Chronic pain: a concept analysis
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Student Research Committee, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
Online publication date: 2018-08-08
Publication date: 2019-04-22
Electron J Gen Med 2019;16(2):em130
Background and Objective:
The concept of chronic pain is a significant nursing notion for which there are various definitions and patterns mentioned in texts. Thus, this survey was carried out to analyze the concept of chronic pain with respect to more clarifications on this concept in nursing with an evolutional approach.

Materials and Methods:
In the present study, Rodgers evolutional method for concept analysis was used. The sources where the required data for analysis was obtained were Nursing Index, ProQuest, and Ovid databases. The criteria for entering these databases were English texts published from 1995 to 2016 years. The keywords used for searching in titles were acute pain, interact abele, trauma pain, non-cancer pain.

In this study, the features of chronic pain were identified as being long, killing, and having visceral nervous roots. The symptoms for this pain are characterized as hurting, acute pain, and passing the acute pain. Its aftermaths consist of physical and psychological disorders, economic problems and lack of appropriate welfare in life.

According to the findings of the present study, it is possible to present a theoretical definition for chronic pain concept. The results may help other researchers in developing a model and theory related to this topic by illuminating the chronic pain concept and regarding the fact that theories are building blocks for formulating theories.

Spacek A. Modern concepts of acute and chronic pain management. Biomed Pharmacother. 2006;60(7):329-35. https://doi.org/10.1016/j.biop... PMid:16814978.
Gaskin DJ, Richard P. The economic costs of pain in the United States. J Pain. 2012;13(8):715-24. https://doi.org/10.1016/j.jpai... PMid:22607834.
Pergolizzi J, Ahlbeck K, Aldington D, Alon E, Collett B, Coluzzi F, et al. The chronic pain conundrum: should we CHANGE from relying on past history to assessing prognostic factors? Current medical research and opinion. 2012;28(2):249-56. https://doi.org/10.1185/030079... PMid:22181344.
Tauben D. Chronic pain management: Measurement-based step care solutions. Pain Clinical Updates. 2012;20(8).
Carnes D, Homer KE, Miles CL, Pincus T, Underwood M, Rahman A, et al. Effective delivery styles and content for self-management interventions for chronic musculoskeletal pain: a systematic literature review. The Clinical journal of pain. 2012;28(4):344-54. https://doi.org/10.1097/AJP.0b... PMid:22001667.
Jamieson-Lega K, Berry R, Brown CA. Pacing: A concept analysis of a chronic pain intervention. Pain Research and Management. 2013;18(4):207-13. https://doi.org/10.1155/2013/6... PMid:23717825.
Meana M, Cho R, DesMeules M. Chronic pain: the extra burden on Canadian women. BMC women’s health. 2004;4(1):1. https://doi.org/10.1186/1472-6....
Holloway I, Wheeler S. Qualitative research in nursing and healthcare: John Wiley & Sons; 2013.
Chinn PL, Kramer MK. Integrated theory & knowledge development in nursing: Elsevier Health Sciences; 2013.
Walker LO, Avant KC. Strategies for theory construction in nursing. 2005.
Hupcey JE, Penrod J. Concept analysis: examining the state of the science. Research and theory for nursing practice. 2005;19(2):197-208. https://doi.org/10.1891/rtnp.1....
Rodgers BL. Concept analysis: an evolutionary view. Concept development in nursing: Foundations, techniques, and applications. 2000;2:77-102.
Rodgers BL. Philosophical foundations of concept development. Concept development in nursing 2nd ed Philadelphia: Saunders. 2000:7-37.
Rafii F, Peyravi H, Mehrdad N. Professional socialization in nursing: An evolutionary concept analysis. Journal of hayat. 2010;16(2):15-28.
Victor-Chmil J. Critical thinking versus clinical reasoning versus clinical judgment: Differential diagnosis. Nurse Educator. 2013;38(1):34-6. https://doi.org/10.1097/NNE.0b... PMid:23222632.
Blau WS. The needle in a haystack. NC Med J. 2013;74(3):215-7. PMid:23940890.
