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Chronic pain

MedGen UID:
Concept ID:
Finding; Sign or Symptom
Synonyms: Chronic Pain; Pain, Chronic
SNOMED CT: Chronic pain (82423001)
HPO: HP:0012532


Persistent pain, usually defined as pain that has lasted longer than 3 to 6 months. [from HPO]

Term Hierarchy

Conditions with this feature

Lipomatosis dolorosa
MedGen UID:
Concept ID:
Disease or Syndrome
Adiposis dolorosa, also known as Dercum disease, is characterized by generalized obesity and pronounced, disabling, and chronic pain in the adipose tissue of the proximal extremities, trunk, pelvic area, and buttocks; the face and hands are usually spared. There are a number of associated symptoms, including multiple lipomas, generalized weakness, fatigue, sleep disturbances, constipation, and psychiatric abnormalities. It is 5 to 30 times more common in women than men, and usually presents between 35 and 50 years of age (summary by Campen et al., 2001; review by Hansson et al., 2012). Based on a review of the literature and studies of 111 patients, Hansson et al. (2012) proposed a classification of Dercum disease into 4 types: (I) generalized diffuse form without clear lipomas, (II) generalized nodular form with multiple lipomas, (III) localized nodular form, and (IV) juxtaarticular form with solitary fatty deposits near joints.
Azorean disease
MedGen UID:
Concept ID:
Disease or Syndrome
Spinocerebellar ataxia type 3 (SCA3), also known as Machado-Joseph disease (MJD), is characterized by progressive cerebellar ataxia and variable findings including pyramidal signs, a dystonic-rigid extrapyramidal syndrome, significant peripheral amyotrophy and generalized areflexia, progressive external ophthalmoplegia, action-induced facial and lingual fasciculations, and bulging eyes. Neurologic findings tend to evolve as the disorder progresses.
Loeys-Dietz syndrome 4
MedGen UID:
Concept ID:
Disease or Syndrome
Loeys-Dietz syndrome (LDS) is characterized by vascular findings (cerebral, thoracic, and abdominal arterial aneurysms and/or dissections), skeletal manifestations (pectus excavatum or pectus carinatum, scoliosis, joint laxity, arachnodactyly, talipes equinovarus, cervical spine malformation and/or instability), craniofacial features (widely spaced eyes, strabismus, bifid uvula / cleft palate, and craniosynostosis that can involve any sutures), and cutaneous findings (velvety and translucent skin, easy bruising, and dystrophic scars). Individuals with LDS are predisposed to widespread and aggressive arterial aneurysms and pregnancy-related complications including uterine rupture and death. Individuals with LDS can show a strong predisposition for allergic/inflammatory disease including asthma, eczema, and reactions to food or environmental allergens. There is also an increased incidence of gastrointestinal inflammation including eosinophilic esophagitis and gastritis or inflammatory bowel disease. Wide variation in the distribution and severity of clinical features can be seen in individuals with LDS, even among affected individuals within a family who have the same pathogenic variant.

Professional guidelines


Urits I, Charipova K, Gress K, Schaaf AL, Gupta S, Kiernan HC, Choi PE, Jung JW, Cornett E, Kaye AD, Viswanath O
Best Pract Res Clin Anaesthesiol 2020 Sep;34(3):427-448. Epub 2020 Aug 8 doi: 10.1016/j.bpa.2020.08.003. PMID: 33004157
Hylands-White N, Duarte RV, Raphael JH
Rheumatol Int 2017 Jan;37(1):29-42. Epub 2016 Apr 23 doi: 10.1007/s00296-016-3481-8. PMID: 27107994
Wieckiewicz M, Boening K, Wiland P, Shiau YY, Paradowska-Stolarz A
J Headache Pain 2015;16:106. Epub 2015 Dec 7 doi: 10.1186/s10194-015-0586-5. PMID: 26644030Free PMC Article


UK NICE Guideline NG193, Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain, 2021

Recent clinical studies


Mills SEE, Nicolson KP, Smith BH
Br J Anaesth 2019 Aug;123(2):e273-e283. Epub 2019 May 10 doi: 10.1016/j.bja.2019.03.023. PMID: 31079836Free PMC Article
Domenichiello AF, Ramsden CE
Prog Neuropsychopharmacol Biol Psychiatry 2019 Jul 13;93:284-290. Epub 2019 Apr 17 doi: 10.1016/j.pnpbp.2019.04.006. PMID: 31004724Free PMC Article
Racine M
Prog Neuropsychopharmacol Biol Psychiatry 2018 Dec 20;87(Pt B):269-280. Epub 2017 Aug 26 doi: 10.1016/j.pnpbp.2017.08.020. PMID: 28847525
Ambrose KR, Golightly YM
Best Pract Res Clin Rheumatol 2015 Feb;29(1):120-30. Epub 2015 May 23 doi: 10.1016/j.berh.2015.04.022. PMID: 26267006Free PMC Article
van Hecke O, Torrance N, Smith BH
Br J Anaesth 2013 Jul;111(1):13-8. doi: 10.1093/bja/aet123. PMID: 23794640


The Lancet
Lancet 2021 May 29;397(10289):2023. doi: 10.1016/S0140-6736(21)01194-6. PMID: 34062132
Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, Cohen M, Evers S, Finnerup NB, First MB, Giamberardino MA, Kaasa S, Korwisi B, Kosek E, Lavand'homme P, Nicholas M, Perrot S, Scholz J, Schug S, Smith BH, Svensson P, Vlaeyen JWS, Wang SJ
Pain 2019 Jan;160(1):19-27. doi: 10.1097/j.pain.0000000000001384. PMID: 30586067
Meints SM, Edwards RR
Prog Neuropsychopharmacol Biol Psychiatry 2018 Dec 20;87(Pt B):168-182. Epub 2018 Jan 31 doi: 10.1016/j.pnpbp.2018.01.017. PMID: 29408484Free PMC Article
Syx D, De Wandele I, Rombaut L, Malfait F
Clin Exp Rheumatol 2017 Sep-Oct;35 Suppl 107(5):116-122. Epub 2017 Sep 28 PMID: 28967365
Edwards RR, Dworkin RH, Sullivan MD, Turk DC, Wasan AD
J Pain 2016 Sep;17(9 Suppl):T70-92. doi: 10.1016/j.jpain.2016.01.001. PMID: 27586832Free PMC Article


