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As is the case for
most diseases, clinical pain conditions range in severity, extent,
and effect. The worst outcome, chronic pain, represents a major
health problem and is difficult to manage successfully. The overwhelming
majority of patients encountered in the primary care setting exhibit
episodic forms of pain and appear to improve with a wide range
of treatments. On the other hand, the pain endured by patients
in the tertiary care environment has usually been persistent and
unresponsive to a multitude of treatments. It is important to
note that females are over-represented among patients with chronic
pain. Among women, prevalence rates are higher for subjects of
reproductive age than subjects in postmenopausal years for many
pain conditions (Unruh,
1996).
| Figure
2.1: Types of Pain Patients
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| Community
cases, primary care patients, and tertiary care
pain patients distinguish themselves in terms
of the number of treatments received, the male-to-female
ratios in the respective populations, and case
severity. |
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Despite
the availability of advanced biotechnologies, the scientific
understanding of pain remains limited. The present understanding
does not support disease taxonomies based on pathogenetic or
even causal processes. Instead, case definitions remain focused
on signs and symptoms that are often poorly understood. Given
this background, a focus on symptoms is highly relevant because
improved knowledge of the pathogenesis of symptoms will lead
to a better understanding of response heterogeneity and possibly
to the cause of pain itself.
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