Jeffery MM, Butler M, Stark A, Kane RL. Multidisciplinary pain programs for chronic noncancer pain. Agency for Healthcare Research and Quality (US), Rockville (MD); 2011.
Main CJ, Spanswick CC. Pain management: an interdisciplinary approach: Elsevier Health Sciences; 2000.
Mosby I. Mosby’s dictionary of medicine, nursing & health professions: Elsevier Health Sciences; 2013.
Fishman SM. Bonica’s management of pain: Lippincott Williams & Wilkins; 2012.
Birke H, Kurita G, Sjøgren P, Højsted J, Simonsen M, Juel K, et al. Chronic non‐cancer pain and the epidemic prescription of opioids in the Danish population: trends from 2000 to 2013. Acta Anaesthesiologica Scandinavica. 2016. https://doi.org/10.1111/aas.12... PMid:26861026.
Von Korff M, Dunn KM. Chronic pain reconsidered. Pain. 2008;138(2):267-76. https://doi.org/10.1016/j.pain... PMid:18226858 PMCid:PMC2613775.
Reuben DB, Alvanzo AA, Ashikaga T, Bogat GA, Callahan CM, Ruffing V, et al. National Institutes of Health Pathways to Prevention Workshop: the role of opioids in the treatment of chronic painthe role of opioids in the treatment of chronic pain. Annals of internal medicine. 2015;162(4):295-300. https://doi.org/10.7326/M14-27... PMid:25581341.
Chou R, Turner JA, Devine EB, Hansen RN, Sullivan SD, Blazina I, et al. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Annals of internal medicine. 2015;162(4):276-86. https://doi.org/10.7326/M14-25... PMid:25581257.
Tauben D. Nonopioid medications for pain. Physical medicine and rehabilitation clinics of North America. 2015;26(2):219-48. https://doi.org/10.1016/j.pmr.... PMid:25952062.
Welsch P, Sommer C, Schiltenwolf M, Hauser W. [Opioids in chronic noncancer pain-are opioids superior to nonopioid analgesics? A systematic review and meta-analysis of efficacy, tolerability and safety in randomized head-to-head comparisons of opioids versus nonopioid analgesics of at least four week’s duration]. Schmerz (Berlin, Germany). 2015;29(1):85-95. https://doi.org/10.1007/s00482... PMid:25376546.
Keay KA, Clement CI, Bandler R. The neuroanatomy of cardiac nociceptive pathways. The nervous system and the heart: Springer; 2000:303-42.
Coda B, Bonica J. General considerations of acute pain: In Loeser, D; Bonica, JJ. Bonica’s management of pain (3 ed.). Philadelphia: Lippincott Williams & Wilkins; 2001.
Paice JA. Mechanisms and management of neuropathic pain in cancer. J Support Oncol. 2003;1(2):107-20.
Bogduk N. Classification of Chronic Pain, Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms: seattle:IASP; 2014.
Diagnostic Methods for Neuropathic Pain: A Review of Diagnostic Accuracy. Rapid Response Report: Summary with Critical Appraisal: Canadian Agency for Drugs and Technologies in Health; 2015.
D’Arcy Y. Managing chronic pain in acute care. The Nurse Practitioner. 2010;35(12):14-6. https://doi.org/10.1097/01.NPR... PMid:21088559.
Boerl RD, Marinusl J, Hiltenl JJ, Huygenl FJ, Eijsl F, Kleefl M, et al. Distribution of signs and symptoms of complex regional pain syndrome type I in patients meeting the diagnostic criteria of the International Association for the Study of Pain. European Journal of Pain. 2011;15(8):830. e1-. e8.
Geertzen J, Van Wilgen C, Schrier E, Dijkstra P. Chronic pain in rehabilitation medicine. Disability and rehabilitation. 2006;28(6):363-7. https://doi.org/10.1080/096382... PMid:16492632.
