Steven Brena, MD There are three kinds of pain. Acute pain is secondary to specific tissue damage such as with a sprained ankle or stomach ulcer. Chronic pain is caused by persistent disease such as rheumatoid arthritis, or it is a condition which lasts beyond the expected recovery time. The type of pain which causes the most puzzlement and frustration to both patient and practitioner is chronic pain, where the pain persists after the physical cause has been treated and considered corrected. The pain is constant, waxing and waning but seldom disappearing, and doesn't respond to treatment.
Back pain is the most common kind of chronic pain.
We have no business calling a patient a malingerer just because we cannot find a physical basis for his pain or because he's had it for a very long period. It is not known why some people's pain lasts far beyond the expected recovery period. Given the difficulty in diagnosing back pain, this is not an unreasonable option. The continuing barrage of pain impulses eventually may break down the brain or spinal cord mechanisms which would normally block perception of minor pain impulses. The pain becomes less and less associated with a physical basis as time goes by.