Pain Medicine Medical Minute

Imagine living in pain every day. It would be tough, but millions of Americans have what is defined as chronic pain. Richard Rosenquist, MD, director of the Pain Medicine Division  at University of Iowa Hospitals and Clinics, says chronic pain is defined as pain that persists beyond three months.

"However, it is difficult to define solely on the basis of time. For instance, a patient diagnosed with cancer who has pain of relatively new onset may often develop chronic pain. In this setting, treatments that would not be employed in most acute pain settings may be implemented much sooner.

"Chronic pain reaches across all societies and all socioeconomic groups. There are some who believe that there is a strong correlation between depression and chronic pain. In some settings, this is viewed as a chicken and egg question as to which came first," says Rosenquist.

"Although we would love to have a simple imaging test, electronic readout or even a blood test to measure pain, we do not have these yet. In most cases, we use either a verbal scale from 0 to 10 or a visual scale from 0 to 100 for adults. In the case of young children, we may use a faces scale that ranges from sad to happy. Trying to measure pain in the elderly or others with difficulty communicating is difficult as well.

"There is a growing research area using functional MRI testing to image active areas of the brain in patients with pain and then reimaging them after the pain has been treated. This is a very promising area that may finally allow us to develop some objective and reproducible measure of pain.

"However, the effects of pain are not merely physiologic," he says. "In many cases, pain may produce other undesirable psychological effects or psychological distress may be manifested as reports of physical pain.

"Pain is one of the most common presenting complaints for patients presenting to a physician. Anyone with new onset pain that is either getting progressively worse or is associated with other symptoms such as fever, chills, night sweats, weight loss, weakness, or numbness should seek medical evaluation.    

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