic pain starts with an acute injury or illness. If the pain of this injury or illness lasts longer than six months, it’s then considered chronic pain. Chronic pain syndromes develop in what we call a vicious cycle. A vicious cycle is the cycle of pain causing pain: chronic pain that causes secondary complications, which subsequently make the original chronic pain worse. What are these secondary complications? Chronic pain can lead to some common problems over time.

For example, many people tend to have trouble sleeping because of pain. After a while, they are so tired and their patience has worn so thin that everything starts bugging them. They also find that coping with chronic pain gets harder and harder too. Some people stop working. With the job loss, they might come to experience financial problems.

The stress of these problems keeps them up at night. Thinking too much in the middle of the night can make the original sleeping problem even worse. It can be hard to shut off the thinking even in the middle day. Chronic pain can also affect the roles people have in the family.

They miss out on children’s activities, family functions, and parties with friends. As a result, many people struggle with guilt. Guilt isn’t the only emotion that is common to living with chronic pain. Patients tend to report some combination of fear, irritability, anxiety and depression. Patients also tend to express that they have lost their sense of direction to life.

They are stuck. These problems are all common when living with chronic pain. These problems cause stress. They are called stressors, which means that they are problems that cause stress. These stressors can make pain worse because stress affects the nervous system.

It makes the nervous system more reactive and you become nervous, Now, pain is also a nerve related problem. Whatever its initial cause, pain travels along the nervous system to the brain, which is also part of the nervous system. Once reaching the brain, it registers as pain. When stress affects the nervous system, making it more reactive, the pain signals reach the brain in an amplified way.

So, stress leads you to have more pain. The vicious cycles of pain become clear. Chronic pain causes stressful problems, which, in turn, cause stress that makes the pain worse, This combination of chronic pain and the resultant problems that make pain worse is what we call a chronic pain syndrome.

Is chronic pain syndrome a diagnosis?

Practice Essentials – Chronic pain syndrome (CPS) is a common problem that presents a major challenge to health-care providers because of its complex natural history, unclear etiology, and poor response to therapy. CPS is a poorly defined condition. Most authors consider ongoing pain lasting longer than 6 months as diagnostic, and others have used 3 months as the minimum criterion.

• In chronic pain, the duration parameter is used arbitrarily.
• Some authors suggest that any pain that persists longer than the reasonably expected healing time for the involved tissues should be considered chronic pain.
• See Presentation and Workup.) CPS is a constellation of syndromes that usually do not respond to the medical model of care.

This condition is managed best with a multidisciplinary approach, requiring good integration and knowledge of multiple organ systems. (The images below demonstrate conditions associated with CPS.) (See Treatment and Medication.) Sagittal magnetic resonance imaging (MRI) scan of the cervical spine in a patient with cervical radiculopathy. This image reveals a C6-C7 herniated nucleus pulposus. Osteoarthritis of the knee, Kellgren stage III. Changes in the hand caused by rheumatoid arthritis. Photograph by David Effron MD, FACEP. Approximately 35% of Americans have some element of chronic pain, and approximately 50 million Americans are disabled partially or totally due to chronic pain. Chronic pain is reported more commonly in women.

How do you code Chronic pain?

Documentation: Key to Coding – Documentation is the key to the correct code assignment when coding these conditions. Several of the codes are similar but vary slightly. Code 338.0 describes central pain syndrome; 338.4, Chronic pain syndrome; and 338.29, Other chronic pain.

These conditions are different, and code assignments are based upon physician documentation. Central pain syndrome is a neurological condition that can be caused by damage to the central nervous system. It can be traumatic (brain or spinal cord) or brain-related (such as stroke, multiple sclerosis, tumors, epilepsy, or Parkinson’s disease).

The character and extent of the pain differs widely depending on the cause. The pain may affect a large portion of the body or may be restricted to specific areas. Central pain syndrome usually begins shortly after the injury or damage, but it can be delayed, especially if related to post-stroke pain.

Patients with central pain syndrome are treated with pain medications and sometimes antidepressants or anticonvulsants. The code for central pain syndrome includes thalamic pain syndrome (previously indexed to code 348.8, Other conditions of brain), Dejerine-Roussy syndrome, and myelopathic pain syndrome.

