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class="vector-toc-text"> 5 Outcomes </div> </a> <ul id="toc-Outcomes-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Psychology" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Psychology"> <div class="vector-toc-text"> 6 Psychology </div> </a> <button aria-controls="toc-Psychology-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Psychology subsection </button> <ul id="toc-Psychology-sublist" class="vector-toc-list"> <li id="toc-Personality" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Personality"> <div class="vector-toc-text"> 6.1 Personality </div> </a> <ul id="toc-Personality-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Comorbidity_with_trauma" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Comorbidity_with_trauma"> <div class="vector-toc-text"> 6.2 Comorbidity with 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id="toc-Social_and_personal_impacts" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Social_and_personal_impacts"> <div class="vector-toc-text"> 8 Social and personal impacts </div> </a> <button aria-controls="toc-Social_and_personal_impacts-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Social and personal impacts subsection </button> <ul id="toc-Social_and_personal_impacts-sublist" class="vector-toc-list"> <li id="toc-Social_support" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Social_support"> <div class="vector-toc-text"> 8.1 Social support </div> </a> <ul id="toc-Social_support-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Racial_disparities" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Racial_disparities"> <div class="vector-toc-text"> 8.2 Racial disparities </div> </a> <ul id="toc-Racial_disparities-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Perceptions_of_injustice" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Perceptions_of_injustice"> <div class="vector-toc-text"> 8.3 Perceptions of injustice </div> </a> <ul id="toc-Perceptions_of_injustice-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Chronic_pain_and_COVID-19" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Chronic_pain_and_COVID-19"> <div class="vector-toc-text"> 8.4 Chronic pain and COVID-19 </div> </a> <ul id="toc-Chronic_pain_and_COVID-19-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Effect_of_chronic_pain_in_the_workplace" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Effect_of_chronic_pain_in_the_workplace"> <div class="vector-toc-text"> 8.5 Effect of chronic pain in the workplace </div> </a> <ul id="toc-Effect_of_chronic_pain_in_the_workplace-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> 9 See also </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Notes" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Notes"> <div class="vector-toc-text"> 10 Notes </div> </a> <ul id="toc-Notes-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> 11 References </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Further_reading" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Further_reading"> <div class="vector-toc-text"> 12 Further reading </div> </a> <ul id="toc-Further_reading-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> 13 External links </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" title="Table of Contents" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" 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Available in 26 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-26" aria-hidden="true" > 26 languages </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D8%A3%D9%84%D9%85_%D9%85%D8%B2%D9%85%D9%86" title="ألم مزمن – Arabic" lang="ar" hreflang="ar" data-title="ألم مزمن" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target">العربية</a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Dolor_cr%C3%B2nic" title="Dolor crònic – Catalan" lang="ca" hreflang="ca" data-title="Dolor crònic" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target">Català</a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Chronisches_Schmerzsyndrom" title="Chronisches Schmerzsyndrom – German" lang="de" hreflang="de" data-title="Chronisches Schmerzsyndrom" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target">Deutsch</a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Dolor_cr%C3%B3nico" title="Dolor crónico – Spanish" lang="es" hreflang="es" data-title="Dolor crónico" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target">Español</a></li><li class="interlanguage-link interwiki-fa badge-Q17437798 badge-goodarticle mw-list-item" title="good article badge"><a href="https://fa.wikipedia.org/wiki/%D8%AF%D8%B1%D8%AF_%D9%85%D8%B2%D9%85%D9%86" title="درد مزمن – Persian" lang="fa" hreflang="fa" data-title="درد مزمن" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target">فارسی</a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Douleur_chronique" title="Douleur chronique – French" lang="fr" hreflang="fr" data-title="Douleur chronique" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target">Français</a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EB%A7%8C%EC%84%B1_%ED%86%B5%EC%A6%9D" title="만성 통증 – Korean" lang="ko" hreflang="ko" data-title="만성 통증" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target">한국어</a></li><li class="interlanguage-link interwiki-hy mw-list-item"><a href="https://hy.wikipedia.org/wiki/%D5%94%D6%80%D5%B8%D5%B6%D5%AB%D5%AF%D5%A1%D5%AF%D5%A1%D5%B6_%D6%81%D5%A1%D5%BE" title="Քրոնիկական ցավ – Armenian" lang="hy" hreflang="hy" data-title="Քրոնիկական ցավ" data-language-autonym="Հայերեն" data-language-local-name="Armenian" class="interlanguage-link-target">Հայերեն</a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Sakit_kronis" title="Sakit kronis – Indonesian" lang="id" hreflang="id" data-title="Sakit kronis" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target">Bahasa Indonesia</a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Dolore_cronico" title="Dolore cronico – Italian" lang="it" hreflang="it" data-title="Dolore cronico" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target">Italiano</a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%9B%D7%90%D7%91_%D7%9B%D7%A8%D7%95%D7%A0%D7%99" title="כאב כרוני – Hebrew" lang="he" hreflang="he" data-title="כאב כרוני" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target">עברית</a></li><li class="interlanguage-link interwiki-ms mw-list-item"><a href="https://ms.wikipedia.org/wiki/Sakit_kronik" title="Sakit kronik – Malay" lang="ms" hreflang="ms" data-title="Sakit kronik" data-language-autonym="Bahasa Melayu" data-language-local-name="Malay" class="interlanguage-link-target">Bahasa Melayu</a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Chronische_pijn" title="Chronische pijn – Dutch" lang="nl" hreflang="nl" data-title="Chronische pijn" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target">Nederlands</a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E6%85%A2%E6%80%A7%E7%96%BC%E7%97%9B" title="慢性疼痛 – Japanese" lang="ja" hreflang="ja" data-title="慢性疼痛" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target">日本語</a></li><li class="interlanguage-link interwiki-no mw-list-item"><a href="https://no.wikipedia.org/wiki/Kronisk_smerte" title="Kronisk smerte – Norwegian Bokmål" lang="nb" hreflang="nb" data-title="Kronisk smerte" data-language-autonym="Norsk bokmål" data-language-local-name="Norwegian Bokmål" class="interlanguage-link-target">Norsk bokmål</a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Dor_cr%C3%B4nica" title="Dor crônica – Portuguese" lang="pt" hreflang="pt" data-title="Dor crônica" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target">Português</a></li><li class="interlanguage-link interwiki-sl mw-list-item"><a href="https://sl.wikipedia.org/wiki/Kroni%C4%8Dna_bole%C4%8Dina" title="Kronična bolečina – Slovenian" lang="sl" hreflang="sl" data-title="Kronična bolečina" data-language-autonym="Slovenščina" data-language-local-name="Slovenian" class="interlanguage-link-target">Slovenščina</a></li><li class="interlanguage-link interwiki-ckb mw-list-item"><a href="https://ckb.wikipedia.org/wiki/%D8%A6%D8%A7%D8%B2%D8%A7%D8%B1%DB%8C_%D8%AF%D8%B1%DB%8E%DA%98%D8%AE%D8%A7%DB%8C%DB%95%D9%86" title="ئازاری درێژخایەن – Central Kurdish" lang="ckb" hreflang="ckb" data-title="ئازاری درێژخایەن" data-language-autonym="کوردی" data-language-local-name="Central Kurdish" class="interlanguage-link-target">کوردی</a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/Hroni%C4%8Dni_bol" title="Hronični bol – Serbian" lang="sr" hreflang="sr" data-title="Hronični bol" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target">Српски / srpski</a></li><li class="interlanguage-link interwiki-sh mw-list-item"><a href="https://sh.wikipedia.org/wiki/Hroni%C4%8Dni_bol" title="Hronični bol – Serbo-Croatian" lang="sh" hreflang="sh" data-title="Hronični bol" data-language-autonym="Srpskohrvatski / српскохрватски" data-language-local-name="Serbo-Croatian" class="interlanguage-link-target">Srpskohrvatski / српскохрватски</a></li><li class="interlanguage-link interwiki-fi mw-list-item"><a href="https://fi.wikipedia.org/wiki/Krooninen_kipu" title="Krooninen kipu – Finnish" lang="fi" hreflang="fi" data-title="Krooninen kipu" data-language-autonym="Suomi" data-language-local-name="Finnish" class="interlanguage-link-target">Suomi</a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/L%C3%A5ngvarig_sm%C3%A4rta" title="Långvarig smärta – Swedish" lang="sv" hreflang="sv" data-title="Långvarig smärta" data-language-autonym="Svenska" data-language-local-name="Swedish" class="interlanguage-link-target">Svenska</a></li><li class="interlanguage-link interwiki-tr mw-list-item"><a href="https://tr.wikipedia.org/wiki/Kronik_a%C4%9Fr%C4%B1" title="Kronik ağrı – Turkish" lang="tr" hreflang="tr" data-title="Kronik ağrı" data-language-autonym="Türkçe" data-language-local-name="Turkish" class="interlanguage-link-target">Türkçe</a></li><li class="interlanguage-link interwiki-uk mw-list-item"><a href="https://uk.wikipedia.org/wiki/%D0%A5%D1%80%D0%BE%D0%BD%D1%96%D1%87%D0%BD%D0%B8%D0%B9_%D0%B1%D1%96%D0%BB%D1%8C" title="Хронічний біль – Ukrainian" lang="uk" hreflang="uk" data-title="Хронічний біль" data-language-autonym="Українська" data-language-local-name="Ukrainian" class="interlanguage-link-target">Українська</a></li><li class="interlanguage-link interwiki-vi mw-list-item"><a href="https://vi.wikipedia.org/wiki/%C4%90au_m%E1%BA%A1n_t%C3%ADnh" title="Đau mạn tính – Vietnamese" lang="vi" hreflang="vi" data-title="Đau mạn tính" data-language-autonym="Tiếng Việt" data-language-local-name="Vietnamese" class="interlanguage-link-target">Tiếng Việt</a></li><li 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searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Chronic pain</th></tr><tr><th scope="row" class="infobox-label">Other names</th><td class="infobox-data">Burning pain, dull pain, throbbing pain</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data">Specialist in pain, <a href="/wiki/Neurology" title="Neurology">neurology</a> and <a href="/wiki/Psychology" title="Psychology">psychology</a><a href="#cite_note-Turk1-1">[1]</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Signs_and_symptoms" title="Signs and symptoms">Symptoms</a></th><td class="infobox-data">Pain lasts longer than the expected period of recovery.