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F r e e S O A P n o t e s w i t h M a s s a g e B o o k f o r A B M P m e m b e r s : a b m p . u s / M a s s a g e b o o k 91 What is Chronic Pain? First, let's define our terms. For our purposes, chronic pain is pain that has to be managed but cannot be cured by medical treatment, including massage. (Before the advent of hip replacement surgery, degenerative hip disease would have been considered a chronic-pain condition.) Medically speaking, chronic pain can be defined as any pain lasting more than three months. By contrast, acute pain is not persistent for long stretches of time. 4 Chronic pain may arise from an injury, illness, or in the absence of both. 5 Acute pain usually occurs suddenly, alerts us to possible injury (e.g., broken bone), and often resolves on its own or with proper medical care. 6 Chronic pain can wreak havoc on sleep, be physically and mentally exhausting, and can lead to body guarding: restricting movements to lessen the pain. Years of restricted movements can result in tight and/or de-conditioned muscles, and, over time, chronic-pain sufferers may not be able to do the activities they once liked to do. For some chronic- pain sufferers, it takes a Herculean effort just to meet the day's basic demands. It is no wonder depression and despair are often associated with chronic pain. Acute or Chronic? How do we know if a client is in acute or chronic pain? Sometimes clients will know and tell you. Others have diagnoses that are associated with chronic pain, like arthritis, degenerative disc disease, fibromyalgia, or radiculopathy. If you are unsure, ask yourself these questions about your client: 1. Did the pain occur suddenly? 2. Has the pain lasted longer than three months? 3. Has the pain been addressed by qualified diagnosticians? Knowing only the onset and duration of a client's pain is not enough information to understand the totality of your client's pain, especially if you are the first person your client has seen for it. For example, Jamur came to me with a shoulder issue. He was into CrossFit, a high-intensity resistance workout. He had injured his shoulder when younger and would tweak it every now and then over the course of four decades. When he first saw me, he said he had been feeling a slow increase in pain in his bad shoulder for about two months. When I palpated his shoulder, I found hyper-tender areas on the tendon of the long head of his biceps. I suggested he go to an orthopedist for a diagnosis. Jamur continued to work out, but modified the exercises. About two months later, I saw him again. I could gently cross-fiber the long head biceps tendon, but there was still significant pain in that area. He also had a new area of pain—in the body of the supraspinatus. At this point, if I had to guess acute or chronic pain based on only two questions—(1) was it sudden pain and (2) has it lasted for more than three months?—I would have guessed chronic. However, Jamur hadn't seen a qualified diagnostician. Eventually, he did take my advice and saw an orthopedist. She ordered an MRI, which showed a labrum tear. Jamur did have a chronic shoulder condition, but he also had an acute shoulder injury caused by multiple soft-tissue tears. When in doubt, encourage the client to seek clarification through qualified diagnosticians. When asked about four common types of pain, respondents of a National Centers for Health Statistics sur vey indicated that low-back pain was the most common (27%), followed by severe headache or migraine pain (15%), neck pain (15%), and facial ache or pain (4%). w w w.painmed.org /patientcenter/facts_on_pain.aspx# refer