Birkinshaw H, Friedrich CM, Cole P, Eccleston C, Serfaty M, Stewart G, White S, Moore RA, Phillippo D, Pincus T
Cochrane Database Syst Rev 2023 May 10;5(5):CD014682. doi: 10.1002/14651858.CD014682.pub2. PMID: 37160297Free PMC Article
O'Keeffe M, O'Sullivan P, Purtill H, Bargary N, O'Sullivan K
Br J Sports Med 2020 Jul;54(13):782-789. Epub 2019 Oct 19 doi: 10.1136/bjsports-2019-100780. PMID: 31630089Free PMC Article
Vickers AJ, Vertosick EA, Lewith G, MacPherson H, Foster NE, Sherman KJ, Irnich D, Witt CM, Linde K; Acupuncture Trialists' Collaboration
J Pain 2018 May;19(5):455-474. Epub 2017 Dec 2 doi: 10.1016/j.jpain.2017.11.005. PMID: 29198932Free PMC Article
Creswell JD
Annu Rev Psychol 2017 Jan 3;68:491-516. Epub 2016 Sep 28 doi: 10.1146/annurev-psych-042716-051139. PMID: 27687118
Lee JH
J Music Ther 2016 Winter;53(4):430-477. Epub 2016 Oct 19 doi: 10.1093/jmt/thw012. PMID: 27760797


Wong CK, Mak RY, Kwok TS, Tsang JS, Leung MY, Funabashi M, Macedo LG, Dennett L, Wong AY
J Pain 2022 Apr;23(4):509-534. Epub 2021 Aug 24 doi: 10.1016/j.jpain.2021.07.012. PMID: 34450274
Fregoso G, Wang A, Tseng K, Wang J
Pain Physician 2019 Sep;22(5):479-488. PMID: 31561647
Urits I, Shen AH, Jones MR, Viswanath O, Kaye AD
Curr Pain Headache Rep 2018 Feb 5;22(2):10. doi: 10.1007/s11916-018-0667-7. PMID: 29404787
van Hecke O, Austin SK, Khan RA, Smith BH, Torrance N
Pain 2014 Apr;155(4):654-662. Epub 2013 Nov 26 doi: 10.1016/j.pain.2013.11.013. PMID: 24291734
Andersson GB
Lancet 1999 Aug 14;354(9178):581-5. doi: 10.1016/S0140-6736(99)01312-4. PMID: 10470716

Clinical prediction guides

Klein-Weigel PF, Volz TS, Richter JG
Vasa 2018 Feb;47(2):91-97. Epub 2018 Jan 4 doi: 10.1024/0301-1526/a000675. PMID: 29299961
Wijma AJ, van Wilgen CP, Meeus M, Nijs J
Physiother Theory Pract 2016 Jul;32(5):368-84. Epub 2016 Jun 28 doi: 10.1080/09593985.2016.1194651. PMID: 27351769
MacIntyre NJ, Dewan N
J Hand Ther 2016 Apr-Jun;29(2):136-45. doi: 10.1016/j.jht.2016.03.003. PMID: 27264899
Ferreira-Valente MA, Pais-Ribeiro JL, Jensen MP
Pain 2011 Oct;152(10):2399-2404. doi: 10.1016/j.pain.2011.07.005. PMID: 21856077
Woby SR, Roach NK, Urmston M, Watson PJ
Pain 2005 Sep;117(1-2):137-44. doi: 10.1016/j.pain.2005.05.029. PMID: 16055269

Recent systematic reviews

Bilbao A, Spanagel R
BMC Med 2022 Aug 19;20(1):259. doi: 10.1186/s12916-022-02459-1. PMID: 35982439Free PMC Article
McDonagh MS, Morasco BJ, Wagner J, Ahmed AY, Fu R, Kansagara D, Chou R
Ann Intern Med 2022 Aug;175(8):1143-1153. Epub 2022 Jun 7 doi: 10.7326/M21-4520. PMID: 35667066
Kim PS, Fishman MA
Curr Pain Headache Rep 2020 Aug 26;24(10):64. doi: 10.1007/s11916-020-00898-0. PMID: 32845365
Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH
Cochrane Database Syst Rev 2017 Apr 24;4(4):CD011279. doi: 10.1002/14651858.CD011279.pub3. PMID: 28436583Free PMC Article
Hilton L, Hempel S, Ewing BA, Apaydin E, Xenakis L, Newberry S, Colaiaco B, Maher AR, Shanman RM, Sorbero ME, Maglione MA
Ann Behav Med 2017 Apr;51(2):199-213. doi: 10.1007/s12160-016-9844-2. PMID: 27658913Free PMC Article

Supplemental Content

Table of contents

    Genetic Testing Registry

    Clinical resources

    Practice guidelines

    • PubMed
      See practice and clinical guidelines in PubMed. The search results may include broader topics and may not capture all published guidelines. See the FAQ for details.
    • Bookshelf
      See practice and clinical guidelines in NCBI Bookshelf. The search results may include broader topics and may not capture all published guidelines. See the FAQ for details.


    • NICE, 2021
      UK NICE Guideline NG193, Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain, 2021

    Consumer resources

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