Complications of Uncontrolled, Persistent Pain
by Forest Tennant MD, DrPH
 To the unfortunate patient who is afflicted and the practitioner
who treats it, incurable, persistent pain is truly its own disease regardless of its
underlying cause.1-3 Persistent pain, which is also often characterized as chronic or
intractable, has all the ramifications of a disease in that it may have pre-clinical and
overt phases.4-6 It may be intermittent or constant, as well as, mild, moderate, or
severe. The most unappreciated clinical feature of persistent pain, however, is the
plethora of complications that may result — particularly if the pain is constant and
unremitting.
Many recent and emerging studies clearly document that persistent pain exerts profound
impacts on the body’s endocrine, cardiovascular, immune, neurologic and
musculo-skeletal systems.7 Presented here is a review and classification of some of
persistent pain’s complications to give the practitioner a basic understanding that
persistent pain may produce a symptom complex or syndrome that must be recognized at the
clinical level.1 Even though our understanding of the occurrence and mechanisms of the
persistent pain syndrome are still quite limited, it is clear that the diagnosis and
treatment of persistent pain’s complications must be simultaneous with pain
treatment.
Deconditioning Complications
Any area of the anatomic body that experiences severe persistent pain will soon
“decondition.” This area will cease normal, symmetric, coordinated movement, and
the patient will simply self-splint, immobilize, and decondition the area. This leads to a
number of complications including muscle atrophy, neuropathies, and in late stages,
contractures. Muscle, nerve, and joint weakness, and deterioration result. It is not
uncommon to see the patient with severe, uncontrolled pain progressively deteriorate due
to muscle atrophy and contractures and go from cane to walker to wheelchair.
An unappreciated complication of deconditioning and immobility is obesity. Excess
weight may further overload a painful, deconditioned anatomical site.
Please refer to the Jan/Feb 2004 issue for the complete text. In the event you need to order a back issue, please click here.
— Jan/Feb 2004
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