Chronic pain syndrome (CPS) is common and poses a major challenge to healthcare providers because it is a complex phenomenon. It has many factors associated with it and at this point is poorly understood. Treatments may consist of a rehabilitation program, surgical interventions, or other treatments such as injections, manipulations, biofeedback, or pharmacotherapy.

Surgical treatment may consist of nerve blocks, spinal cord stimulation, trigger point injections, and intrathecal morphine pumps. CPS is different than the term “chronic pain,” and therefore code 338.4 should only be used when the provider has specifically documented this condition. Chronic pain is classified to subcategory 338.2.

There is no time frame defining when pain becomes chronic pain. The provider’s documentation should be used to guide the use of the code, not an interpretation by the coding professional.

What is the ICD-10 code for Chronic neck pain?

ICD-10 Code: M54.2 – Cervicalgia – ICD-Code M54.2 is a billable ICD-10 code used for healthcare diagnosis reimbursement of Cervicalgia. Its corresponding ICD-9 code is 723.1. Billable: Yes ICD-9 Code Transition: 723.1 Code M54.2 is the diagnosis code used for Cervicalgia (Neck Pain).

Neck pain Neck pain less than 3 months, acute Neck pain, chronic Pain in cervical spine for less than 3 months Pain in cervical spine for more than 3 months Pain, cervical (neck) spine, acute less than 3 months Pain, cervical (neck), chronic, more than 3 months Chronic neck pain Chronic neck pain for greater than 3 months Chronic neck pain greater than 3 months

Is chronic pain syndrome a disability?

Chronic pain syndrome can force people to retire early or severely limit their daily activities. – In many cases, people have pain that is not curable. The Social Security Administration does not consider chronic pain to be a disability and chronic pain syndrome is not listed as an impairment in the Blue Book.

Is chronic pain syndrome same as fibromyalgia?

References – Jung CK, Park JY, Kim NS, et al. Status of chronic pain prevalence in the Korean adults, Public Health Weekly Report 2015; 8 :728–34. Turk DC, Okifuji A. Psychological factors in chronic pain: evolution and revolution, J Consulting Clin Psychol 2002; 70 :678.

1. Ang YK. Evaluation and management of chronic pain,
2. J Korean Acad Fam Med 2003; 24 :103–11.
3. De Mos M, Huygen FJ, Dieleman JP, et al.
4. Medical history and the onset of complex regional pain syndrome (CRPS),
5. Pain 2008; 139 :458–66.
6. Jänig W, Baron R.
7. Complex regional pain syndrome: mystery explained? Lancet Neurol 2003; 2 :687–97.

Schwartzman RJ, Erwin KL, Alexander GM. The natural history of complex regional pain syndrome, Clin J Pain 2009; 25 :273–80. Kuttikat A, Noreika V, Shenker N, et al. Neurocognitive and neuroplastic mechanisms of novel clinical signs in CRPS, Front Human Neurosci 2016; 10 :16.

Li W, Shi X, Wang L, et al. Epidermal adrenergic signaling contributes to inflammation and pain sensitization in a rat model of complex regional pain syndrome, Pain 2013; 154 :1224–36. Wurtman RJ. Fibromyalgia and the complex regional pain syndrome: similarities in pathophysiology and treatment, Metabolism 2010; 59 :S37–40.

Gracely RH, Petzke F, Wolf JM, et al. Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia, Arthritis Rheum 2002; 46 :1333–43. Kosek E, Altawil R, Kadetoff D, et al. Evidence of different mediators of central inflammation in dysfunctional and inflammatory pain—interleukin-8 in fibromyalgia and interleukin-1 in rheumatoid arthritis,

• J Neuroimmunol 2015; 280 :49–55.
• Thieme K, Turk DC, Gracely RH, et al.
• Differential psychophysiological effects of operant and cognitive behavioural treatments in women with fibromyalgia,
• Eur J Pain 2016; 20 :1478–89.
• Littlejohn G.
• Neurogenic neuroinflammation in fibromyalgia and complex regional pain syndrome,

Nat Rev Rheumatol 2015; 11 :639. Kim S, Shin JE, Kim MJ, et al. Correlation between quantitative electroencephalogram findings and neurocognitive functions in patients with obsessive-compulsive disorder and schizophrenia, Korean J Biol Psychiatry 2016; 23 :193–8.