</td></tr><tr><th scope="row" class="infobox-label">Usual onset</th><td class="infobox-data">All age groups</td></tr><tr><th scope="row" class="infobox-label">Duration</th><td class="infobox-data">From three months to several years [<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>]</td></tr><tr><th scope="row" class="infobox-label">Causes</th><td class="infobox-data"><a href="/wiki/Blood_sugar" class="mw-redirect" title="Blood sugar">high blood sugar</a>, cancer, genetic disorder in neural differentiation, tissue damage, <a href="/wiki/Neurological_disorder" title="Neurological disorder">neurological disorder</a> and <a href="/wiki/Viral_diseases" class="mw-redirect" title="Viral diseases">viral diseases</a><a href="#cite_note-Dydyk-2023-2">[2]</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Risk_factor" title="Risk factor">Risk factors</a></th><td class="infobox-data"><a href="/wiki/Diabetes" title="Diabetes">diabetes</a>, <a href="/wiki/Cancer" title="Cancer">cancer</a> and <a href="/wiki/Cardiovascular_disease" title="Cardiovascular disease">heart diseases</a>[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>]</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_diagnosis" title="Medical diagnosis">Diagnostic method</a></th><td class="infobox-data">Based on <a href="/wiki/Medical_history" title="Medical history">medical history</a>, <a href="/wiki/Clinical_examination" class="mw-redirect" title="Clinical examination">clinical examination</a>, questionnaire and <a href="/wiki/Neuroimaging" title="Neuroimaging">neuroimaging</a><a href="#cite_note-Dydyk-2023-2">[2]</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Differential_diagnosis" title="Differential diagnosis">Differential diagnosis</a></th><td class="infobox-data"><a href="/wiki/Gastric_ulcer" class="mw-redirect" title="Gastric ulcer">gastric ulcer</a>, <a href="/wiki/Bone_fracture" title="Bone fracture">bone fracture</a>, <a href="/wiki/Hernia" title="Hernia">hernia</a> and <a href="/wiki/Neoplasia" class="mw-redirect" title="Neoplasia">neoplasia</a> of the spinal cord<a href="#cite_note-3">[3]</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medication" title="Medication">Medication</a></th><td class="infobox-data">Non-opioid: <a href="/wiki/Ibuprofen" title="Ibuprofen">ibuprofen</a>, <a href="/wiki/Acetaminophen" class="mw-redirect" title="Acetaminophen">acetaminophen</a>, <a href="/wiki/Naproxen" title="Naproxen">naproxen</a>, <a href="/wiki/Non-steroidal_anti-inflammatory_drug" class="mw-redirect" title="Non-steroidal anti-inflammatory drug">NSAIDs</a> and <a href="/wiki/Olanzapine" title="Olanzapine">olanzapine</a>[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] Opioid: <a href="/wiki/Morphine" title="Morphine">morphine</a>, <a href="/wiki/Codeine" title="Codeine">codeine</a>, <a href="/wiki/Endorphins" title="Endorphins">endorphins</a> and <a href="/wiki/Buprenorphine" title="Buprenorphine">buprenorphine</a><a href="#cite_note-Mehan-2018-4">[4]</a></td></tr><tr><th scope="row" class="infobox-label">Frequency</th><td class="infobox-data">8% to 55.2% in different countries[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>]</td></tr></tbody></table>Chronic pain or chronic pain syndrome is a type of <a href="/wiki/Pain" title="Pain">pain</a> that is also known by other titles such as gradual burning pain, electrical pain, throbbing pain, and nauseating pain. This type of pain is sometimes confused with acute pain<a href="#cite_note-8">[a]</a> and can last from three months to several years; various diagnostic manuals such as <a href="/wiki/DSM-5" title="DSM-5">DSM-5</a> and <a href="/wiki/ICD-11" title="ICD-11">ICD-11</a> have proposed several definitions of chronic pain, but the accepted definition is that it is "pain that lasts longer than the expected <a href="/wiki/Post-anesthesia_care_unit" title="Post-anesthesia care unit">period of recovery</a>." Creating a pain mechanism prevents possible damage to the body, but chronic pain is a pain without biological value (doesn't have a positive effect). This pain has different divisions; <a href="/wiki/Cancer" title="Cancer">cancer</a>, post-<a href="/wiki/Major_trauma" title="Major trauma">traumatic</a> or <a href="/wiki/Surgery" title="Surgery">surgery</a>, <a href="/wiki/Musculoskeletal" class="mw-redirect" title="Musculoskeletal">musculoskeletal</a> and <a href="/wiki/Visceral" class="mw-redirect" title="Visceral">visceral</a> are the most important of these divisions. Various factors cause the formation of chronic pain, which can be <a href="/wiki/Neurogenic" class="mw-redirect" title="Neurogenic">neurogenic</a> (gene-dependent), <a href="/wiki/Nociceptive" class="mw-redirect" title="Nociceptive">nociceptive</a>, <a href="/wiki/Neuropathic" class="mw-redirect" title="Neuropathic">neuropathic</a>, <a href="/wiki/Psychological" class="mw-redirect" title="Psychological">psychological</a> or unknown. Some diseases such as <a href="/wiki/Diabetes" title="Diabetes">diabetes</a> (<a href="/wiki/High_blood_sugar" class="mw-redirect" title="High blood sugar">high blood sugar</a>), <a href="/wiki/Shingles" title="Shingles">shingles</a> (some <a href="/wiki/Viral_diseases" class="mw-redirect" title="Viral diseases">viral diseases</a>), <a href="/wiki/Phantom_limb" title="Phantom limb">phantom limb</a> pain, <a href="/wiki/Hypertension" title="Hypertension">hypertension</a> and <a href="/wiki/Stroke" title="Stroke">stroke</a> also play a role in the formation of chronic pain. The most common types of chronic pain are <a href="/wiki/Back_pain" title="Back pain">back pain</a>, severe <a href="/wiki/Headache" title="Headache">headache</a>, <a href="/wiki/Migraine" title="Migraine">migraine</a>, and <a href="/wiki/Facial_pain" class="mw-redirect" title="Facial pain">facial pain</a>. Chronic pain can cause very severe psychological and physical effects that sometimes continue until the end of life. Analysis of the <a href="/wiki/Grey_matter" title="Grey matter">grey matter</a> (damage to <a href="/wiki/Brain" title="Brain">brain</a> neurons), <a href="/wiki/Insomnia" title="Insomnia">insomnia</a> and <a href="/wiki/Sleep_deprivation" title="Sleep deprivation">sleep deprivation</a>, <a href="/wiki/Metabolic" class="mw-redirect" title="Metabolic">metabolic</a> problems, <a href="/wiki/Chronic_stress" title="Chronic stress">chronic stress</a>, <a href="/wiki/Obesity" title="Obesity">obesity</a> and <a href="/wiki/Heart_attack" class="mw-redirect" title="Heart attack">heart attack</a> are examples of physical disorder; and <a href="/wiki/Depression_(mood)" title="Depression (mood)">depression</a>, <a href="/wiki/Cognitive_disorders" class="mw-redirect" title="Cognitive disorders">cognitive disorders</a>, <a href="/w/index.php?title=Perceived_injustice&action=edit&redlink=1" class="new" title="Perceived injustice (page does not exist)">perceived injustice</a> (PI) and <a href="/wiki/Neuroticism" title="Neuroticism">neuroticism</a> are examples of <a href="/wiki/Mental_disorder" title="Mental disorder">mental disorder</a>. A wide range of treatments are performed for this disease; <a href="/wiki/Drug_therapy" class="mw-redirect" title="Drug therapy">drug therapy</a> (types of <a href="/wiki/Opioid" title="Opioid">opioid</a> and <a href="/wiki/Nonopiod_analgesics" class="mw-redirect" title="Nonopiod analgesics">non-opioid</a> drugs), <a href="/wiki/Cognitive_behavioral_therapy" title="Cognitive behavioral therapy">cognitive behavioral therapy</a> and <a href="/wiki/Physical_therapy" title="Physical therapy">physical therapy</a> are the most significant of them. Medicines are usually associated with <a href="/wiki/Side_effect" title="Side effect">side effects</a> and are prescribed when the effects of pain become severe. Medicines such as <a href="/wiki/Aspirin" title="Aspirin">aspirin</a> and <a href="/wiki/Ibuprofen" title="Ibuprofen">ibuprofen</a> are used for milder pain and <a href="/wiki/Morphine" title="Morphine">morphine</a> and <a href="/wiki/Codeine" title="Codeine">codeine</a> for severe pain. Other treatment methods, such as behavioral therapy and physiotherapy, are often used as a supplement along with drugs due to their low effectiveness. There is currently no definitive cure for any of these methods, and research continues into a wide variety of new management and therapeutic interventions, such as <a href="/wiki/Nerve_block" title="Nerve block">nerve block</a> and <a href="/wiki/Radiation_therapy" title="Radiation therapy">radiation therapy</a>. Chronic pain is considered a kind of <a href="/wiki/Disease" title="Disease">disease</a>; this type of pain has affected the people of the world more than diabetes, cancer and <a href="/wiki/Heart_diseases" class="mw-redirect" title="Heart diseases">heart diseases</a>. During several <a href="/wiki/Epidemiology" title="Epidemiology">epidemiological</a> studies conducted in different countries, wide differences in the <a href="/wiki/Prevalence" title="Prevalence">prevalence</a> of chronic pain have been reported from 8% to 55.2% in countries; for example, studies evaluate the incidence in <a href="/wiki/Iran" title="Iran">Iran</a> and <a href="/wiki/Canada" title="Canada">Canada</a> between 10% and 20% and in the <a href="/wiki/United_States" title="United States">United States</a> between 30% and 40%. The results show that an average of 8% to 11.2% of people in different countries have severe chronic pain, and its epidemic is higher in industrialized countries than in other countries. According to the estimates of the <a href="/wiki/American_Medical_Association" title="American Medical Association">American Medical Association</a>, the costs related to this disease in this country are about 560 to 635 billion dollars. <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Classification">Classification</h2>[<a href="/w/index.php?title=Chronic_pain&action=edit&section=1" title="Edit section: Classification">edit</a>]</div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Pain#Classification" title="Pain">Pain § Classification</a></div> The <a href="/wiki/International_Association_for_the_Study_of_Pain" title="International Association for the Study of Pain">International Association for the Study of Pain</a> (IASP) defines chronic pain as a general <a href="/wiki/Pain" title="Pain">pain</a> without <a href="/wiki/Biological" class="mw-redirect" title="Biological">biological</a> value that sometimes continues even after the healing of the affected area;<a href="#cite_note-Turk12-9">[8]</a><a href="#cite_note-Thienhaus12-10">[9]</a> a type of pain that cannot be classified as acute pain<a href="#cite_note-11">[b]</a> and lasts longer than expected to heal, or typically, pain that has been experienced on most days or daily for the past six months, is considered chronic pain.<a href="#cite_note-Henning-2022-12">[10]</a><a href="#cite_note-Main-2001-13">[11]</a> According to the <a href="/wiki/DSM-5" title="DSM-5">DSM-5</a> index, a complication is "chronic" when the resulting complication (pain, disorder, and illness) lasts for a period of more than six months (this type of classification does not have any prerequisites such as physical or mental injury).<a href="#cite_note-14">[12]</a> The classification of chronic pain is not only limited to pains that arise in the presence of real tissue damage (secondary pains resulting from a primary event); the title "nociplastic pain" or primary pain is related to the pains that occur in the absence of a health-threatening factor, such as disease or damage to the body's <a href="/wiki/Somatosensory_system" title="Somatosensory system">somatosensory system</a>, and as a result of permanent <a href="/wiki/Nerve" title="Nerve">nerve</a> stimulation.<a href="#cite_note-15">[13]</a><a href="#cite_note-Treede-2019-16">[14]</a> The <a href="/wiki/International_Statistical_Classification_of_Diseases" class="mw-redirect" title="International Statistical Classification of Diseases">International Statistical Classification of Diseases</a>, in its 11th edition (<a href="/wiki/ICD-11" title="ICD-11">ICD-11</a>), proposed a seven-category classification for chronic pain:<a href="#cite_note-Treede-2015-17">[15]</a> <ol><li>Primary chronic pain: Defined by 3 months of continuous pain in one or more areas of the <a href="/wiki/Human_body" title="Human body">body</a>, the origin of which is not understood.