Chronic pain affects about a third of the population at least once during a patient's lifetime, at a cost of—80 to 90 billion dollars in health care payments and lawsuit settlements annually. Chronic pain is also common in those who do not seek medical attention. Despite similar subjective pain, those who seek medical attention are less physically active, experience more social alienation and more psychologic distress than those who do not seek medical attention.
The causes of chronic pain are more complex than the causes of acute pain. Chronic pain may be caused by (1) a chronic pathologic process in the musculoskeletal or vascular system, (2) a chronic pathologic process in one of the organ systems, (3) a prolonged dysfunction in the peripheral or central nervous system, or (4) a psychological or environmental disorder. In contrast, acute pain may be influenced by, but is not primarily caused by, a psychological or continuous environmental disorder. A detailed listing of all the epidemiologic factors of the various chronic pain syndromes is beyond the scope of this chapter. However, in general, patients who attribute their pain to a specific traumatic event experience more emotional distress, more life interference, and more severe pain than those with other causes. 2
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