Chronic Persistent Pain Case Study

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Abstract: Chronic persistent pain is a heterogeneous group of conditions that can be classified as neuropathic, muscular, mechanical or compression, inflammatory, or mixed. Most pathogenesis is not completely understood. When approaching a patient with chronic persistent pain, it is best to first classify the type of pain, assess its intensity, impact and co-morbid conditions. Doing so helps tailor a treatment plan.

Case 1. A.Z. is a 44-year-old female, new to the clinic. She has a history of low back pain. For the past 8 months the pain is getting worse, and is not relieved by acetaminophen.

Introduction to Chronic Persistent Pain

Approximately 100 million adults in the United States (U.S.) suffer from chronic persistent pain (CPP), more than the number affected by heart disease, diabetes, and cancer combined,1 at a cost of $560-635 billion annually.2 It is the number one cause for “years lived with disability.”3 Overall, the quality of pain management remains unacceptable for millions of U.S. patients with acute and chronic pain. Under recognition and under treatment of pain are of particular concern in primary care.4
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Surprising, primary care clinicians are also not in favor of mandatory pain education.5 Family clinicians are, by training, well suited to provide pain management using the “whole person,” and “bio-psycho-social” models, handling co-morbidities, and coordination of care. They apply non-pharmaceutical, and pharmaceutical modalities, and know the patients and their family