Patients with no measurable anatomical, physiological, or biochemical evidences of functional impairment who continue to feel pain despite rational treatment strategies post a problem for health care providers.
In dealing with this issue, more attention is being focused on the iatrogenic (resulting from the activity of physicians), pistigenic (resulting from the activity of insurance companies) and normogenic components (resulting from the activity of attorneys) of the chronic pain syndrome (Nicolas & Walsh, 1991). For example, consider the routinely prescribed admonishment about acute pain. If it hurts, don't do it. This recommendation often gets interpreted by the patient as an ever-decreasing level of activity and increasing level of disability (Nicolas & Walsh, 1991). Likewise, chronic pain behavior and chronic pain syndrome are part of the socioeconomic environment and culture of the Western industrial society. Hence, as the definition of pain by the International Association of Pain Study emphasizes, "Each individual learns the application of the word" [pain] (Nicolas & Walsh, 1991).
As a result of the uncertainty involving chronic pain syndrome, an attempt to better understand the underlying causes of chronic pain was made. This system divides the development of chronic pain into three stages (Nicolas & Walsh, 1991): Stage of Acute Injury- At this stage, the sensory-discriminative dimension predominates. The degree of physical impairment and social disability related to or at least correlated with identifiable physical and pathological impairments or with what has come to be expected with a given injury. The Transition Period- This is a critical period in the recovery process. In most patients, the injury heals, the person goes on to a "good recovery" and resumes a role in society, or the residual disabilities closely correlate with the residual impairments. The Learned Phase- Through conditioning (learning), further impairments and disabilities result from drug misuse, inactivity, and deconditioning and from prolonged and repetitive functioning in a "sick" or unhealthy role. Here the cognitive-evaluation and affective-motivational aspects of pain predominates.
This step-wise process of developing chronic pain further emphasized the notion that the experience of pain is subjective. As you can see, in the first step, depending on the degree of severity of the injury, an expectation of the degree of pain a person should feel is established. For example, if the person had a broken leg, its level of pain would be expected to fall within the appropriate range of the degree of pain that a broken leg causes. Then, when a person is in the second step, he or she either recover or remain in a state of illness. Finally, in the third step, misuse of analgesic drugs result, chronic pain syndrome develops and the person remains in a sick role. When he or she become deconditioned, chronic pain result.
In accordance with the gate theory, when people with chronic pain feel depressed or despairing, or they are simply not coping too well, their relay stations gates are open more than usual, allowing more pain information to the brain (Wells & Nown, 1998). In this case, even though the original illness or injury does not worsen and the initial number of signals is constant, the experience of pain increases (Wells & Nown, 1998).