TY - JOUR
T1 - The chronic pain conundrum
T2 - Should we CHANGE from relying on past history to assessing prognostic factors?
AU - Pergolizzi, Joseph
AU - Ahlbeck, Karsten
AU - Aldington, Dominic
AU - Alon, Eli
AU - Collett, Beverly
AU - Coluzzi, Flaminia
AU - Huygen, Frank
AU - Jaksch, Wolfgang
AU - Kocot-Kȩpska, Magdalena
AU - Mangas, Ana Cristina
AU - Margarit, Cesar
AU - Mavrocordatos, Philippe
AU - Morlion, Bart
AU - Müller-Schwefe, Gerhard
AU - Nicolaou, Andrew
AU - Hernández, Concepción Pérez
AU - Sichere, Patrick
AU - Varrassi, Giustino
PY - 2012/2
Y1 - 2012/2
N2 - Background: Despite limited empirical support, chronic pain has traditionally been defined mainly on the basis of its duration, which takes no account of the causative mechanisms or its clinical significance. Scope: For this commentary on current pain management practice, the CHANGE PAIN Advisory Board considered the evidence for adopting a prognostic definition of chronic pain. The rationale underlying this approach is to take psychological and behavioural factors into account, as well as the multidimensional nature of pain. Measures of pain intensity, interference with everyday activities, role disability, depression, duration and number of pain sites are used to calculate a risk score, which indicates the likelihood of a patient having pain in the future. The consistency of a prognostic definition with the concept of integrated patient care was also considered. Findings: When this method was compared with the number of pain days experienced over the previous 6 months in patients with back pain, headache or orofacial pain it was a better predictor of clinically significant pain 6 months later for all three pain conditions. Further evidence supporting this approach is that several factors other than the duration of pain have been shown to be important prognostic indicators, including unemployment, functional disability, anxiety and self-rated health. The use of a multifactorial risk score may also suggest specific measures to improve outcomes, such as addressing emotional distress. These measures should be undertaken as part of an integrated pain management strategy; chronic pain is a biopsychosocial phenomenon and all aspects of the patient's pain must be dealt with appropriately and simultaneously for treatment to be effective. Conclusion: The implementation of a prognostic definition and wider adoption of integrated care could bring significant advantages. However, these measures require improved training in pain management and structural revision of specialist facilities, for which political support is essential.
AB - Background: Despite limited empirical support, chronic pain has traditionally been defined mainly on the basis of its duration, which takes no account of the causative mechanisms or its clinical significance. Scope: For this commentary on current pain management practice, the CHANGE PAIN Advisory Board considered the evidence for adopting a prognostic definition of chronic pain. The rationale underlying this approach is to take psychological and behavioural factors into account, as well as the multidimensional nature of pain. Measures of pain intensity, interference with everyday activities, role disability, depression, duration and number of pain sites are used to calculate a risk score, which indicates the likelihood of a patient having pain in the future. The consistency of a prognostic definition with the concept of integrated patient care was also considered. Findings: When this method was compared with the number of pain days experienced over the previous 6 months in patients with back pain, headache or orofacial pain it was a better predictor of clinically significant pain 6 months later for all three pain conditions. Further evidence supporting this approach is that several factors other than the duration of pain have been shown to be important prognostic indicators, including unemployment, functional disability, anxiety and self-rated health. The use of a multifactorial risk score may also suggest specific measures to improve outcomes, such as addressing emotional distress. These measures should be undertaken as part of an integrated pain management strategy; chronic pain is a biopsychosocial phenomenon and all aspects of the patient's pain must be dealt with appropriately and simultaneously for treatment to be effective. Conclusion: The implementation of a prognostic definition and wider adoption of integrated care could bring significant advantages. However, these measures require improved training in pain management and structural revision of specialist facilities, for which political support is essential.
KW - Biopsychosocial pain model
KW - Chronic pain
KW - Integrated pain management strategy
KW - Multifactorial risk score
KW - Prognostic definition
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U2 - 10.1185/03007995.2011.651525
DO - 10.1185/03007995.2011.651525
M3 - Article
C2 - 22181344
AN - SCOPUS:84856506697
VL - 28
SP - 249
EP - 256
JO - Current Medical Research and Opinion
JF - Current Medical Research and Opinion
SN - 0300-7995
IS - 2
ER -