Hargrove JB, Bennett RM, Simons DG, et al. Quantitative electroencephalographic abnormalities in fibromyalgia patients, Clin EEG Neurosci 2010; 41 :132–9. Prichep LS, John ER, Ferris SH, et al. Quantitative EEG correlates of cognitive deterioration in the elderly, Neurobiol Aging 1994; 15 :85–90. Klimesch W.

EEG alpha and theta oscillations reflect cognitive and memory performance: a review and analysis, Brain Res Rev 1999; 29 :169–95. Kang DH, Jung YH, Park SY, et al. The impairment of vocabulary ability in complex regional pain syndrome patients, Int J Pain 2010; 1 :8–14.

• Jasper H, Penfield W.
• Electrocorticograms in man: effect of voluntary movement upon the electrical activity of the precentral gyrus,
• Archiv Psychiatr Nervenkr 1949; 183 :163–74.
• Pfurtscheller G, Berghold A.
• Patterns of cortical activation during planning of voluntary movement,
• Electroencephalogr Clin Neurophysiol 1989; 72 :250–8.

Pfurtscheller G, Da Silva FL. Event-related EEG/MEG synchronization and desynchronization: basic principles, Clin Neurophysiol 1999; 110 :1842–57. Lalo E, Gilbertson T, Doyle L, et al. Phasic increases in cortical beta activity are associated with alterations in sensory processing in the human,

Exp Brain Res 2007; 177 :137–45. Androulidakis AG, Kühn AA, Chu Chen C, et al. Dopaminergic therapy promotes lateralized motor activity in the subthalamic area in Parkinson’s disease, Brain 2007; 130 :457–68. Pogosyan A, Gaynor LD, Eusebio A, et al. Boosting cortical activity at beta-band frequencies slows movement in humans,

Curr Biol 2009; 19 :1637–41. Uhlhaas P, Pipa G, Lima B, et al. Neural synchrony in cortical networks: history, concept and current status, Front Integr Neurosci 2009; 3 :17. Uhlhaas PJ, Singer W. High-frequency oscillations and the neurobiology of schizophrenia,

• Dialogues Clin Neurosci 2013; 15 :301.
• Coutin-Churchman P, Anez Y, Uzcategui M, et al.
• Quantitative spectral analysis of EEG in psychiatry revisited: drawing signs out of numbers in a clinical setting,
• Clin Neurophysiol 2003; 114 :2294–306.
• Ribas VR, Ribas RD, Martins HA.
• The learning curve in neurofeedback of peter van deusen: a review article,

Dement Neuropsychol 2016; 10 :98–103. Ribas VR, De Souza MV, Tulio VW, et al. Treatment of depression with quantitative electroencephalography (QEEG) of the TQ-7 neuro-feedback system increases the level of attention of patients, J Neurol Disord 2017; 5 :2.

Bruehl S. Complex regional pain syndrome, BMJ 2015; 351 :h2730. Clauw DJ. Fibromyalgia: a clinical review, JAMA 2014; 311 :1547–55. Leon-Carrion J, Martin-Rodriguez JF, Damas-Lopez J, et al. Delta–alpha ratio correlates with level of recovery after neurorehabilitation in patients with acquired brain injury,

Clin Neurophysiol 2009; 120 :1039–45. Sheikh N, Wong A, Read S, et al. QEEG may uniquely inform and expedite decisions regarding intra-arterial clot retrieval in acute stroke, Clin Neurophysiol 2013; 124 :1913–4. Rabiner D. Do QEEG scan results differentiate ADHD from other psychiatric disorders,

Is chronic pain a disease or disorder?

What is chronic pain? – Chronic pain is long standing pain that persists beyond the usual recovery period or occurs along with a chronic health condition, such as arthritis. Chronic pain may be “on” and “off” or continuous. It may affect people to the point that they can’t work, eat properly, take part in physical activity, or enjoy life.

