One of the challenges for clinicians working in the field of pain management is the modification of behavior that follows adequate treatment
Fig. 1. The pain pentagon represents a cycle of pain, treatment, and improved function and activity, which produces further local irritation or remote injury, resulting in new or recurrent pain. (Copyright 2003, F. Michael Gloth, III, MD. Used with permission.)
of pain. Once pain relief is achieved, a patient is very likely to enter a cycle not generally discussed (Fig. 1). Once pain is controlled, an individual usually becomes more functional and then more active. This can lead to irritation of the area that previously caused pain. Such irritation can lead to increased inflammation and consequent recurrence of pain. Thus, successful pain control is perceived as short lived, and this cyclical process makes good pain control more challenging. This sequence of events should be recognized so adequate counseling can take place to prevent such a cycle of pain.
It also should be recognized that prolonged pain could lead to disuse atrophy. Again, the resolution of pain may lead to further activity. In this setting, the lack of muscular balance may be associated with malalignment of the spine or increased trauma to insufficiently supported joints. Consequently, injury and pain can result (Fig. 1).
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