There are few factors that can initiate, sustain or aggravatechronic pain. Many a times, the patient suffers from a characteristically painful disease which is difficult to completely cure, like cancer, arthritis, migraine, fibromyalgia, etc. Second, there may be auxiliary perpetuatingfactors that are starts with the disease and remain even after that diseasehas resolved. Finally, a varietyof psychological conditions can worsen or even cause pain. Other clues that can lead to a conclusion that a significant emotional disturbance is the reason behind a patient’s chronic pain include: pain occurring in multiple unrelated sites; pain beginning at a time of emotional trauma, such as the loss of a parent or spouse; a past or present history of physical or sexual or drug abuse. On examination, the doctor should observe whether the patient guards the painful area and restricts certain movements or postures due to pain. Painful areas should be examined for deep tenderness, noting if it originates from muscle, ligaments, or joints. A neuropathic component to the pain is indicated by evidence of nerve damage, such as sensory impairment, exquisitely sensitive skin, weakness and muscle atrophy, or loss of reflexes. A guiding principle in assessing patients with chronic pain is to evaluate both emotional and organic factors before starting treatment. Tending to these issues of emotional and organic factors together rather than waiting to address them one after the other improves the outcome of cure. For instance, a cancer patient with bone metastases may have pain as well as may also be depressed. Optimal therapy necessitates that each of these factors be evlautedfor and treated.

There are few factors that can initiate, sustain or aggravatechronic pain. Many a times, the patient suffers from a characteristically painful disease which is difficult to completely cure, like cancer, arthritis, migraine, fibromyalgia, etc. Second, there may be auxiliary perpetuatingfactors that are starts with the disease and remain even after that diseasehas resolved. Finally, a varietyof psychological conditions can worsen or even cause pain. Other clues that can lead to a conclusion that a significant emotional disturbance is the reason behind a patient’s chronic pain include: pain occurring in multiple unrelated sites; pain beginning at a time of emotional trauma, such as the loss of a parent or spouse; a past or present history of physical or sexual or drug abuse. On examination, the doctor should observe whether the patient guards the painful area and restricts certain movements or postures due to pain. Painful areas should be examined for deep tenderness, noting if it originates from muscle, ligaments, or joints. A neuropathic component to the pain is indicated by evidence of nerve damage, such as sensory impairment, exquisitely sensitive skin, weakness and muscle atrophy, or loss of reflexes. A guiding principle in assessing patients with chronic pain is to evaluate both emotional and organic factors before starting treatment. Tending to these issues of emotional and organic factors together rather than waiting to address them one after the other improves the outcome of cure. For instance, a cancer patient with bone metastases may have pain as well as may also be depressed. Optimal therapy necessitates that each of these factors be evlautedfor and treated.