Roditi D, Robinson ME. The role of psychological interventions in the management of patients with chronic pain. Psychol Res Behav Manag. 2011;4:41-9. https://doi.org/10.2147/PRBM.S... PMid:22114534 PMCid:PMC3218789.
Turk DC, Wilson HD, Cahana A. Treatment of chronic non-cancer pain. The Lancet. 2011;377(9784):2226-35. https://doi.org/10.1016/S0140-....
Boulanger A, Clark AJ, Squire P, Cui E, Horbay G. Chronic pain in Canada: have we improved our management of chronic noncancer pain? Pain Research and Management. 2007;12(1):39-47. https://doi.org/10.1155/2007/7... PMid:17372633.
Lalonde L, Choinière M, Martin É, Berbiche D, Perreault S, Lussier D. Costs of moderate to severe chronic pain in primary care patients–a study of the ACCORD program. Journal of pain research. 2014;7:389. https://doi.org/10.2147/JPR.S5... PMid:25045282 PMCid:PMC4094572.
Robbins WR, Staats PS, Levine J, Fields HL, Allen RW, Campbell JN, et al. Treatment of intractable pain with topical large-dose capsaicin: preliminary report. Anesthesia & Analgesia. 1998;86(3):579-83. https://doi.org/10.1213/000005....
Beaver WT. Management of cancer pain with parenteral medication. Jama. 1980;244(23):2653-7. https://doi.org/10.1001/jama.1... PMid:7431615.
Behar M, Olshwang D, Magora F, Davidson JT. Epidural morphine in treatment of pain. The lancet. 1979;313(8115):527-9. https://doi.org/10.1016/S0140-....
Woolf CJ, Salter MW. Neuronal plasticity: increasing the gain in pain. Science. 2000;288(5472):1765-8. https://doi.org/10.1126/scienc....
DeLeo JA, Yezierski RP. The role of neuroinflammation and neuroimmune activation in persistent pain. Pain. 2001;90(1-2):1-6. https://doi.org/10.1016/S0304-....
Association AN. Nursing’s social policy statement: The essence of the profession: Nursesbooks. org; 2010.
Shirazi M, Manoochehri H, Zagheri TM, Zayeri F, Alipour V. Explaining of chronic pain management process in older people: a grounded theory study. 2016.
Dworkin RH, Turk DC, Wyrwich KW, Beaton D, Cleeland CS, Farrar JT, et al. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. The Journal of Pain. 2008;9(2):105-21. https://doi.org/10.1016/j.jpai... PMid:18055266.
Yousefinezhad OA, Madadi A, Majedzadeh S, Shabannia R, Sadeghian N, Zarinara A, et al. The effect of music therapy on chronic pain in patients with cancer. 2005.
Kelly JF, Ritenour AE, McLaughlin DF, Bagg KA, Apodaca AN, Mallak CT, et al. Injury severity and causes of death from Operation Iraqi Freedom and Operation Enduring Freedom: 2003–2004 versus 2006. Journal of Trauma and Acute Care Surgery. 2008;64(2):S21-S7. https://doi.org/10.1097/TA.0b0... PMid:18376168.
Geniusas S. On naturalism in pain research: a phenomenological critique. Metodo International Studies in Phenomenology and Philosophy. 2013;1(1).
Larner D. Chronic pain transition: A concept analysis. Pain Management Nursing. 2014;15(3):707-17. https://doi.org/10.1016/j.pmn.... PMid:23769800.
Cedraschi C, Allaz A. How to identify patients with a poor prognosis in daily clinical practice. Best Practice & Research Clinical Rheumatology. 2005;19(4):577-91. https://doi.org/10.1016/j.berh... PMid:15949777.
Facione PA, Facione NC. Thinking and reasoning in human decision making: The method of argument and heuristic analysis: Insight Assessment; 2007.
Barry DT, Irwin KS, Jones ES, Becker WC, Tetrault JM, Sullivan LE, et al. Integrating buprenorphine treatment into office-based practice: a qualitative study. Journal of general internal medicine. 2009;24(2):218-25. https://doi.org/10.1007/s11606... PMid:19089500 PMCid:PMC2628993.