</li> <li>Chronic cancer pain: pain in one of the body's organs caused by <a href="/wiki/Cancer" title="Cancer">cancer</a> damage (in <a href="/wiki/Internal_organs" class="mw-redirect" title="Internal organs">internal organs</a>, <a href="/wiki/Bone" title="Bone">bone</a> or <a href="/wiki/Skeletal_muscular" class="mw-redirect" title="Skeletal muscular">skeletal muscular</a>) is formed.</li> <li>Chronic pain post-<a href="/wiki/Major_trauma" title="Major trauma">traumatic</a> or <a href="/wiki/Surgery" title="Surgery">surgery</a>: Pain that occurs 3 months after an injury or surgery, without taking into account <a href="/wiki/Infection" title="Infection">infectious</a> conditions and the severity of tissue damage; also, the person's past pain is not important in this classification.</li> <li>Chronic <a href="/wiki/Neuropathic_pain" title="Neuropathic pain">neuropathic pain</a>: pain caused by damage to the <a href="/wiki/Somatosensory_system" title="Somatosensory system">somatosensory nervous system</a>.</li> <li>Chronic <a href="/wiki/Headache" title="Headache">headache</a> and <a href="/wiki/Orofacial_pain" title="Orofacial pain">orofacial pain</a>: pain that originates in the head or <a href="/wiki/Face" title="Face">face</a>, and occurs for 50% or more days over a 3 months period.</li> <li>Chronic visceral pain: pain originating in an internal organ.</li> <li>Chronic musculoskeletal pain: pain originating in the bones, muscles, <a href="/wiki/Joint" title="Joint">joints</a> or <a href="/wiki/Connective_tissue" title="Connective tissue">connective tissue</a>.</li></ol> Also, the <a href="/wiki/World_Health_Organization" title="World Health Organization">World Health Organization</a> (WHO) states that optional criteria or codes can be used in the classification of chronic pain for each of the seven categories of chronic pain (for example, "diabetic neuropathic" pain).<a href="#cite_note-Treede-2019-16">[14]</a> Another classification for chronic pain is "nociceptive" (caused by <a href="/wiki/Inflamed" class="mw-redirect" title="Inflamed">inflamed</a> or damaged tissue that activates special pain sensors called <a href="/wiki/Nociceptors" class="mw-redirect" title="Nociceptors">nociceptors</a>) and "neuropathic" (caused by damage or malfunction of the <a href="/wiki/Nervous_system" title="Nervous system">nervous system</a>).<a href="#cite_note-Treede-2015-17">[15]</a> The type of "nociceptive" itself is divided into two parts: "superficial" and "deep"; also, deep pains are divided into two parts: "deep physical" and "deep visceral" pain.<a href="#cite_note-18">[16]</a> "neuropathic" pains are also divided into "peripheral" (source The <a href="/wiki/Peripheral_nervous_system" title="Peripheral nervous system">peripheral nervous system</a>) and "central" (<a href="/wiki/Central_nervous_system" title="Central nervous system">Central nervous system</a> from the brain or <a href="/wiki/Spinal_cord" title="Spinal cord">spinal cord</a>) are divided.<a href="#cite_note-Bogduk1994-19">[17]</a><a href="#cite_note-20">[18]</a> <a href="/wiki/Peripheral_neuropathy" title="Peripheral neuropathy">Peripheral neuropathic pain</a> is often described as "burning", "tingling", "electrical", "stabbing", or "pins and needles".<a href="#cite_note-Paice2003-21">[19]</a> "Superficial pain" is the result of the activation of pain receptors in the <a href="/wiki/Skin" title="Skin">skin</a> or superficial tissues; "deep somatic pain" is caused by stimulation of pain receptors in <a href="/wiki/Ligament" title="Ligament">ligaments</a>, <a href="/wiki/Tendon" title="Tendon">tendons</a>, bones, <a href="/wiki/Blood_vessel" title="Blood vessel">blood vessels</a>, <a href="/wiki/Fascia" title="Fascia">fascia</a>, and muscles. (this type of pain is constant but weak)<a href="#cite_note-Coda-2001-22">[20]</a> and "deep visceral pain" is pain that originates from one of the body's organs. Deep pain is often very difficult to localize and occurs in multiple areas of the body when injured or inflamed. In the "deep visceral" type, the feeling of pain exists in a place far from the injury, for this reason it is also called vague pain.<a href="#cite_note-Coda-2001-22">[20]</a> <div class="mw-heading mw-heading2"><h2 id="Etiology">Etiology</h2>[<a href="/w/index.php?title=Chronic_pain&action=edit&section=2" title="Edit section: Etiology">edit</a>]</div> Chronic pain has many <a href="/wiki/Pathophysiology" title="Pathophysiology">pathophysiological</a> and environmental causes and can occur in cases such as <a href="/wiki/Peripheral_neuropathy" title="Peripheral neuropathy">neuropathy</a> of the central nervous system, after cerebral hemorrhage, tissue damage such as extensive burns, inflammation, autoimmune disorders such as rheumatoid arthritis, psychological stress such as headache, migraine or abdominal pain (caused by emotional, psychological or behavioral) and mechanical pain caused by tissue wear and tear such as arthritis.<a href="#cite_note-Dydyk-2023-2">[2]</a> In some cases, chronic pain can be caused by genetic factors which interfere with neuronal differentiation, leading to a permanently lowered threshold for pain.<a href="#cite_note-23">[21]</a> The pathophysiological <a href="/wiki/Etiology" title="Etiology">etiology</a> of chronic pain remains unclear. Many theories of chronic pain<a href="#cite_note-24">[22]</a><a href="#cite_note-25">[23]</a> fail to clearly explain why the same pathological conditions do not invariably result in chronic pain. Patients' anatomical predisposition to proximal neural compression (in particular of peripheral nerves) may be the answer to this conundrum. Proximal neural lesion at the level of the <a href="/wiki/Dorsal_root_ganglion" title="Dorsal root ganglion">dorsal root ganglion</a> (DRG) may drive a <a rel="nofollow" class="external text" href="https://www.frontiersin.org/files/Articles/1037376/fpain-04-1037376-HTML-r1/image_m/fpain-04-1037376-g002.jpg">vicious cycle of chronic pain</a> by causing postural protection of the painful site and consequent neural compression in the same spinal region. Difficulties in diagnosing proximal neural lesion<a href="#cite_note-26">[24]</a> may account for the theoretical perplexity of chronic pain. <div class="mw-heading mw-heading3"><h3 id="Pathophysiology">Pathophysiology</h3>[<a href="/w/index.php?title=Chronic_pain&action=edit&section=3" title="Edit section: Pathophysiology">edit</a>]</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Discogenic_Pain.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/2/27/Discogenic_Pain.png/220px-Discogenic_Pain.png" decoding="async" width="220" height="293" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/2/27/Discogenic_Pain.png/330px-Discogenic_Pain.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/2/27/Discogenic_Pain.png/440px-Discogenic_Pain.png 2x" data-file-width="768" data-file-height="1024" /></a><figcaption>Continuous pressure on the spine can destroy the <a href="/wiki/Intervertebral_disc" title="Intervertebral disc">intervertebral disc</a> and cause the <a href="/wiki/Sciatic_nerve" title="Sciatic nerve">sciatic nerve</a> to actively produce pain.</figcaption></figure> The mechanism of continuous activation and transmission of pain messages, leads the body to an activity to relieve pain (a <a href="/wiki/Mechanism_(biology)" title="Mechanism (biology)">mechanism</a> to prevent damage in the body), this action causes the release of <a href="/wiki/Prostaglandin" title="Prostaglandin">prostaglandin</a> and increase the sensitivity of that part to <a href="/wiki/Stimulation" title="Stimulation">stimulation</a>; Prostaglandin secretion causes unbearable and chronic pain.<a href="#cite_note-Panahi-2018-27">[25]</a> Under persistent activation, the transmission of pain signals to the <a href="/wiki/Posterior_horn_of_spinal_cord" class="mw-redirect" title="Posterior horn of spinal cord">dorsal horn</a> may produce a <a href="/wiki/Pain_wind-up" title="Pain wind-up">pain wind-up</a> phenomenon. This triggers changes that lower the threshold for pain signals to be transmitted. In addition, it may cause non-nociceptive nerve fibers to respond to, generate, and transmit pain signals.<a href="#cite_note-Hansson-1998-28">[26]</a><a href="#cite_note-Jena-2015-29">[27]</a> Researchers believe that the nerve fibers that cause this type of pain are <a href="/wiki/Group_C_nerve_fiber" title="Group C nerve fiber">group C nerve fibers</a>; these fibers are not <a href="/wiki/Myelinated" class="mw-redirect" title="Myelinated">myelinated</a> (have low transmission speed) and cause long-term pain.<a href="#cite_note-Jena-2015-29">[27]</a><a href="#cite_note-Dickenson-2002-30">[28]</a> These changes in neural structure can be explained by <a href="/wiki/Neuroplasticity" title="Neuroplasticity">neuroplasticity</a>.<a href="#cite_note-Dickenson-2002-30">[28]</a> When there is chronic pain, the <a href="/wiki/Somatotopic_arrangement" title="Somatotopic arrangement">somatotopic arrangement</a> of the body (the distribution view of nerve cells) is abnormally changed due to continuous stimulation and can cause <a href="/wiki/Allodynia" title="Allodynia">allodynia</a> or <a href="/wiki/Hyperalgesia" title="Hyperalgesia">hyperalgesia</a>.<a href="#cite_note-32">[c]</a> In chronic pain, this process is difficult to reverse or stop once established.<a href="#cite_note-Vadivelu_N,_Sinatra_R.-33">[30]</a> <a href="/wiki/EEG" class="mw-redirect" title="EEG">EEG</a> of people with chronic pain showed that brain activity and <a href="/wiki/Synaptic_plasticity" title="Synaptic plasticity">synaptic plasticity</a> change as a result of pain, and specifically, the relative activity of <a href="/wiki/Beta_wave" title="Beta wave">beta wave</a> increases and <a href="/wiki/Alpha_wave" title="Alpha wave">alpha</a> and <a href="/wiki/Theta_wave" title="Theta wave">theta waves</a> decrease.<a href="#cite_note-Jensen,_M.P._20092-31">[29]</a> Inefficient management of <a href="/wiki/Dopamine" title="Dopamine">dopamine</a> secretion in the brain can act as a common mechanism between chronic pain, <a href="/wiki/Insomnia" title="Insomnia">insomnia</a> and <a href="/wiki/Major_depressive_disorder" title="Major depressive disorder">major depressive disorder</a> and cause its unpleasant side effects.<a href="#cite_note-34">[31]</a> <a href="/wiki/Astrocytes" class="mw-redirect" title="Astrocytes">Astrocytes</a>, <a href="/wiki/Microglia" title="Microglia">microglia</a> and <a href="/wiki/Satellite_glial_cell" title="Satellite glial cell">satellite glial cells</a> also lose their effective function in chronic pain. Increasing the activity of microglia, changing microglia networks, and increasing the production of <a href="/wiki/Chemokine" title="Chemokine">chemokines</a> and <a href="/wiki/Cytokine" title="Cytokine">cytokines</a> by microglia may exacerbate chronic pain.<a href="#cite_note-Panahi-2018-27">[25]</a><a href="#cite_note-Ji-2013-35">[32]</a> It has also been observed that astrocytes lose their ability to regulate the <a href="/wiki/Electron_mobility" title="Electron mobility">excitability of neurons</a> and increase the spontaneous activity of neurons in pain circuits.