Is chronic pain syndrome autoimmune?

Public Summary – What are the aims of this research? Complex regional pain syndrome (CRPS) causes severe pain in a specific area of the body. It most commonly affects part of a limb, such as the hand or ankle, but sometimes the whole limb is affected.

Often it follows an earlier injury to the affected area, but the response is much stronger and may affect a wider area than the original injury. The cause of this pain is unclear and so the researchers aim to identify the underlying mechanisms leading to the pain experienced by people with CRPS. Why is this research important? There is no single treatment available for CRPS that will help everybody, but a combination of rehabilitation therapies and pain relief medication is used to try and keep movement in the affected limb as much as possible.

This means that the earlier treatment is started, the more effective it is. For this reason, there is a need for faster diagnosis and new drug targets for pain relief. Recent observations indicate that CRPS may be an autoimmune condition, in which a person’s own immune system starts to attack healthy tissue.

• For example, in some autoimmune conditions, plasma cells (found in the blood) start to make large amounts of proteins called antibodies which attack the body.
• To treat this, blood can be extracted and filtered to reduce the number of antibodies present in the blood, before being returned to the patient.

This is known as plasma exchange therapy, and initial data suggests that people with long-standing CRPS experience dramatic pain improvement following this treatment. The researchers will use this knowledge to study mice with a CRPS like condition. This will allow them to identify which nerve cells are responsible for the pain signals, and how CRPS antibodies work with them to cause pain.

• How will the findings benefit patients? By identifying how this process works, it could lead to the identification of molecular targets that can be used for both the production of diagnostic kits and the development of new drugs.
• Development of new diagnostic kits will provide a simpler method of diagnosis and means that it may be possible to predict whether trauma patients are likely to develop CRPS.

This is particularly important as treatment can be started earlier. Furthermore, the findings could be of interest and/or relevance to other chronic musculoskeletal pain conditions. : Complex regional pain syndrome – Understanding what causes pain in complex regional pain syndrome

Is there a DSM 5 diagnosis for chronic pain?

In DSM-5, some individuals with chronic pain would be appropriately diagnosed as having somatic symp- tom disorder, with predominant pain. For others, psychological factors affecting other medical con- ditions or an adjustment disorder would be more appropriate.

Does chronic pain syndrome ever go away?

What is complex regional pain syndrome? – Complex regional pain syndrome (CRPS) is a broad term describing excess and prolonged pain and inflammation that follows an injury to an arm or leg. CRPS has acute (recent, short-term) and chronic (lasting greater than six months) forms.

If you have CRPS you will have changing combinations of spontaneous pain or excess pain that is much greater than normal following something as mild as a touch. Other symptoms include changes in skin color, temperature, and/or swelling on the arm or leg below the site of injury. Although CRPS improves over time, eventually going away in most people, the severe or prolonged cases are profoundly disabling.

Because of the varied symptoms, the fact that symptoms may change over time, and the difficulty finding a positive cause in some cases, CRPS is hard to treat. There is no treatment that rapidly cures CRPS. Symptoms Most individuals do not have all of these symptoms, and the number of symptoms typically reduces during recovery.

