Question

Chronic pain is typically divided into three broad types by mechanism. Describe each of the mechanisms.

Answer

 

Chronic pain is typically divided into three broad types by mechanism: somatic, neuropathic, and psychologic

1. Somatic- arising from injury, ischemia, infection, or inflammation of the musculoskeletal, connective tissue skin i.e., arthritis, scleroderma, lupus erythematosis, whiplash, temporomandibular joint dysfunction (TMJD), posttraumatic headaches, endometriosis, and sickle cell crisis.

2. Neuropathic-

  • Central- arising from injury to the central nervous system (spinal nerve root entry zones, spinal cord and brain), i.e., painful paraplegia or Hemiplegia, post-thalamic stroke pain (Dejerine-Roussy Syndrome), phantom limb pain or complex regional pain syndrome (CRPS)- type I (reflex sympathetic dystrophy).
  • Peripheral- arising from nerve injury, nerve destruction (deafferentation) or autonomic nervous system dysfunction, i.e., post-herpetic neuralgia, trigeminal neuralgia, ischemic or diabetic peripheral neuropathy, complex regional pain syndrome (CRPS)- type 2 (causalgia), Charcot-Marie- Tooth Syndrome, compressive spinal nerve root syndromes, entrapment neuropathies (i.e. Carpal Tunnel Syndrome), intercoastal neuralgia, post-irradiation neuralgia.

3. Psychological- arising from emotional stress expressed somatically- i.e. non-specific vaginismus, many myofascial syndromes, factitious disorder, conversion disorder, Munchausen’s syndrome.

 

See Online Reading Assignment: “Introduction to Chronic Pain” Written by J.K. Lilly and Carol Walker.

Lilly and Walker. “Introduction to Chronic Pain.” In P. Deutsch and H. Sawyer (Ed.) A Guide to Rehabilitation. White Plains, NY: AHAB Press.

last - long - blue Table of ContentsNext - long - blue