<a href="#cite_note-Ji-2013-35">[32]</a> <div class="mw-heading mw-heading2"><h2 id="Management">Management</h2>[<a href="/w/index.php?title=Chronic_pain&action=edit&section=4" title="Edit section: Management">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Pain_management" title="Pain management">Pain management</a></div> <a href="/wiki/Pain_management" title="Pain management">Pain management</a> is a branch of medicine that uses an interdisciplinary approach. The combined knowledge of various medical professions and <a href="/wiki/Allied_health_professions" title="Allied health professions">allied health professions</a> is used to ease <a href="/wiki/Pain" title="Pain">pain</a> and improve the <a href="/wiki/Quality_of_life" title="Quality of life">quality of life</a> of those living with pain.<a href="#cite_note-36">[33]</a> The typical pain management team includes <a href="/wiki/Medical_practitioner" class="mw-redirect" title="Medical practitioner">medical practitioners</a> (particularly anesthesiologists), <a href="/wiki/Rehabilitation_psychology" title="Rehabilitation psychology">rehabilitation psychologists</a>, <a href="/wiki/Physiotherapist" class="mw-redirect" title="Physiotherapist">physiotherapists</a>, <a href="/wiki/Occupational_therapist" title="Occupational therapist">occupational therapists</a>, <a href="/wiki/Physician_assistants" class="mw-redirect" title="Physician assistants">physician assistants</a>, and <a href="/wiki/Nurse_practitioner" title="Nurse practitioner">nurse practitioners</a>.<a href="#cite_note-37">[34]</a> <a href="/wiki/Acute_pain" class="mw-redirect" title="Acute pain">Acute pain</a> usually resolves with the efforts of one practitioner; however, the management of chronic pain frequently requires the coordinated efforts of a treatment team.<a href="#cite_note-38">[35]</a><a href="#cite_note-Henningsen_P,_Zipfel_S.-39">[36]</a><a href="#cite_note-Stanos_S,_Houle_TT.-40">[37]</a> Complete, longterm <a href="/wiki/Remission_(medicine)" title="Remission (medicine)">remission</a> of many types of chronic pain is rare.<a href="#cite_note-chronic_low_back_pain.-41">[38]</a> Chronic pain may originate in the body, or in the brain or spinal cord. It is often difficult to treat. Epidemiological studies have found that 8–11.2% of people in various countries have chronic widespread pain.<a href="#cite_note-Andrews-2018-42">[39]</a> Various <a href="/wiki/Nonopiod_analgesics" class="mw-redirect" title="Nonopiod analgesics">non-opioid</a> medicines are initially recommended to treat chronic pain, depending on whether the pain is due to tissue damage or is <a href="/wiki/Peripheral_neuropathy" title="Peripheral neuropathy">neuropathic</a>.<a href="#cite_note-Tauben2015-43">[40]</a><a href="#cite_note-Welsch2015-44">[41]</a> Psychological treatments including <a href="/wiki/Cognitive_behavioral_therapy" title="Cognitive behavioral therapy">cognitive behavioral therapy</a> and <a href="/wiki/Acceptance_and_commitment_therapy" title="Acceptance and commitment therapy">acceptance and commitment therapy</a> may be effective for improving quality of life in those with chronic pain. Some people with chronic pain may benefit from <a href="/wiki/Opioid" title="Opioid">opioid</a> treatment while others can be harmed by it.<a href="#cite_note-Reuben2015-45">[42]</a><a href="#cite_note-46">[43]</a> People with non-cancer pain who have not been helped by non-opioid medicines might be recommended to try opioids if there is no history of <a href="/wiki/Substance_use_disorder" title="Substance use disorder">substance use disorder</a> and no current <a href="/wiki/Mental_illness" class="mw-redirect" title="Mental illness">mental illness</a>.<a href="#cite_note-Bus2017-47">[44]</a> <div class="mw-heading mw-heading3"><h3 id="Nonopioids">Nonopioids</h3>[<a href="/w/index.php?title=Chronic_pain&action=edit&section=5" title="Edit section: Nonopioids">edit</a>]</div> Initially recommended efforts are <a href="/wiki/Analgesic" title="Analgesic">non-opioid</a> based therapies.<a href="#cite_note-Bus2017-47">[44]</a> Non-opioid treatment of chronic pain with pharmaceutical medicines might include <a href="/wiki/Acetaminophen" class="mw-redirect" title="Acetaminophen">acetaminophen (paracetamol)</a><a href="#cite_note-48">[45]</a> or <a href="/wiki/Nonsteroidal_anti-inflammatory_drug" title="Nonsteroidal anti-inflammatory drug">NSAIDs</a>.<a href="#cite_note-49">[46]</a> Various other nonopioid medicines can be used, depending on whether the pain is a result of tissue damage or is <a href="/wiki/Neuropathic" class="mw-redirect" title="Neuropathic">neuropathic</a> (pain caused by a damaged or dysfunctional nervous system). There is limited evidence that <a href="/wiki/Cancer_pain" title="Cancer pain">cancer pain</a> or chronic pain from tissue damage as a result of a conditions (e.g. <a href="/wiki/Rheumatoid_arthritis" title="Rheumatoid arthritis">rheumatoid arthritis</a>) is best treated with opioids. For <a href="/wiki/Neuropathic_pain" title="Neuropathic pain">neuropathic pain</a> other drugs may be more effective than opioids,<a href="#cite_note-Tauben2015-43">[40]</a><a href="#cite_note-Welsch2015-44">[41]</a><a href="#cite_note-50">[47]</a><a href="#cite_note-51">[48]</a> such as <a href="/wiki/Tricyclic_antidepressants" class="mw-redirect" title="Tricyclic antidepressants">tricyclic antidepressants</a>,<a href="#cite_note-Moore2015-52">[49]</a> <a href="/wiki/Serotonin-norepinephrine_reuptake_inhibitors" class="mw-redirect" title="Serotonin-norepinephrine reuptake inhibitors">serotonin-norepinephrine reuptake inhibitors</a>,<a href="#cite_note-Gilron2015-53">[50]</a> and <a href="/wiki/Anticonvulsants" class="mw-redirect" title="Anticonvulsants">anticonvulsants</a>.<a href="#cite_note-Gilron2015-53">[50]</a> Some atypical antipsychotics, such as <a href="/wiki/Olanzapine" title="Olanzapine">olanzapine</a>, may also be effective, but the evidence to support this is in very early stages.<a href="#cite_note-54">[51]</a> In women with chronic pain, hormonal medications such as oral contraceptive pills ("the pill") might be helpful.<a href="#cite_note-55">[52]</a> When there is no evidence of a single best fit, doctors may need to look for a treatment that works for the individual person.<a href="#cite_note-Moore2015-52">[49]</a> It is difficult for doctors to predict who will use opioids just for pain management and who will go on to develop an addiction. It is also challenging for doctors to know which patients ask for opioids because they are living with an opioid addiction. Withholding, interrupting or withdrawing opioid treatment in people who benefit from it can cause harm.<a href="#cite_note-Reuben2015-45">[42]</a> <a href="/wiki/Interventional_pain_management" title="Interventional pain management">Interventional pain management</a> may be appropriate, including techniques such as <a href="/wiki/Myofascial_trigger_point#Trigger_point_injection" title="Myofascial trigger point">trigger point injections</a>, <a href="/wiki/Neurolytic_block" class="mw-redirect" title="Neurolytic block">neurolytic blocks</a>, and <a href="/wiki/Radiotherapy" class="mw-redirect" title="Radiotherapy">radiotherapy</a>. While there is no high quality evidence to support <a href="/wiki/Therapeutic_ultrasound" title="Therapeutic ultrasound">ultrasound</a>, it has been found to have a small effect on improving function in non-specific chronic low back pain.<a href="#cite_note-56">[53]</a> Psychological treatments, including <a href="/wiki/Cognitive_behavioral_therapy" title="Cognitive behavioral therapy">cognitive behavioral therapy</a><a href="#cite_note-pmid23091394-57">[54]</a><a href="#cite_note-pmid23175199-58">[55]</a> and <a href="/wiki/Acceptance_and_commitment_therapy" title="Acceptance and commitment therapy">acceptance and commitment therapy</a><a href="#cite_note-pmid23090719-59">[56]</a><a href="#cite_note-60">[57]</a> can be helpful for improving quality of life and reducing pain interference. Brief mindfulness-based treatment approaches have been used, but they are not yet recommended as a first-line treatment.<a href="#cite_note-61">[58]</a> The effectiveness of <a href="/wiki/Mindfulness-based_pain_management" title="Mindfulness-based pain management">mindfulness-based pain management</a> (MBPM) has been supported by a range of studies.<a href="#cite_note-Mehan-2018-4">[4]</a><a href="#cite_note-Long-2016-62">[59]</a><a href="#cite_note-Brown-2013-63">[60]</a> Among older adults psychological interventions can help reduce pain and improve <a href="/wiki/Self-efficacy" title="Self-efficacy">self-efficacy</a> for pain management.<a href="#cite_note-64">[61]</a> Psychological treatments have also been shown to be effective in children and teens with chronic headache or mixed chronic pain conditions.<a href="#cite_note-65">[62]</a> While exercise has been offered as a method to lessen chronic pain and there is some evidence of benefit, this evidence is tentative.<a href="#cite_note-Geneen-2017-66">[63]</a> For people living with chronic pain, exercise results in few side effects.<a href="#cite_note-Geneen-2017-66">[63]</a> <div class="mw-heading mw-heading3"><h3 id="Opioids">Opioids</h3>[<a href="/w/index.php?title=Chronic_pain&action=edit&section=6" title="Edit section: Opioids">edit</a>]</div> In those who have not benefited from other measures and have no history of either <a href="/wiki/Mental_illness" class="mw-redirect" title="Mental illness">mental illness</a> or <a href="/wiki/Substance_use_disorder" title="Substance use disorder">substance use disorder</a> treatment with opioids may be tried.<a href="#cite_note-Bus2017-47">[44]</a> If significant benefit does not occur it is recommended that they be stopped.<a href="#cite_note-Bus2017-47">[44]</a> In those on opioids, stopping or decreasing their use may improve outcomes including pain.<a href="#cite_note-67">[64]</a> Some people with chronic pain benefit from <a href="/wiki/Opioid" title="Opioid">opioid</a> treatment and others do not; some are harmed by the treatment.<a href="#cite_note-Reuben2015-45">[42]</a> Possible harms include reduced sex hormone production, <a href="/wiki/Hypogonadism" title="Hypogonadism">hypogonadism</a>, infertility, impaired immune system, falls and fractures in older adults, <a href="/wiki/Neonatal_abstinence_syndrome" class="mw-redirect" title="Neonatal abstinence syndrome">neonatal abstinence syndrome</a>, heart problems, sleep-disordered breathing, <a href="/wiki/Physical_dependence" title="Physical dependence">physical dependence</a>, addiction, abuse, and overdose.<a href="#cite_note-Neurology2014-68">[65]</a><a href="#cite_note-69">[66]</a> <div class="mw-heading mw-heading3"><h3 id="Alternative_medicine">Alternative medicine</h3>[<a href="/w/index.php?title=Chronic_pain&action=edit&section=7" title="Edit section: Alternative medicine">edit</a>]</div> Alternative medicine refers to health practices or products that are used to treat pain or illness that are not necessarily considered a part of conventional medicine.<a href="#cite_note-Lee-2011-70">[67]</a> When dealing with chronic pain, these practices generally fall into the following four categories: biological, mind-body, manipulative body, and energy medicine.<a href="#cite_note-Lee-2011-70">[67]</a> Implementing dietary changes, which is considered a biological-based alternative medicine practice, has been shown to help improve symptoms of chronic pain over time.<a href="#cite_note-Lee-2011-70">[67]</a> Adding supplements to one's diet is a common dietary change when trying to relieve chronic pain, with some of the most studied supplements being: <a href="/wiki/Acetyl_L_Carnitine" class="mw-redirect" title="Acetyl L Carnitine">acetyl-L-carnitine</a>, <a href="/wiki/Alpha-lipoic_acid" class="mw-redirect" title="Alpha-lipoic acid">alpha-lipoic acid</a>, and <a href="/wiki/Vitamin_E" title="Vitamin E">vitamin E</a>.<a href="#cite_note-Lee-2011-70">[67]</a><a href="#cite_note-71">[68]</a><a href="#cite_note-72">[69]</a><a href="#cite_note-Argyriou-2006-73">[70]</a> Vitamin E is perhaps the most studied out of the three, with strong evidence that it helps lower <a href="/wiki/Neurotoxicity" title="Neurotoxicity">neurotoxicity</a> in those with cancer, multiple sclerosis, and cardiovascular diseases.