Yarnall KS, Pollak KI, Østbye T, Krause KM, Michener JL. Primary care: is there enough time for prevention? American journal of public health. 2003;93(4):635-41. https://doi.org/10.2105/AJPH.9... PMid:12660210 PMCid:PMC1447803.
Becker WC, Sullivan LE, Tetrault JM, Desai RA, Fiellin DA. Non-medical use, abuse and dependence on prescription opioids among US adults: psychiatric, medical and substance use correlates. Drug and alcohol dependence. 2008;94(1):38-47. https://doi.org/10.1016/j.drug... PMid:18063321.
Parish SJ, Ramaswamy M, Stein MR, Kachur EK, Arnsten JH. Teaching about substance abuse with objective structured clinical exams. Journal of general internal medicine. 2006;21(5):453-9. https://doi.org/10.1111/j.1525... PMid:16704387 PMCid:PMC1484780.
Gallagher AM, Leighton-Scott J, van Staa TP. Utilization characteristics and treatment persistence in patients prescribed low-dose buprenorphine patches in primary care in the United Kingdom: a retrospective cohort study. Clinical therapeutics. 2009;31(8):1707-15. https://doi.org/10.1016/j.clin... PMid:19808129.
Alsaadi SM, McAuley JH, Hush JM, Maher CG. Prevalence of sleep disturbance in patients with low back pain. European Spine Journal. 2011;20(5):737-43. https://doi.org/10.1007/s00586... PMid:21190045 PMCid:PMC3082679.
Van Dongen HP, Maislin G, Mullington JM, Dinges DF. The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep-New York then Westchester-. 2003;26(2):117-29. https://doi.org/10.1093/sleep/....
Chung OY, Bruehl S. The impact of blood pressure and baroreflex sensitivity on wind-up. Anesthesia & Analgesia. 2008;107(3):1018-25. https://doi.org/10.1213/ane.0b... PMid:18713923.
Bruehl S, Chung OY, Ward P, Johnson B, McCubbin JA. The relationship between resting blood pressure and acute pain sensitivity in healthy normotensives and chronic back pain sufferers: the effects of opioid blockade. Pain. 2002;100(1):191-201. https://doi.org/10.1016/S0304-....
Ambler N, de C Williams AC, Hill P, Gunary R, Cratchley G. Sexual difficulties of chronic pain patients. The Clinical journal of pain. 2001;17(2):138-45. https://doi.org/10.1097/000025... PMid:11444715.
Anderson RU, Wise D, Sawyer T, Chan CA. Sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome: improvement after trigger point release and paradoxical relaxation training. The Journal of urology. 2006;176(4):1534-9. https://doi.org/10.1016/j.juro... PMid:16952676.
Ashory A. The prevalence of pain among residents of nursing homes and the impact of pain on their mood and quality of life. Archives of Iranian Medicine. 2006;9(4):368-73. PMid:17061612.
Shirazi M, Manoochehri H, Zagheri Tafreshi M, Zayeri F, Alipour V. Prevalence of chronic pain and its characteristics among elderly people in Ahvaz city: a cross sectional study. Journal of Clinical Nursing and Midwifery 2015;4(3):13-28.
McCracken LM, Eccleston C. Coping or acceptance: what to do about chronic pain? Pain. 2003;105(1):197-204. https://doi.org/10.1016/S0304-....
Risdon A, Eccleston C, Crombez G, McCracken L. How can we learn to live with pain? A Q-methodological analysis of the diverse understandings of acceptance of chronic pain. Social science & medicine. 2003;56(2):375-86. https://doi.org/10.1016/S0277-....
Turk DC, Okifuji A. Psychological factors in chronic pain: evolution and revolution. Journal of consulting and clinical psychology. 2002;70(3):678. https://doi.org/10.1037/0022-0....
Wang CK, Hah JM, Carroll I. Factors contributing to pain chronicity. Current pain and headache reports. 2009;13(1):7-11. https://doi.org/10.1007/s11916... PMid:19126364 PMCid:PMC2743454.