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Pain — certainly no one wants it. But to those who suffer in its clutches for extended periods, it’s a particularly nasty beast. Nurses are quick to tame acute pain in their patients, but chronic pain is another creature altogether. RNs have learned a great deal about pain treatment options, but accurately assessing and treating neverending pain remains a Godzilla-sized task for any nurse. Effective treatment of the condition requires finesse, skill, and fortitude.

Chronic nonmalignant pain traditionally has been defined as pain that is noncancerous in origin and continues in the absence of ongoing illness or after healing is completed. Patients with chronic pain are five times more likely than those without chronic pain to use health care services.¹

Acute pain, on the other hand, is pain caused by tissue inflammation or injury. Acute pain, unlike chronic nonmalignant pain, typically begins to degrade as tissue healing commences.

Terminology is useful only as a starting point, though. Patients with pain are not easily pigeonholed into specific categories. Acute and chronic pain may overlap; patients may experience physical distress from many different types of pain at the same time.

Neverending nightmare

Effectively assessing a patient for pain includes obtaining a pain history, which assists in identifying patients with chronic nonmalignant pain. These patients may have sought various treatment options or care providers for their symptoms. They may describe pain that is continuous, relentless, burning, stinging, shooting, or electrifying in nature. The pain may disrupt their sleep, their mood, and their daily ability to function. A patient with this type of pain also may appear depressed or withdrawn and may portray a hopeless attitude toward pursuing additional pain treatment plans.

To empathize and effectively treat these patients, caregivers must grasp the complexity of each patient’s condition.

What it looks like

Many complex pain syndromes fall under the heading of “chronic nonmalignant pain.” A few of the more easily recognized pain diagnoses include diabetic neuropathy, postmastectomy pain, complex regional pain syndrome (formerly labeled reflex sympathetic dystrophy, or RSD), postherpetic pain syndrome, phantom limb pain, trigeminal neuralgia, and chronic back pain.

All of these conditions include some component of neuropathic pain. Experts often described neuropathic pain as pain conduction “gone awry” or pain messages that continue to be sent to the spinal cord and brain long after the initial insult or injury to tissue has healed.

Why it happens

Researchers hope to determine why some patients develop chronic nonmalignant pain and others do not. They hypothesize several factors come into play. Those factors include genetic predisposition, as well as the correct “recipe” of sympathetic nervous system stimulators and chemical mediators (for example, prostaglandins, histamine, and bradykinin, among others) at the time of initial injury to tissue.

A relatively minor assault to tissue can lead to disastrous results. Once nerve fibers become “irritated,” they seem determined to transmit pain signals relentlessly, eventually creating wider pathways for the signals to follow. As the pain signal (or conduction “traffic”) continues, high and low pain thresholds may become confused. When this occurs, patients can begin to experience extreme discomfort with such stimuli as light touch, air blowing on a limb, or the weight of linens. This horribly painful condition is referred to as allodynia.

What can be done