<a href="#cite_note-Argyriou-2006-73">[70]</a> <a href="/wiki/Hypnosis" title="Hypnosis">Hypnosis</a>, including <a href="/wiki/Self-hypnosis" title="Self-hypnosis">self-hypnosis</a>, has tentative evidence.<a href="#cite_note-pmid22655332-74">[71]</a> Hypnosis, specifically, can offer pain relief for most people and may be a safe alternative to pharmaceutical medication.<a href="#cite_note-75">[72]</a> Evidence does not support hypnosis for chronic pain due to a spinal cord injury.<a href="#cite_note-76">[73]</a> Preliminary studies have found <a href="/wiki/Medical_marijuana" class="mw-redirect" title="Medical marijuana">medical marijuana</a> to be beneficial in treating neuropathic pain, but not other kinds of long term pain.<a href="#cite_note-77">[74]</a> As of 2018<a class="external text" href="https://en.wikipedia.org/w/index.php?title=Chronic_pain&action=edit">[update]</a>, the evidence for its efficacy in treating neuropathic pain or pain associated with rheumatic diseases is not strong for any benefit and further research is needed.<a href="#cite_note-78">[75]</a><a href="#cite_note-79">[76]</a><a href="#cite_note-Hauser-2018-80">[77]</a> For chronic non-cancer pain, a recent study concluded that it is unlikely that <a href="/wiki/Cannabinoid" title="Cannabinoid">cannabinoids</a> are highly effective.<a href="#cite_note-81">[78]</a> However, more rigorous research into cannabis or cannabis-based medicines is needed.<a href="#cite_note-Hauser-2018-80">[77]</a> <a href="/wiki/Tai_chi" title="Tai chi">Tai chi</a> has been shown to improve pain, stiffness, and quality of life in chronic conditions such as osteoarthritis, low back pain, and osteoporosis.<a href="#cite_note-82">[79]</a><a href="#cite_note-83">[80]</a> <a href="/wiki/Acupuncture" title="Acupuncture">Acupuncture</a> has also been found to be an effective and safe treatment in reducing pain and improving quality of life in chronic pain including <a href="/wiki/Chronic_prostatitis/chronic_pelvic_pain_syndrome" title="Chronic prostatitis/chronic pelvic pain syndrome">chronic pelvic pain syndrome</a>.<a href="#cite_note-84">[81]</a><a href="#cite_note-85">[82]</a> <a href="/wiki/Transcranial_magnetic_stimulation" title="Transcranial magnetic stimulation">Transcranial magnetic stimulation</a> for reduction of chronic pain is not supported by high quality evidence, and the demonstrated effects are small and short-term.<a href="#cite_note-86">[83]</a> Spa therapy could potentially improve pain in patients with chronic lower back pain, but more studies are needed to provide stronger evidence of this.<a href="#cite_note-87">[84]</a> While some studies have investigated the efficacy of St John's Wort or nutmeg for treating neuropathic (nerve) pain, their findings have raised serious concerns about the accuracy of their results.<a href="#cite_note-88">[85]</a> <a href="/wiki/KT_tape" class="mw-redirect" title="KT tape">Kinesio tape</a> has not been shown to be effective in managing chronic non-specific low-back pain.<a href="#cite_note-89">[86]</a> <a href="/wiki/Myofascial_release" title="Myofascial release">Myofascial release</a> has been used in some cases of <a href="/wiki/Fibromyalgia" title="Fibromyalgia">fibromyalgia</a>, chronic <a href="/wiki/Low_back_pain" title="Low back pain">low back pain</a>, and <a href="/wiki/Tennis_elbow" title="Tennis elbow">tennis elbow</a> but there is not enough evidence to support this as method of treatment.<a href="#cite_note-90">[87]</a> <div class="mw-heading mw-heading2"><h2 id="Epidemiology">Epidemiology</h2>[<a href="/w/index.php?title=Chronic_pain&action=edit&section=8" title="Edit section: Epidemiology">edit</a>]</div> Chronic pain varies in different countries affecting anywhere from 8% to 55% of the population. It affects women at a higher rate than men, and chronic pain uses a large amount of healthcare resources around the globe.<a href="#cite_note-Harstall2003-91">[88]</a><a href="#cite_note-Andrews-2018-42">[39]</a> A large-scale telephone survey of 15 European countries and Israel found that 19% of respondents over 18 years of age had suffered pain for more than 6 months, including the last month, and more than twice in the last week, with pain intensity of 5 or more for the last episode, on a scale of 1 (no pain) to 10 (worst imaginable). 4839 of these respondents with chronic pain were interviewed in-depth. Sixty-six percent scored their pain intensity at moderate (5–7), and 34% at severe (8–10); 46% had constant pain, 56% intermittent; 49% had suffered pain for 2–15 years; and 21% had been diagnosed with depression due to the pain. Sixty-one percent were unable or less able to work outside the home, 19% had lost a job, and 13% had changed jobs due to their pain. Forty percent had inadequate pain management and less than 2% were seeing a pain management specialist.<a href="#cite_note-92">[89]</a> In the United States, chronic pain has been estimated to occur in approximately 35% of the population, with approximately 50 million Americans experiencing partial or total disability as a consequence.<a href="#cite_note-93">[90]</a> According to the <a href="/wiki/Institute_of_Medicine" class="mw-redirect" title="Institute of Medicine">Institute of Medicine</a>, there are about 116 million Americans living with chronic pain, which suggests that approximately half of American adults have some chronic pain condition.<a href="#cite_note-painreview-94">[91]</a><a href="#cite_note-95">[92]</a> The Mayday Fund estimate of 70 million Americans with chronic pain is slightly more conservative.<a href="#cite_note-96">[93]</a> In an internet study, the prevalence of chronic pain in the United States was calculated to be 30.7% of the population: 34.3% for women and 26.7% for men.<a href="#cite_note-pmid20797916-97">[94]</a> In Canada it is estimated that approximately 1 in 5 Canadians live with chronic pain and half of those people have lived with chronic pain for 10 years or longer.<a href="#cite_note-Health_Canada-2019-98">[95]</a> Chronic pain in Canada also occurs more and is more severe in women and Canada's <a href="/wiki/Indigenous_peoples_in_Canada" title="Indigenous peoples in Canada">Indigenous communities</a>.<a href="#cite_note-Health_Canada-2019-98">[95]</a> <div class="mw-heading mw-heading2"><h2 id="Outcomes">Outcomes</h2>[<a href="/w/index.php?title=Chronic_pain&action=edit&section=9" title="Edit section: Outcomes">edit</a>]</div> Sleep disturbance, and <a href="/wiki/Insomnia" title="Insomnia">insomnia</a> due to medication and illness symptoms are often experienced by those with chronic pain.<a href="#cite_note-99">[96]</a> These conditions can be difficult to treat due to the high potential of medication interactions, especially when the conditions are treated by different doctors.<a href="#cite_note-100">[97]</a> Severe chronic pain is associated with increased risk of death over a ten-year period, particularly from heart disease and respiratory disease.<a href="#cite_note-pmid19726210-101">[98]</a> Several mechanisms have been proposed for this increase, such as an abnormal <a href="/wiki/Fight-or-flight_response" title="Fight-or-flight response">stress response</a> in the body's <a href="/wiki/Endocrine_system" title="Endocrine system">endocrine system</a>.<a href="#cite_note-102">[99]</a> Additionally, chronic stress seems to affect risks to heart and lung (<a href="/wiki/Cardiovascular" class="mw-redirect" title="Cardiovascular">cardiovascular</a>) health by increasing how quickly plaque can build up on artery walls (<a href="/wiki/Arteriosclerosis" title="Arteriosclerosis">arteriosclerosis</a>). However, further research is needed to clarify the relationship between severe chronic pain, stress and cardiovascular health.<a href="#cite_note-pmid19726210-101">[98]</a> People with chronic pain tend to have higher rates of depression<a href="#cite_note-103">[100]</a> and although the exact connection between the comorbidities is unclear, a 2017 study on neuroplasticity found that "injury sensory pathways of body pains have been shown to share the same brain regions involved in mood management."<a href="#cite_note-104">[101]</a> Chronic pain can contribute to decreased physical activity due to fear of making the pain worse. Pain intensity, pain control, and resilience to pain can be influenced by different levels and types of <a href="/wiki/Social_support" title="Social support">social support</a> that a person with chronic pain receives, and are also influenced by the person's <a href="/wiki/Socioeconomic_status" title="Socioeconomic status">socioeconomic status</a>.<a href="#cite_note-105">[102]</a> In a study, <a href="/wiki/Mendelian_randomization" title="Mendelian randomization">Mendelian randomization</a> was used to identify <a href="/wiki/Causality" title="Causality">causal relationships</a> between chronic pain and certain psychiatric, cardiovascular, and inflammatory conditions that were initially thought to be unrelated to pain. It was found that exposure to <a href="/wiki/Depression_(mood)" title="Depression (mood)">depression</a> increases the likelihood of reporting pain, but not the other way around. Exposure to <a href="/wiki/Coronary_artery_disease" title="Coronary artery disease">coronary diseases</a> increases the risk of developing chronic pain, and vice versa. An increase in <a href="/wiki/Body_mass_index" title="Body mass index">body mass index</a> modestly raises the likelihood of experiencing pain, while high blood <a href="/wiki/High-density_lipoprotein" title="High-density lipoprotein">HDL</a> levels reduce the probability of suffering from chronic pain. Regarding inflammatory traits, exposure to <a href="/wiki/Asthma" title="Asthma">asthma</a> increases the likelihood of experiencing pain, and vice versa.<a href="#cite_note-106">[103]</a> Chronic pain of different causes has been characterized as a disease that affects brain structure and function. <a href="/wiki/Magnetic_resonance_imaging" title="Magnetic resonance imaging">MRI</a> studies have shown abnormal anatomical<a href="#cite_note-geha-107">[104]</a> and functional connectivity, even during rest<a href="#cite_note-baliki-108">[105]</a><a href="#cite_note-taglia-109">[106]</a> involving areas related to the processing of pain. Also, persistent pain has been shown to cause <a href="/wiki/Grey_matter" title="Grey matter">grey matter</a> loss, which is reversible once the pain has resolved.<a href="#cite_note-may-110">[107]</a><a href="#cite_note-seminowicz-111">[108]</a> One approach to predicting a person's experience of chronic pain is the <a href="/wiki/Biopsychosocial_model" title="Biopsychosocial model">biopsychosocial model</a>, according to which an individual's experience of chronic pain may be affected by a complex mixture of their biology, psychology, and their social environment.<a href="#cite_note-Hochwarter-2010-112">[109]</a> Chronic pain may be an important contributor to <a href="/wiki/Suicide" title="Suicide">suicide</a>.<a href="#cite_note-113">[110]</a> <div class="mw-heading mw-heading2"><h2 id="Psychology">Psychology</h2>[<a href="/w/index.php?title=Chronic_pain&action=edit&section=10" title="Edit section: Psychology">edit</a>]</div> <div class="mw-heading mw-heading3"><h3 id="Personality">Personality</h3>[<a href="/w/index.php?title=Chronic_pain&action=edit&section=11" title="Edit section: Personality">edit</a>]</div> Two of the most frequent personality profiles found in people with chronic pain by the <a href="/wiki/Minnesota_Multiphasic_Personality_Inventory" title="Minnesota Multiphasic Personality Inventory">Minnesota Multiphasic Personality Inventory</a> (MMPI) are the conversion V and the neurotic triad. The conversion V personality expresses exaggerated concern over body feelings, develops bodily symptoms in response to stress, and often fails to recognize their own emotional state, including depression. The neurotic triad personality also expresses exaggerated concern over body feelings and develops bodily symptoms in response to stress, but is demanding and complaining.