Unprovoked or spontaneous pain that can be constant or fluctuate with activity—You might feel a “burning” or “pins and needles” sensation, or as if the affected limb was being squeezed. Over time, if nerves remain chronically inflamed, pain can spread to involve most or all of your arm or leg, even if the originally affected area was smaller. In rare cases, pain and other symptoms occur in a matching location on the opposite limb. This “mirror pain” is thought to reflect secondary involvement of spinal cord neurons (nerve cells). Mirror pain is less severe and resolves as the injured nerves recover. Excess or prolonged pain after use or contact—You may notice an increased sensitivity in the affected area, known as allodynia, in which light touch, normal physical contact, and use is very painful. You also might notice severe or prolonged pain after a mildly painful stimulus such as a pin prick, known as hyperalgesia. Changes in skin temperature, skin color, or swelling of the affected limb—The injured arm or leg may feel warmer or cooler than the opposite limb. Skin on the affected limb may change color, becoming blotchy, blue, purple, gray, pale, or red. These skin symptoms typically fluctuate as they indicate abnormal blood flow in the area. Changes in skin texture—Over time, insufficient delivery of oxygen and nutrients can cause skin in your affected limb to change texture. In some cases, it becomes shiny and thin, in others thick and scaly. Avoiding contact or washing painful skin contributes to this build-up. Sweating and nail and hair growth—On the affected limb, hair and nails may grow abnormally rapidly, or not at all, and you may notice patches of profuse sweating or no sweating. All are under neural control and influenced by local blood circulation. Stiffness in affected joints—This common problem is that reduced movement leads to reduced flexibility of tendons and ligaments. Tight ligaments or tendons sometimes rub or pinch nerves to provide an internal cause of CRPS in people who do not have external injuries. Wasting away or excess bone growth—In CRPS-affected limbs, bones that receive signals from the damaged nerves rarely become affected. These abnormalities are often visible on X-rays or other imaging where they help specialists pinpoint the location of nerve damage and identify best treatments. Rough or enlarged areas of bone, such as after a poorly healed fracture or from a bone cyst, can irritate passing nerves and initiate or prolong CRPS. Impaired muscle strength and movement—Most people with CRPS do not have direct injury to the nerve fibers that control the muscles coordinating muscle movement. However, most report reduced ability to move the affected body part. This is usually due to pain and abnormalities in the sensory input that helps coordinate movements. Also, the excess inflammation and poor circulation are not healthy for muscles. Rare patients report abnormal movement in the affected limbs, fixed abnormal posture called dystonia, and tremors in or jerking. These can reflect secondary spread of disturbed neural activity to the brain and spinal cord. Most resolve by themselves during CRPS healing, but some people require orthopedic surgery to lengthen contracted tendons and restore normal flexibility and position.

Outcome The outcome of CRPS is highly variable:

Most illnesses are mild and recover over months to a few years as the injured nerve regrows. If this doesn’t happen, symptoms can linger to cause long-term disability. The outcome depends not only on the severity of the original injury, but also on underlying general and nerve health. Younger people, children, and teenagers almost always recover, as do older adults with good circulation and nutrition. Smoking is a major impediment to nerve regeneration as is diabetes and previous chemotherapy. Removing barriers to healing increases the chance and speed of your recovery. Rarely, individuals may experience prolonged severe pain and disability despite treatment. This may indicate underlying separate problems interfering with healing requiring additional testing and treatment.

Can chronic pain syndrome be cured?

There’s no known cure for complex regional pain syndrome (CRPS), but a combination of physical treatments, medicine and psychological support can help manage the symptoms. It’s estimated around 85% of people with CRPS slowly experience a reduction in their pain and some of their symptoms in the first 2 years.

What are the 3 stages of CRPS?

History – The three clinical stages of type 1 complex regional pain syndrome (CRPS 1) are acute, subacute, and chronic. The acute form lasts approximately 3 months. Pain, often burning in nature, is one of the first symptoms that initially limits function.

1. Swelling, redness with vasomotor instability that worsens with dependency, hyperhidrosis, and coolness to the touch are common physical findings.
2. Demineralization of the underlying bony skeleton begins because of disuse.
3. If the process is not arrested or reversed in the acute phase, the condition may progress to the subacute stage, which can last for up to 9 months.

The patient develops persistent severe pain in the extremity and fixed edema that would have been reversible with elevation during the acute phase. The redness of the acute stage gives way to cyanosis or pallor and hyperhidrosis to dry skin. Loss of function progresses, both because of increased pain and fibrosis of the joints caused by chronic inflammation.

In the hand, this leads to flexion deformity of the fingers. The skin and subcutaneous tissues begin to atrophy. Demineralization of the underlying bony skeleton becomes pronounced. If the process continues, the chronic phase may develop approximately 1 year after disease onset. This stage may last for many years or can be permanent.

Pain is more variable during this period. It may continue undiminished or abate. Edema tends to subside over time, leaving fibrosis around the involved joints. The skin is dry, pale, cool, and shiny. Flexion and extension creases are absent. Loss of function and stiffness are marked, and osteoporosis is extreme.

