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and increased metabolic processes in the local tissue brought on by many factors including stress, injury, a sedentary lifestyle, poor posture, and repetitive stress. Reducing trigger points is an important treatment goal in the rehabilitation of clients with many different conditions. THE "YOU" FACTOR The compassion and understanding you demonstrate toward clients living with chronic pain enhances the therapeutic relationship, builds trust, and provides psychological comfort. The therapeutic value of this increased awareness and level of empathy cannot be quantified but will help you provide the best possible care to clients. Notes 1. Ortho-McNeil Pharmaceutical, "National Pain Survey," accessed September 2014, www.chiro.org/LINKS/FULL/1999_ National_Pain_Survey.shtml. 2. Gallup Organization, "Pain in America: A Research Report," survey conducted for Merck, 2000. 3. L. Von Knorring, "The Experience of Pain in Depressed Patients," Neuropsychobiology 1 (1975): 155–65. 4. Chris Pasero and Margo McCaffery, Pain: Clinical Manual (St. Louis, MO: Mosby, 1999). 5. LifeNews.com, Steven Ertelt, "Study Shows People with More Chronic Pain More Likely to Commit Suicide," University of Michigan Research Department, accessed September 2014, www.lifenews.com/bio2627.html. 6. Lynda Juall Carpenito-Moyet, Handbook of Nursing Diagnosis, 12th ed. (Baltimore, MD: Lippincott Williams & Wilkins, 2008). Anne Williams is the director of education for Associated Bodywork & Massage Professionals and author of Massage Mastery: from Student to Professional (Lippincott Williams & Wilkins, 2012), from which this article was adapted, and Spa Bodywork: A Guide for Massage Therapists (Lippincott Williams & Wilkins, 2006). She can be reached at anne@abmp.com. Classification of Pain TERM DEFINED EXAMPLE Time Acute pain Pain that comes on quickly, can be severe, but lasts only as long as the reason for the pain is present. Stubbed toe, burn, scraped knee. Recurrent acute pain Acute pain that occurs regularly or irregularly. Menstrual pain, migraine. Chronic pain Pain that persists for a long time past the point of typical injury recovery or in relationship to a medical condition. Old musculoskeletal injury, cancer, fibromyalgia, arthritis. Intractable pain Chronic pain that persists without a known cause and despite treatment. Not associated with a particular disease or injury. Location Focal pain Pain restricted to one local region of the body. The pain is felt in only one place. Stubbed toe, scraped knee, broken bone. Multifocal pain Pain sensations are broadly distributed. Pain is felt in more than one place. Stomachache, toothache. Radiating pain Pain that extends out from the injured area along specific spinal nerve root distributions (dermatomes). Sciatica, thoracic outlet syndrome, trigger points. Referred pain Pain experienced at a site different from the injured or diseased part, with a nerve supply different from that of the source of pain. Heart attack = referred pain in the arm and jaw. Tissue Type Somatic pain Pain associated with structures of the body wall. Broken limbs, burns, cuts. Visceral pain Pain associated with internal organs. Damage to liver, spleen, lungs, or other internal organs. Nociceptive pain Pain caused by tissue injury or the potential for tissue injury detected by nociceptors. Pain diminishes as tissues heal. Musculoskeletal or skin injury. Neuropathic pain Pain resulting from injury or malfunction in the peripheral or central nervous system. Pain is often triggered by an injury but then persists for months or years beyond the healing of damaged tissues. Nerve trauma, neuropathy caused by diabetes, alcohol abuse, exposure to chemicals, vitamin deficiencies, or others. Allodynia A type of neuropathic pain from stimuli that are not usually experienced as painful. Cutaneous allodynia (pain from non-painful touch). How the Pain is Generated Psychogenic pain Pain associated with psychological factors such as depression or anxiety. Headaches, muscle pain, back pain, stomach pains associated with depression. Idiopathic pain Pain with an unknown cause that cannot be categorized or diagnosed. Can present as many painful conditions like fibromyalgia or persistent back pain. Phantom pain Pain experienced in a limb that has been amputated. Believed to be caused by spontaneous nerve impulses generated due to damage from the amputation. Amputated limbs. Malingering Pain fabricated for the purposes of achieving personal reward or satisfaction. Pain that is fabricated in order to ensure an insurance payout.