<a href="#cite_note-114">[111]</a> Some investigators have argued that it is this <a href="/wiki/Neuroticism" title="Neuroticism">neuroticism</a> that causes acute pain to turn chronic, but clinical evidence points the other way, to chronic pain causing neuroticism. When long term pain is relieved by therapeutic intervention, scores on the neurotic triad and <a href="/wiki/Anxiety" title="Anxiety">anxiety</a> fall, often to normal levels.<a href="#cite_note-pmid17112364-115">[112]</a><a href="#cite_note-pmid9648998-116">[113]</a><a href="#cite_note-pmid7846260-117">[114]</a><a href="#cite_note-Melzack_Wall_1996_31-32-118">[115]</a> Self-esteem, often low in people with chronic pain, also shows improvement once pain has resolved.<a href="#cite_note-Melzack_Wall_1996_31-32-118">[115]</a> It has been suggested that <a href="/wiki/Pain_catastrophizing" title="Pain catastrophizing">catastrophizing</a> might play a role in the experience of pain. Pain catastrophizing is the tendency to describe a pain experience in more exaggerated terms than the average person, to think a great deal more about the pain when it occurs, or to feel more helpless about the experience.<a href="#cite_note-Damme-119">[116]</a> People who score highly on measures of catastrophization are likely to rate a pain experience as more intense than those who score low on such measures. It is often reasoned that the tendency to catastrophize causes the person to experience the pain as more intense. One suggestion is that catastrophizing influences pain perception through altering attention and anticipation, and heightening emotional responses to pain.<a href="#cite_note-Grace-120">[117]</a> However, at least some aspects of catastrophization may be the product of an intense pain experience, rather than its cause. That is, the more intense the pain feels to the person, the more likely they are to have thoughts about it that fit the definition of catastrophization.<a href="#cite_note-121">[118]</a> <div class="mw-heading mw-heading3"><h3 id="Comorbidity_with_trauma">Comorbidity with trauma</h3>[<a href="/w/index.php?title=Chronic_pain&action=edit&section=12" title="Edit section: Comorbidity with trauma">edit</a>]</div> Individuals with post-traumatic stress disorder (PTSD) have a high comorbidity with chronic pain.<a href="#cite_note-122">[119]</a> Patients with both PTSD and chronic pain report higher severity of pain than those who do not have a PTSD comorbidity.<a href="#cite_note-123">[120]</a><a href="#cite_note-124">[121]</a> <div class="mw-heading mw-heading3"><h3 id="Comorbidity_with_depression">Comorbidity with depression</h3>[<a href="/w/index.php?title=Chronic_pain&action=edit&section=13" title="Edit section: Comorbidity with depression">edit</a>]</div> People with chronic pain may also have symptoms of depression.<a href="#cite_note-125">[122]</a><a href="#cite_note-126">[123]</a> In 2017, the British Medical Association found that 49% of people with chronic pain had depression.<a href="#cite_note-127">[124]</a> <div class="mw-heading mw-heading3"><h3 id="Effect_on_cognition">Effect on cognition</h3>[<a href="/w/index.php?title=Chronic_pain&action=edit&section=14" title="Edit section: Effect on cognition">edit</a>]</div> Chronic pain's impact on cognition is an under-researched area, but several tentative conclusions have been published. Most people with chronic pain complain of <a href="/wiki/Cognitive_impairment" title="Cognitive impairment">cognitive impairment</a>, such as forgetfulness, difficulty with attention, and difficulty completing tasks. Objective testing has found that people in chronic pain tend to experience impairment in attention, memory, mental flexibility, verbal ability, speed of response in a cognitive task, and speed in executing structured tasks.<a href="#cite_note-128">[125]</a> A review of studies in 2018 reports a relationship between people in chronic pain and abnormal results in test of memory, attention, and processing speed.<a href="#cite_note-129">[126]</a> <div class="mw-heading mw-heading2"><h2 id="Prognosis">Prognosis</h2>[<a href="/w/index.php?title=Chronic_pain&action=edit&section=15" title="Edit section: Prognosis">edit</a>]</div> Chronic pain leads to a significant decrease in quality of life, decreased productivity, decreased wages, worsening of other chronic diseases, and mental disorders such as depression, anxiety, and <a href="/wiki/Substance_use_disorder" title="Substance use disorder">substance use disorder</a>.<a href="#cite_note-Dydyk-2023-2">[2]</a> Many drugs that are often used to treat chronic pain have risks and potential side effects and possible complications associated with their use, and the constant use of opioids is associated with decreased life expectancy and increased mortality of patients.<a href="#cite_note-130">[127]</a><a href="#cite_note-131">[128]</a> Acetaminophen, a standard drug treatment for chronic pain, can cause <a href="/wiki/Hepatotoxicity" title="Hepatotoxicity">hepatotoxicity</a> when taken in excess of four grams per day.<a href="#cite_note-132">[129]</a><a href="#cite_note-133">[130]</a> In addition, therapeutic doses for patients with chronic <a href="/wiki/Liver_diseases" class="mw-redirect" title="Liver diseases">liver diseases</a> may also cause hepatotoxicity.<a href="#cite_note-134">[131]</a> Long-term risks and side effects of opioids include <a href="/wiki/Constipation" title="Constipation">constipation</a>, drug <a href="/wiki/Drug_tolerance" title="Drug tolerance">tolerance</a> or <a href="/wiki/Drug_dependence" class="mw-redirect" title="Drug dependence">dependence</a>, <a href="/wiki/Nausea" title="Nausea">nausea</a>, <a href="/wiki/Indigestion" title="Indigestion">indigestion</a>, <a href="/wiki/Arrhythmia" title="Arrhythmia">arrhythmia</a> (QT prolongation of <a href="/wiki/Electrocardiography" title="Electrocardiography">electrocardiography</a> in <a href="/wiki/Methadone" title="Methadone">methadone</a> treatment), and <a href="/wiki/Endocrine_gland" title="Endocrine gland">endocrine gland</a> problems that can lead to <a href="/wiki/Amenorrhea" title="Amenorrhea">amenorrhea</a>, <a href="/wiki/Impotence" class="mw-redirect" title="Impotence">impotence</a>, <a href="/wiki/Gynecomastia" title="Gynecomastia">gynecomastia</a>, and decreased become energy. Also there is a risk of opioid <a href="/wiki/Drug_overdose" title="Drug overdose">overdose</a> depending on the dose taken by the patient.<a href="#cite_note-Dydyk-2023-2">[2]</a><a href="#cite_note-135">[132]</a> Current treatments for chronic pain can reduce pain by 30%.<a href="#cite_note-136">[133]</a> This reduction in pain can significantly improve patients' performance and quality of life. However, the general and long-term prognosis of chronic pain shows decreased function and quality of life.<a href="#cite_note-137">[134]</a> Also, this disease causes many complications and increases the possibility of death of patients and suffering from other chronic diseases and <a href="/wiki/Obesity" title="Obesity">obesity</a>.<a href="#cite_note-Dydyk-2023-2">[2]</a> Similarly, patients with chronic pain who require opioids often develop drug tolerance over time, and this increase in the amount of the dose taken to be effective increases the risk of side effects and death.<a href="#cite_note-Dydyk-2023-2">[2]</a> Mental disorders can amplify pain signals and make symptoms more severe.<a href="#cite_note-138">[135]</a> In addition, comorbid psychiatric disorders, such as major depressive disorder, can significantly delay the diagnosis of pain disorders.<a href="#cite_note-139">[136]</a> Major depressive disorder and generalized anxiety disorder are the most common comorbidities associated with chronic pain. Patients with underlying pain and comorbid mental disorders receive twice as much medication from doctors annually as compared to patients who do not have such co-morbidities.<a href="#cite_note-Closs-2002-140">[137]</a> Studies have shown that when coexisting diseases exist along with chronic pain, the treatment and improvement of one of these disorders can be effective in the improvement of the other.<a href="#cite_note-Tang-2006-141">[138]</a><a href="#cite_note-Petrosky-2018-142">[139]</a> Patients with chronic pain are at higher risk for <a href="/wiki/Suicide" title="Suicide">suicide</a> and <a href="/wiki/Suicidal_thought" class="mw-redirect" title="Suicidal thought">suicidal thoughts</a>. Research has shown approximately 20% of people with suicidal thoughts and between 5 and 14% of patients with chronic pain who commit suicide.<a href="#cite_note-Tang-2006-141">[138]</a> Of patients who attempted suicide, 53.6% died of gunshot wounds and 16.2% died of opioid overdose.<a href="#cite_note-Petrosky-2018-142">[139]</a> A multimodal treatment approach is important for better pain control and outcomes, as well as minimizing the need for high-risk treatments such as opioid medications. Managing comorbid depression and anxiety is critical in reducing chronic pain.<a href="#cite_note-Dydyk-2023-2">[2]</a><a href="#cite_note-Tang-2006-141">[138]</a> Also, patients with chronic pain should be carefully monitored for severe depression and any suicidal thoughts and plans.<a href="#cite_note-Dydyk-2023-2">[2]</a><a href="#cite_note-Petrosky-2018-142">[139]</a> Periodic referral of the patient to the doctor for physical examination and to check the effectiveness of treatment 2 is necessary, and the rapid and correct treatment and management of chronic pain can prevent the occurrence of potential negative consequences on the patient's life and increase in healthcare costs.<a href="#cite_note-Dydyk-2023-2">[2]</a> <div class="mw-heading mw-heading2"><h2 id="Social_and_personal_impacts">Social and personal impacts</h2>[<a href="/w/index.php?title=Chronic_pain&action=edit&section=16" title="Edit section: Social and personal impacts">edit</a>]</div> <div class="mw-heading mw-heading3"><h3 id="Social_support">Social support</h3>[<a href="/w/index.php?title=Chronic_pain&action=edit&section=17" title="Edit section: Social support">edit</a>]</div> <a href="/wiki/Social_support" title="Social support">Social support</a> has important consequences for individuals with chronic pain. In particular, pain intensity, pain control, and resiliency to pain have been implicated as outcomes influenced by different levels and types of social support. Much of this research has focused on emotional, instrumental, tangible and informational social support. People with persistent pain conditions tend to rely on their social support as a coping mechanism and therefore have better outcomes when they are a part of larger more supportive social networks. Across a majority of studies investigated, there was a direct significant association between social activities or social support and pain. Higher levels of pain were associated with a decrease in social activities, lower levels of social support, and reduced social functioning.<a href="#cite_note-143">[140]</a><a href="#cite_note-144">[141]</a> <div class="mw-heading mw-heading3"><h3 id="Racial_disparities">Racial disparities</h3>[<a href="/w/index.php?title=Chronic_pain&action=edit&section=18" title="Edit section: Racial disparities">edit</a>]</div> Evidence exists for unconscious biases and negative stereotyping against <a href="/wiki/Racial_minority" class="mw-redirect" title="Racial minority">racial minorities</a> requesting pain treatment, although clinical decision making was not affected, according to one 2017 review.