• In the upper extremity, this can manifest as a frozen shoulder and claw hand.
• A thorough general history is strongly suggested.
• Maintaining a high index of suspicion is important because proper treatment requires rapid diagnosis and prompt therapy.
• CRPS 1 commonly involves only one extremity.
• It is bilateral in approximately 25% of cases, but in those cases it is usually more prominent on one side.

Pain in CRPS 1 has the following characteristics:

• Usually constant and disproportionate to the precipitant injury
• May be exacerbated by ambient factors such as loud noises and emotional factors (eg, stress, light touch, active motion, passive motion)
• May be described as burning, cutting, searing, pressure, or tearing
• Usually begins locally but may progress to involve the entire extremity
• Stiffness is more severe than expected and may be very distressing to the patient.

Possible evidence of prior increased sympathetic activity includes the following:

• Hyperhidrosis
• Cold hands
• Fainting

Precipitating factors may include any of the following:

• Prior trauma, which may be trivial (eg, venipuncture) or significant (eg, Colles fracture), with or without diagnosable nerve injury
• Prior surgery
• Recent limb immobilization due to hemiplegic stroke, myocardial infarction
• Systemic disease such as diabetes

What happens to a person with chronic pain?

A Picture of Pain: What Life is Really Like with Chronic Pain Almost everyone has experienced some type of acute, or temporary, pain in their lives. Acute pain is a protective response to tissue injury that typically resolves with the healing process and lasts less than three months. While the impact of chronic pain is undeniable to those who live with the condition, its often-invisible nature can lead to many misconceptions. To mark Pain Awareness Month, which is recognized in September each year, we spoke to illustrator Ciara Chapman, who has been living with chronic pain for five years and uses her artwork to share her experiences with the condition.

Ciara says, “My chronic pain illustrations began as art therapy and the artwork has saved me. It reminds me who I am and reminds me of my ambitions in this world. When it came to describing the experience of living with chronic pain, sometimes words failed me, or there were things I wasn’t comfortable saying.

Now I draw my pain, and my loved ones and other patients’ loved ones understand a little bit more what we are going through.” Below, Ciara helps correct some common myths that she and other chronic pain patients face. MYTH: If someone doesn’t look or act like they’re in pain, it can’t be that bad.

Ciara: “Because chronic pain is an invisible demon, a lot of people have told me, ‘ It’s all in your head ‘, or, ‘ I heard you were sick, but you look fine to me,’ To be in constant pain and at your lowest point, and not be believed by loved ones, is one of the hardest things I’ve had to face. You may look the same, but you are not the same.” MYTH: They went to work or an event, so they can’t be in that much pain.

Ciara: “There is no point of the day or night when I don’t feel pain. As a result, I have to weigh every small decision in my life and ask myself, is it worth it? Is the cup of tea I crave worth the pain of making it, and getting up to go to the bathroom later? Am I sick enough to justify going to the doctor, or would I be better off staying home and suffering? If I decide to go for coffee with a friend, it takes me two days to recover.

I wake up feeling as though somebody has pushed me down the stairs. Unfortunately, the payoff isn’t always there.” MYTH: The impact of chronic pain is only physical. Ciara: “Chronic pain doesn’t just affect your body. Every aspect of your life is impacted when you live in pain. When you live with chronic pain, your mental wellbeing is affected as much as your physical wellbeing, and you need to give both equal attention.

My husband and I worry constantly about money now and an unexpected expense, like the car breaking down, can finish us. Your pain changes your personal relationships too. My husband really misses going on dates with me and we’ve never celebrated our wedding anniversary, as my pain developed shortly after we got married.

• I miss seeing my nephews grow up, and I don’t even contact my friends because I don’t want to bring them down.
• I feel really bad for the people closest to me, because this affects them too.” Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education.
• Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research.

Washington, DC: The National Academies Press; 2011. Goldberg DS., et al. Pain as a global public health priority. BMC Public Health. Volume 11, Article number: 770 (2011) Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education.

Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press; 2011.

Woo, A. Depression and Anxiety in Pain. Rev Pain.2010; 4(1): 8–12., Accessed July 29, 2019. doi: 10.1177/204946371000400103. : A Picture of Pain: What Life is Really Like with Chronic Pain