What is Primary Pain?

Primary pain is a newer concept informed by the latest published scientific and clinical evidence-based research. The ICD-11 now includes the diagnosis: chronic primary pain. Top pain specialists, Dr. Shaheen Lakhan, Dr. Howard Shubiner, Dr. Yoni Ashar, and more shed light on a chronic primary pain diagnosis.
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Primary pain is a newer concept that's been informed by the latest scientific and clinical evidence that's been published. A lot of it actually came from FMRI research, pain reprocessing therapy research, and also the ICD-11 now includes a diagnosis of chronic primary pain.

Primary pain is where pain is the primary problem. It is not secondary to any disease or pathology in the body.

And so primary pain is pain that is originating in the brain. There is no structure abnormality, no pathologic entity, which we have found, which will explain it.

You might think of it as something similar to Phantom limb pain. That's the type of primary pain. Been recognized as very real for many, many years. And yet there's no actual continued ongoing damage in that part of the body. Their brain will just continue to fire these pain pathways, letting them know that there's a problem when there actually isn't any problem.

The pain has basically become self reinforcing, self perpetuating, taking on a life of its own due to changes in brain pathways.

The final common pathway of all pain, whether it started off as inflammatory disc disease of the lower back or knee osteoarthritis or neuropathic pain caused by diabetes in the feet end up with chronic primary pain. It's important for us as physicians to understand that although in primary pain, you don't have that structural, mechanical, physical aberration, but the functioning, the disability, the agony, the suffering really exists over there. And actually, it takes brain retraining and exercises to mitigate against its effects.