<a href="#cite_note-dehon-145">[142]</a> Minorities may be denied diagnoses for pain and pain medications, and are more likely to go through <a href="/wiki/Substance_abuse" title="Substance abuse">substance abuse</a> assessment, and are less likely to transfer for pain specialist referral.<a href="#cite_note-tait-146">[143]</a> A 2010 University of Michigan Health study found that black patients in pain clinics received 50% of the amount of drugs that patients who were white received.<a href="#cite_note-147">[144]</a> Preliminary research showed that health providers might have less empathy for black patients and underestimated their pain levels, resulting in treatment delays.<a href="#cite_note-dehon-145">[142]</a><a href="#cite_note-tait-146">[143]</a> Minorities may experience a <a href="/wiki/Language_barrier" title="Language barrier">language barrier</a>, limiting the high level of engagement between the person with pain and health providers for treatment.<a href="#cite_note-tait-146">[143]</a> <div class="mw-heading mw-heading3"><h3 id="Perceptions_of_injustice">Perceptions of injustice</h3>[<a href="/w/index.php?title=Chronic_pain&action=edit&section=19" title="Edit section: Perceptions of injustice">edit</a>]</div> Similar to the damaging effects seen with catastrophizing, perceived injustice is thought to contribute to the severity and duration of chronic pain.<a href="#cite_note-148">[145]</a> Pain-related injustice perception has been conceptualized as a cognitive appraisal reflecting the severity and irreparability of pain- or injury-related loss (e.g., "I just want my life back"), and externalizing blame and unfairness ("I am suffering because of someone else's negligence.").<a href="#cite_note-149">[146]</a> It has been suggested that understanding problems with top down processing/cognitive appraisals can be used to better understand and treat this problem.<a href="#cite_note-150">[147]</a> <div class="mw-heading mw-heading3"><h3 id="Chronic_pain_and_COVID-19">Chronic pain and COVID-19</h3>[<a href="/w/index.php?title=Chronic_pain&action=edit&section=20" title="Edit section: Chronic pain and COVID-19">edit</a>]</div> <a href="/wiki/COVID-19" title="COVID-19">COVID-19</a> has disrupted the lives of many, leading to major physical, psychological and socioeconomic impacts in the general population.<a href="#cite_note-doi.org-151">[148]</a> Social distancing practices defining the response to the pandemic alter familiar patterns of social interaction, creating the conditions for what some psychologists are describing as a period of collective grief.<a href="#cite_note-152">[149]</a> Individuals with chronic pain tend to embody an ambiguous status, at times expressing that their type of suffering places them between and outside of conventional medicine.<a href="#cite_note-153">[150]</a> With a large proportion of the global population enduring prolonged periods of social isolation and distress, one study found that people with chronic pain from COVID-19 experienced more empathy towards their suffering during the pandemic.<a href="#cite_note-doi.org-151">[148]</a> <div class="mw-heading mw-heading3"><h3 id="Effect_of_chronic_pain_in_the_workplace">Effect of chronic pain in the workplace</h3>[<a href="/w/index.php?title=Chronic_pain&action=edit&section=21" title="Edit section: Effect of chronic pain in the workplace">edit</a>]</div> In the workplace, chronic pain conditions are a significant problem for both the person with the condition and the organization; a problem only expected to increase in many countries due to an aging workforce.<a href="#cite_note-Hochwarter-2010-112">[109]</a> In light of this, it may be helpful for organizations to consider the social environment of their workplace, and how it may be working to ease or worsen chronic pain issues for employees.<a href="#cite_note-Hochwarter-2010-112">[109]</a> As an example of how the social environment can affect chronic pain, some research has found that high levels of socially prescribed perfectionism (perfectionism induced by external pressure from others, such as a supervisor) can interact with the guilt felt by a person with chronic pain, thereby increasing job tension, and decreasing job satisfaction.<a href="#cite_note-Hochwarter-2010-112">[109]</a> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2>[<a href="/w/index.php?title=Chronic_pain&action=edit&section=22" title="Edit section: See also">edit</a>]</div> <ul><li><a href="/wiki/List_of_chronic_pain_syndromes" title="List of chronic pain syndromes">List of chronic pain syndromes</a></li> <li><a href="/wiki/Childhood_chronic_pain" title="Childhood chronic pain">Childhood chronic pain</a></li> <li><a href="/wiki/Dopaminergic_pathways" title="Dopaminergic pathways">Dopaminergic pathways</a></li> <li><a href="/wiki/List_of_investigational_analgesics" title="List of investigational analgesics">List of investigational analgesics</a></li> <li><a href="/wiki/Neurodegeneration" class="mw-redirect" title="Neurodegeneration">Neurodegeneration</a></li> <li><a href="/wiki/Neuroinflammation" title="Neuroinflammation">Neuroinflammation</a></li> <li><a href="/wiki/Neurotherapy" title="Neurotherapy">Neurotherapy</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="Notes">Notes</h2>[<a href="/w/index.php?title=Chronic_pain&action=edit&section=23" title="Edit section: Notes">edit</a>]</div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist reflist-lower-alpha"> <div class="mw-references-wrap"><ol class="references"> <li id="cite_note-8"><a href="#cite_ref-8">^</a> Doctors define acute pain as pain associated with a cause that can be relieved by treating the cause. In the general sense, acute pain means pain that decreases or stops when the disease improves.<a href="#cite_note-upmc.com-7">[7]</a> </li> <li id="cite_note-11"><a href="#cite_ref-11">^</a> Doctors define acute pain as pain associated with a cause that can be relieved by treating the cause. In the general sense, acute pain means pain that decreases or stops when the disease improves.<a href="#cite_note-upmc.com-7">[7]</a> </li> <li id="cite_note-32"><a href="#cite_ref-32">^</a> The continuous sending of messages from one body part causes its somatotopic area to become larger than the normal state, and the brain of the area attaches more and abnormal energy and importance to the tissue stimuli of that part of the body.<a href="#cite_note-Jensen,_M.P._20092-31">[29]</a> </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="References">References</h2>[<a href="/w/index.php?title=Chronic_pain&action=edit&section=24" title="Edit section: References">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239543626"><div class="reflist reflist-columns references-column-width" style="column-width: 30em;"> <ol class="references"> <li id="cite_note-Turk1-1"><a href="#cite_ref-Turk1_1-0">^</a> <style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFTurkOkifuji2001" class="citation book cs1">Turk DC, Okifuji A (2001). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=TyNEicOiJqQC&q=Pain+terms+and+taxonomies&pg=RA1-PA18">"Pain terms and taxonomies"</a>. In Loeser D, Butler SH, Chapman JJ, Turk DC (eds.). Bonica's Management of Pain (3rd ed.). 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International Journal for Equity in Health. 20 (1): 147. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1186%2Fs12939-021-01496-1">10.1186/s12939-021-01496-1</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8220113">8220113</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/34162393">34162393</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Journal+for+Equity+in+Health&rft.atitle=Chronic+pain+experience+and+health+inequities+during+the+COVID-19+pandemic+in+Canada%3A+qualitative+findings+from+the+chronic+pain+%26+COVID-19+pan-Canadian+study&rft.volume=20&rft.issue=1&rft.pages=147&rft.date=2021-06&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC8220113%23id-name%3DPMC&rft_id=info%3Apmid%2F34162393&rft_id=info%3Adoi%2F10.1186%2Fs12939-021-01496-1&rft.aulast=Dassieu&rft.aufirst=L&rft.au=Pag%C3%A9%2C+MG&rft.au=Lacasse%2C+A&rft.au=Laflamme%2C+M&rft.au=Perron%2C+V&rft.au=Janelle-Montcalm%2C+A&rft.au=Hudspith%2C+M&rft.au=Moor%2C+G&rft.au=Sutton%2C+K&rft.au=Thompson%2C+JM&rft.au=Choini%C3%A8re%2C+M&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC8220113&rfr_id=info%3Asid%2Fen.wikipedia.org%3AChronic+pain" class="Z3988"> </li> <li id="cite_note-152"><a href="#cite_ref-152">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFWeir2020" class="citation journal cs1">Weir K (June 2020). <a rel="nofollow" class="external text" href="https://www.apa.org/monitor/2020/06/covid-grieving-life">"Grieving Life and Loss"</a>. Monitor on Psychology. 51 (4).</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Monitor+on+Psychology&rft.atitle=Grieving+Life+and+Loss&rft.volume=51&rft.issue=4&rft.date=2020-06&rft.aulast=Weir&rft.aufirst=K&rft_id=https%3A%2F%2Fwww.apa.org%2Fmonitor%2F2020%2F06%2Fcovid-grieving-life&rfr_id=info%3Asid%2Fen.wikipedia.org%3AChronic+pain" class="Z3988"> </li> <li id="cite_note-153"><a href="#cite_ref-153">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFJackson2005" class="citation journal cs1">Jackson JE (2005). <a rel="nofollow" class="external text" href="https://www.jstor.org/stable/3805289">"Stigma, Liminality, and Chronic Pain: Mind-Body Borderlands"</a>. American Ethnologist. 32 (3): 332–353. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1525%2Fae.2005.32.3.332">10.1525/ae.2005.32.3.332</a>. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/0094-0496">0094-0496</a>. <a href="/wiki/JSTOR_(identifier)" class="mw-redirect" title="JSTOR (identifier)">JSTOR</a> <a rel="nofollow" class="external text" href="https://www.jstor.org/stable/3805289">3805289</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=American+Ethnologist&rft.atitle=Stigma%2C+Liminality%2C+and+Chronic+Pain%3A+Mind-Body+Borderlands&rft.volume=32&rft.issue=3&rft.pages=%3Cspan+class%3D%22nowrap%22%3E332-%3C%2Fspan%3E353&rft.date=2005&rft.issn=0094-0496&rft_id=https%3A%2F%2Fwww.jstor.org%2Fstable%2F3805289%23id-name%3DJSTOR&rft_id=info%3Adoi%2F10.1525%2Fae.2005.32.3.332&rft.aulast=Jackson&rft.aufirst=JE&rft_id=https%3A%2F%2Fwww.jstor.org%2Fstable%2F3805289&rfr_id=info%3Asid%2Fen.wikipedia.org%3AChronic+pain" class="Z3988"> </li> </ol></div> <div class="mw-heading mw-heading2"><h2 id="Further_reading">Further reading</h2>[<a href="/w/index.php?title=Chronic_pain&action=edit&section=25" title="Edit section: Further reading">edit</a>]</div> <style data-mw-deduplicate="TemplateStyles:r1239549316">.mw-parser-output .refbegin{margin-bottom:0.5em}.mw-parser-output .refbegin-hanging-indents>ul{margin-left:0}.mw-parser-output .refbegin-hanging-indents>ul>li{margin-left:0;padding-left:3.2em;text-indent:-3.2em}.mw-parser-output .refbegin-hanging-indents ul,.mw-parser-output .refbegin-hanging-indents ul li{list-style:none}@media(max-width:720px){.mw-parser-output .refbegin-hanging-indents>ul>li{padding-left:1.6em;text-indent:-1.6em}}.mw-parser-output .refbegin-columns{margin-top:0.3em}.mw-parser-output .refbegin-columns ul{margin-top:0}.mw-parser-output .refbegin-columns li{page-break-inside:avoid;break-inside:avoid-column}@media screen{.mw-parser-output .refbegin{font-size:90%}}</style><div class="refbegin" style=""> <ul><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation journal cs1">Dowell D, Haegerich TM, Chou R (April 2016). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6390846">"CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016"</a>. JAMA. 315 (15): 1624–1645. