Chronic low back pain or chronic pain syndrome

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The International Association for the Study for Pain defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.22 Chronic low back pain is defined and distinguished from acute pain by symptom duration, treatment responses, the concept of neuroplasticity (sensitization) of the central nervous system, and the relationship of symptoms to the initial noxious stimulus. In contrast, in chronic pain syndrome, the balance between the sensation of pain and the emotional experience associated with it is far out of balance in favor of the emotional side.23 The criteria are as follows:

• chronic symptoms often severe;

• disproportionate to the pathology;

• atypical sensory features;

• "nonanatomic" location;

• associated symptoms (fatigue, sleep, memory, libido);

• psychological distress (depression, anxiety, posttraumatic stress disorder (PTSD));

• social role dysfunction (work, home, play);

• excessive healthcare utilization.

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