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1001%2Fjama.2016.1464">10.1001/jama.2016.1464</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6390846">6390846</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/26977696">26977696</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=JAMA&rft.atitle=CDC+Guideline+for+Prescribing+Opioids+for+Chronic+Pain+%26ndash%3B%26%2332%3BUnited+States%2C+2016&rft.volume=315&rft.issue=15&rft.pages=%3Cspan+class%3D%22nowrap%22%3E1624-%3C%2Fspan%3E1645&rft.date=2016-04&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC6390846%23id-name%3DPMC&rft_id=info%3Apmid%2F26977696&rft_id=info%3Adoi%2F10.1001%2Fjama.2016.1464&rft.aulast=Dowell&rft.aufirst=D&rft.au=Haegerich%2C+TM&rft.au=Chou%2C+R&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC6390846&rfr_id=info%3Asid%2Fen.wikipedia.org%3AChronic+pain" class="Z3988"></li></ul> </div> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2>[<a href="/w/index.php?title=Chronic_pain&action=edit&section=26" title="Edit section: External links">edit</a>]</div> <ul><li><a rel="nofollow" class="external text" href="https://www.iasp-pain.org/index.aspx">International Association for the Study of Pain</a> <a rel="nofollow" class="external text" href="https://web.archive.org/web/20210501224152/https://www.iasp-pain.org/index.aspx">Archived</a> 2021-05-01 at the <a href="/wiki/Wayback_Machine" title="Wayback Machine">Wayback Machine</a></li> <li><a href="/wiki/File:Commons-logo.svg" class="mw-file-description"><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/4/4a/Commons-logo.svg/12px-Commons-logo.svg.png" decoding="async" width="12" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/4/4a/Commons-logo.svg/18px-Commons-logo.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/4/4a/Commons-logo.svg/24px-Commons-logo.svg.png 2x" data-file-width="1024" data-file-height="1376" /></a> Media related to <a href="https://commons.wikimedia.org/wiki/Category:Pain" class="extiw" title="commons:Category:Pain">pain</a> at Wikimedia Commons</li></ul> <div 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style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q1088113" class="extiw" title="d:Q1088113">D</a></div><div class="hlist" style="text-align:left;"><ul><li><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/R52.1">R52.1</a>, <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/R52.2">R52.2</a></li><li><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=338.2">338.2</a></li><li><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D059350">D059350</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><a href="/wiki/EMedicine" title="EMedicine">eMedicine</a>: <a rel="nofollow" class="external text" href="https://emedicine.medscape.com/article/310834-overview">article/310834</a></li></ul></div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Pain112" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Pain" title="Template:Pain"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Pain" title="Template talk:Pain"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Pain" title="Special:EditPage/Template:Pain"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Pain112" style="font-size:114%;margin:0 4em"><a href="/wiki/Pain" title="Pain">Pain</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">By region/system</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Head and neck</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Eye_strain" title="Eye strain">Eye strain</a></li> <li><a href="/wiki/Headache" title="Headache">Headache</a></li> <li><a href="/wiki/Neck_pain" title="Neck pain">Neck</a></li> <li><a href="/wiki/Odynophagia" title="Odynophagia">Odynophagia (swallowing)</a></li> <li><a href="/wiki/Toothache" title="Toothache">Toothache</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Respiratory_system" title="Respiratory system">Respiratory system</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Sore_throat" title="Sore throat">Sore throat</a></li> <li><a href="/wiki/Bornholm_disease" title="Bornholm disease">Pleurodynia</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Human_musculoskeletal_system" title="Human musculoskeletal system">Musculoskeletal</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Arthralgia" title="Arthralgia">Arthralgia (joint)</a></li> <li><a href="/wiki/Bone_pain" title="Bone pain">Bone pain</a></li> <li><a href="/wiki/Myalgia" title="Myalgia">Myalgia (muscle)</a></li> <li><a href="/wiki/Acute_muscle_soreness" title="Acute muscle soreness">Acute</a></li> <li><a href="/wiki/Delayed_onset_muscle_soreness" title="Delayed onset muscle soreness">Delayed-onset</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Neurology" title="Neurology">Neurologic</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Neuralgia" title="Neuralgia">Neuralgia</a></li> <li><a href="/wiki/Pain_asymbolia" title="Pain asymbolia">Pain asymbolia</a></li> <li><a href="/wiki/Pain_disorder" title="Pain disorder">Pain disorder</a></li> <li><a href="/wiki/Paroxysmal_extreme_pain_disorder" title="Paroxysmal extreme pain disorder">Paroxysmal extreme pain disorder</a></li> <li><a href="/wiki/Allodynia" title="Allodynia">Allodynia</a></li> <li><a class="mw-selflink selflink">Chronic pain</a></li> <li><a href="/wiki/Hyperalgesia" title="Hyperalgesia">Hyperalgesia</a></li> <li><a href="/wiki/Hypoalgesia" title="Hypoalgesia">Hypoalgesia</a></li> <li><a href="/wiki/Hyperpathia" title="Hyperpathia">Hyperpathia</a></li> <li><a href="/wiki/Phantom_pain" title="Phantom pain">Phantom pain</a></li> <li><a href="/wiki/Referred_pain" title="Referred pain">Referred pain</a></li> <li><a href="/wiki/Congenital_insensitivity_to_pain" title="Congenital insensitivity to pain">Congenital insensitivity to pain</a> <ul><li><a href="/wiki/Congenital_insensitivity_to_pain_with_anhidrosis" title="Congenital insensitivity to pain with anhidrosis">congenital insensitivity to pain with anhidrosis</a></li> <li><a href="/wiki/Congenital_insensitivity_to_pain_with_partial_anhidrosis" class="mw-redirect" title="Congenital insensitivity to pain with partial anhidrosis">congenital insensitivity to pain with partial anhidrosis</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Pelvic_pain" title="Pelvic pain">Pelvic pain</a></li> <li><a href="/wiki/Proctalgia_fugax" title="Proctalgia fugax">Proctalgia</a></li> <li><a href="/wiki/Back_pain" title="Back pain">Back</a></li> <li><a href="/wiki/Low_back_pain" title="Low back pain">Low back pain</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Measurement and testing</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Pain_scale" title="Pain scale">Pain scale</a></li> <li><a href="/wiki/Cold_pressor_test" title="Cold pressor test">Cold pressor test</a></li> <li><a href="/wiki/Dolorimeter" title="Dolorimeter">Dolorimeter</a></li> <li><a href="/wiki/Grimace_scale" title="Grimace scale">Grimace scale</a></li> <li><a href="/wiki/Hot_plate_test" title="Hot plate test">Hot plate test</a></li> <li><a href="/wiki/Tail_flick_test" title="Tail flick test">Tail flick test</a></li> <li><a href="/wiki/Visual_analogue_scale" title="Visual analogue scale">Visual analogue scale</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Pathophysiology" title="Pathophysiology">Pathophysiology</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Nociception" title="Nociception">Nociception</a></li> <li><a href="/wiki/Anterolateral_system" class="mw-redirect" title="Anterolateral system">Anterolateral system</a></li> <li><a href="/wiki/Marginal_nucleus_of_spinal_cord" title="Marginal nucleus of spinal cord">Posteromarginal nucleus</a></li> <li><a href="/wiki/Substance_P" title="Substance P">Substance P</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Pain_management" title="Pain management">Management</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Analgesia" class="mw-redirect" title="Analgesia">Analgesia</a></li> <li><a href="/wiki/Anesthesia" title="Anesthesia">Anesthesia</a></li> <li><a href="/wiki/Cordotomy" title="Cordotomy">Cordotomy</a></li> <li><a href="/wiki/Eradication_of_suffering" title="Eradication of suffering">Pain eradication</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Related concepts</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Threshold_of_pain" title="Threshold of pain">Pain threshold</a></li> <li><a href="/wiki/Pain_tolerance" title="Pain tolerance">Pain tolerance</a></li> <li><a href="/wiki/Suffering" title="Suffering">Suffering</a></li> <li><a href="/wiki/SOCRATES_(pain_assessment)" title="SOCRATES (pain assessment)">SOCRATES</a></li> <li><a href="/wiki/Pain_(philosophy)" title="Pain (philosophy)">Philosophy of pain</a></li> <li><a href="/wiki/Cancer_pain" title="Cancer pain">Cancer pain</a></li> <li><a href="/wiki/Drug-seeking_behavior" class="mw-redirect" title="Drug-seeking behavior">Drug-seeking behavior</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Signs_and_symptoms_that_are_general_or_constitutional159" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:General_symptoms_and_signs" title="Template:General symptoms and signs"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:General_symptoms_and_signs" title="Template talk:General symptoms and signs"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:General_symptoms_and_signs" 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title="Fever">Fever</a> <ul><li><a href="/wiki/Fever_of_unknown_origin" title="Fever of unknown origin">of unknown origin</a></li> <li><a href="/wiki/Drug-induced_hyperthermia" title="Drug-induced hyperthermia">drug-induced</a></li> <li><a href="/wiki/Postoperative_fever" title="Postoperative fever">postoperative</a></li></ul></li> <li><a href="/wiki/Hyperthermia" title="Hyperthermia">Hyperthermia</a></li> <li><a href="/wiki/Hyperhidrosis" title="Hyperhidrosis">Hyperhidrosis</a></li> <li><a href="/wiki/Night_sweats" title="Night sweats">Night sweats</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">cold</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Chills" title="Chills">Chills</a></li> <li><a href="/wiki/Hypothermia" title="Hypothermia">Hypothermia</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Aches and <a href="/wiki/Pain" title="Pain">pains</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Headache" title="Headache">Headache</a></li> <li><a class="mw-selflink selflink">Chronic pain</a></li> <li><a href="/wiki/Cancer_pain" title="Cancer pain">Cancer pain</a></li> <li><a href="/wiki/Myalgia" title="Myalgia">Myalgia</a></li> <li><a href="/wiki/Tenderness_(medicine)" title="Tenderness (medicine)">Tenderness</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Malaise" title="Malaise">Malaise</a> and <a href="/wiki/Fatigue" title="Fatigue">fatigue</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Fatigue" title="Fatigue">Lassitude</a></li> <li><a href="/wiki/Lethargy" title="Lethargy">Lethargy</a></li> <li><a href="/wiki/Atrophy" title="Atrophy">Atrophy</a> <ul><li><a href="/wiki/Muscle_atrophy" title="Muscle atrophy">of muscle</a></li></ul></li> <li><a href="/wiki/Weakness" title="Weakness">Asthenia</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Miscellaneous</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cachexia" title="Cachexia">Cachexia</a></li> <li><a href="/wiki/Anorexia" class="mw-redirect" title="Anorexia">Anorexia</a></li> <li><a href="/wiki/Polyphagia" title="Polyphagia">Polyphagia</a> and <a href="/wiki/Polydipsia" title="Polydipsia">polydipsia</a></li> <li><a href="/wiki/Influenza-like_illness" title="Influenza-like illness">Flu-like symptoms</a></li></ul> </div></td></tr></tbody></table></div>    </div><noscript><img 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